Premium Transparency Act

Issues: ACA Healthcare tax credits; Transparency in coverage; Surprise Billing; 2025 Proposed NBPP/Individual Market/ACA exchanges; Prior Authorization; Hospital Consolidation; Employer-provided health coverage; Cyber Attack/ Cyber Security; Community Health + Maternal Health; Hospital Billing; Anti-tiering, Anti-steering; Artificial Intelligence; Individual Market Reforms and eAPTC Extension; Healthcare Affordability Bills: S.4027 - Healthy Competition for Better Care Act To ban anticompetitive terms in facility and insurance contracts that limit access to higher quality, lower cost care. Sponsor: Sen. Husted, Jon [R-OH] H.R.6248 - Healthy Competition for Better Care Act To ban anticompetitive terms in facility and insurance contracts that limit access to higher quality, lower cost care. Sponsor: Rep. Arrington, Jodey C. [R-TX-19] H.R.4710 - No Surprises Act Enforcement Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to increase penalties for group health plans and health insurance issuers for practices that violate balance billing requirements, and for other purposes. Sponsor: Rep. Murphy, Gregory F. [R-NC-3] S.2420 - No Surprises Act Enforcement Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to increase penalties for group health plans, health insurance issuers, and nonparticipating providers or facilities for practices that violate balance billing requirements, and for other purposes. Sponsor: Sen. Marshall, Roger [R-KS] S.2355 - Patients Deserve Price Tags Act To amend the Public Health Service Act to provide for hospital and insurer price transparency. Sponsor: Sen. Marshall, Roger [R-KS] H.R.8684 - Transparency in Billing Act of 2026 To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes. Sponsor: Rep. Foxx, Virginia [R-NC-5] H.R.9393 - Lower Costs, More Transparency Act of 2026 To promote price transparency in the health care sector. Sponsor: Rep. Guthrie, Brett [R-KY-2] H.R.9397 - Premium Transparency Act To amend title XXVII of the Public Health Service Act and title XVIII of the Social Security Act to ensure health insurer accountability through publishing of overhead costs and claim payments, and to direct the Secretary of Health and Human Services to issue guidance on the provision of certain insurance information. Sponsor: Rep. Pfluger, August [R-TX-11] H.R.9117 - Clear Healthcare Expense Cost Knowledge Act (CHECK Act) To promote the availability of certain healthcare information, and for other purposes. Sponsor: Rep. Langworthy, Nicholas A. [R-NY-23] H.R.9390 - Prices on the Wall Act of 2026 To amend title XXVII of the Public Health Service Act to require certain facilities to post prices on the walls. Sponsor: Rep. Miller-Meeks, Mariannette [R-IA-1] H.R.9396 - Prior Authorization Accountability Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require the displaying of claim denial rates. Sponsor: Rep. Goldman, Craig A. [R-TX-12] H.R. 8209 - School Based-Health Centers Reauthorization Act To amend the Public Health Service Act to reauthorize the school-based health centers grant program. Sponsor: Rep. Tonko, Paul [D-NY-20] H.R.9389 - Nutrition Education and Chronic Disease Prevention in Community Health Centers Act of 2026 To amend the Public Health Service Act to authorize funding for nutrition education and chronic disease prevention at federally qualified health centers, and for other purposes. Sponsor: Rep. Harshbarger, Diana [R-TN-1] H.R. 8201 - Expanding Community Access to Health Services Act To amend Public Health Service Act to require community health centers to provide behavioral and mental health and substance use disorder services, and for other purposes. Sponsor: Rep. Lee, Susie [D-NV-3] S.380 - Rural Obstetrics Readiness Act To improve obstetric emergency care. Sponsor: Sen. Hassan, Margaret Wood [D-NH] H.R.1254 - Rural Obstetrics Readiness Act To improve obstetric emergency care. Sponsor: Rep. Kelly, Robin L. [D-IL-2] H.R.7973 - Momnibus Act To end preventable maternal mortality, severe maternal morbidity, and maternal health disparities in the United States, and for other purposes. Sponsor: Rep. Underwood, Lauren [D-IL-14] H.R.1521 - DOC Access Act of 2025 To amend title XXVII of the Public Health Service Act to improve health care coverage under vision and dental plans, and for other purposes. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] S.3097 - Health Information Privacy Reform Act To provide additional protections with respect to health information, and for other purposes. Sponsor: Sen. Cassidy, Bill [R-LA] S.1874 - Title VIII Nursing Workforce Reauthorization Act of 2026 To amend the Public Health Service Act to reauthorize certain nursing workforce development programs, and for other purposes. Sponsor: Sen. Merkley, Jeff [D-OR] S.2301 - Improving Care in Rural America Reauthorization Act of 2025 To reauthorize certain programs regarding rural health care. Sponsor: Sen. Scott, Tim [R-SC]

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

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

ACA Healthcare tax credits; Transparency in coverage; Surprise Billing; 2025 Proposed NBPP/Individual Market/ACA exchanges; Prior Authorization; Hospital Consolidation; Employer-provided health coverage; Cyber Attack/ Cyber Security; Community Health + Maternal Health; Hospital Billing; Anti-tiering, Anti-steering; Artificial Intelligence; Individual Market Reforms and eAPTC Extension; Healthcare Affordability S.4027 - Healthy Competition for Better Care Act To ban anticompetitive terms in facility and insurance contracts that limit access to higher quality, lower cost care. Sponsor: Sen. Husted, Jon [R-OH] H.R.6248 - Healthy Competition for Better Care Act To ban anticompetitive terms in facility and insurance contracts that limit access to higher quality, lower cost care. Sponsor: Rep. Arrington, Jodey C. [R-TX-19] H.R.4710 - No Surprises Act Enforcement Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to increase penalties for group health plans and health insurance issuers for practices that violate balance billing requirements, and for other purposes. Sponsor: Rep. Murphy, Gregory F. [R-NC-3] S.2420 - No Surprises Act Enforcement Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to increase penalties for group health plans, health insurance issuers, and nonparticipating providers or facilities for practices that violate balance billing requirements, and for other purposes. Sponsor: Sen. Marshall, Roger [R-KS] S.2355 - Patients Deserve Price Tags Act To amend the Public Health Service Act to provide for hospital and insurer price transparency. Sponsor: Sen. Marshall, Roger [R-KS] H.R.8684 - Transparency in Billing Act of 2026 To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes. Sponsor: Rep. Foxx, Virginia [R-NC-5] H.R.9393 - Lower Costs, More Transparency Act of 2026 To promote price transparency in the health care sector. Sponsor: Rep. Guthrie, Brett [R-KY-2] H.R.9397 - Premium Transparency Act To amend title XXVII of the Public Health Service Act and title XVIII of the Social Security Act to ensure health insurer accountability through publishing of overhead costs and claim payments, and to direct the Secretary of Health and Human Services to issue guidance on the provision of certain insurance information. Sponsor: Rep. Pfluger, August [R-TX-11] H.R.9117 - Clear Healthcare Expense Cost Knowledge Act (CHECK Act) To promote the availability of certain healthcare information, and for other purposes. Sponsor: Rep. Langworthy, Nicholas A. [R-NY-23] H.R.9390 - Prices on the Wall Act of 2026 To amend title XXVII of the Public Health Service Act to require certain facilities to post prices on the walls. Sponsor: Rep. Miller-Meeks, Mariannette [R-IA-1] H.R.9396 - Prior Authorization Accountability Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require the displaying of claim denial rates. Sponsor: Rep. Goldman, Craig A. [R-TX-12] H.R. 8209 - School Based-Health Centers Reauthorization Act To amend the Public Health Service Act to reauthorize the school-based health centers grant program. Sponsor: Rep. Tonko, Paul [D-NY-20] H.R.9389 - Nutrition Education and Chronic Disease Prevention in Community Health Centers Act of 2026 To amend the Public Health Service Act to authorize funding for nutrition education and chronic disease prevention at federally qualified health centers, and for other purposes. Sponsor: Rep. Harshbarger, Diana [R-TN-1] H.R. 8201 - Expanding Community Access to Health Services Act To amend Public Health Service Act to require community health centers to provide behavioral and mental health and substance use disorder services, and for other purposes. Sponsor: Rep. Lee, Susie [D-NV-3] S.380 - Rural Obstetrics Readiness Act To improve obstetric emergency care. Sponsor: Sen. Hassan, Margaret Wood [D-NH] H.R.1254 - Rural Obstetrics Readiness Act To improve obstetric emergency care. Sponsor: Rep. Kelly, Robin L. [D-IL-2] H.R.7973 - Momnibus Act To end preventable maternal mortality, severe maternal morbidity, and maternal health disparities in the United States, and for other purposes. Sponsor: Rep. Underwood, Lauren [D-IL-14] H.R.1521 - DOC Access Act of 2025 To amend title XXVII of the Public Health Service Act to improve health care coverage under vision and dental plans, and for other purposes. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] S.3097 - Health Information Privacy Reform Act To provide additional protections with respect to health information, and for other purposes. Sponsor: Sen. Cassidy, Bill [R-LA] S.1874 - Title VIII Nursing Workforce Reauthorization Act of 2026 To amend the Public Health Service Act to reauthorize certain nursing workforce development programs, and for other purposes. Sponsor: Sen. Merkley, Jeff [D-OR] S.2301 - Improving Care in Rural America Reauthorization Act of 2025 To reauthorize certain programs regarding rural health care. Sponsor: Sen. Scott, Tim [R-SC]

Client expense: $1,240,000 · 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: ACA Healthcare tax credits; Transparency in coverage; Surprise Billing; 2025 Proposed NBPP/Individual Market/ACA exchanges; Prior Authorization; Hospital Consolidation; Employer-provided health coverage; Cyber Attack/ Cyber Security; Community Health + Maternal Health; Hospital Billing; Anti-tiering, Anti-steering; Artificial Intelligence; Individual Market Reforms and eAPTC Extension; Healthcare Affordability Bills: H.R.4710 - No Surprises Act Enforcement Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to increase penalties for group health plans and health insurance issuers for practices that violate balance billing requirements, and for other purposes. Sponsor: Rep. Murphy, Gregory F. [R-NC-3] S.2420 - No Surprises Act Enforcement Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to increase penalties for group health plans, health insurance issuers, and nonparticipating providers or facilities for practices that violate balance billing requirements, and for other purposes. Sponsor: Sen. Marshall, Roger [R-KS] S.2355 - Patients Deserve Price Tags Act To amend the Public Health Service Act to provide for hospital and insurer price transparency. Sponsor: Sen. Marshall, Roger [R-KS] H.R.8684 - Transparency in Billing Act of 2026 To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes. Sponsor: Rep. Foxx, Virginia [R-NC-5] H.R.9393 - Lower Costs, More Transparency Act of 2026 To promote price transparency in the health care sector. Sponsor: Rep. Guthrie, Brett [R-KY-2] H.R.9397 - Premium Transparency Act To amend title XXVII of the Public Health Service Act and title XVIII of the Social Security Act to ensure health insurer accountability through publishing of overhead costs and claim payments, and to direct the Secretary of Health and Human Services to issue guidance on the provision of certain insurance information. Sponsor: Rep. Pfluger, August [R-TX-11] H.R.9396 - Prior Authorization Accountability Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require the displaying of claim denial rates. Sponsor: Rep. Goldman, Craig A. [R-TX-12] H.R. 8209 - School Based-Health Centers Reauthorization Act To amend the Public Health Service Act to reauthorize the school-based health centers grant program. Sponsor: Rep. Tonko, Paul [D-NY-20] H.R.9389 - Nutrition Education and Chronic Disease Prevention in Community Health Centers Act of 2026 To amend the Public Health Service Act to authorize funding for nutrition education and chronic disease prevention at federally qualified health centers, and for other purposes. Sponsor: Rep. Harshbarger, Diana [R-TN-1] H.R. 8201 - Expanding Community Access to Health Services Act To amend Public Health Service Act to require community health centers to provide behavioral and mental health and substance use disorder services, and for other purposes. Sponsor: Rep. Lee, Susie [D-NV-3]

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HJRes 197 / SJRes 197, CRA related to the 2027 NBPP; HR 247 / S 46, Health Care Affordability Act; HR 6867 / S 3562, the NIH Clinical Trial Integrity Act; HR 3521 / S 4440, the Clinical Trial Modernization Act; HR 4710 / S 2420, No Surprises Act Enforcement Act; HR 5526 / S 1954, Biosimilar Red Tape Elimination Act; HR 5582 / S 2355, the Patients Deserve Price Tags Act; HR 6248 / S 4027, Healthy Competition for Better Care Act HR 6485 / S 43, Skinny Labels, Big Savings Act; HR 6867 / S 3562, NIH Clinical Trial Integrity Act; HR 7895, the PBM Kickback Prohibition Act; HR 8879 / S 4509, Patients Before Monopolies Act; HR 8908, the STOP GAMES Act; HR 9393, Lower Costs, More Transparency Act; HR 9396, the Prior Authorization Accountability Act; HR 9397, the Premium Transparency Act; HR 9645, the Health Care Price Certainty for All Americans Act; HR 9661 / S 1414, the Expedited Access to Biosimilars Act; HR 10370, the AIM to Cure Kids with Cancer Act; HR 10788, the Lower Premiums, Faster Payments Act; S 976, the Insurance Fraud Accountability Act; S 1041, Affordable Prescriptions for Patients Act; S 1095, Stop STALLING Act; S 1096, Preserve Access to Affordable Generics & Biosimilars Act S 1097, Interagency Patent Coordination & Improvements Act; S 2658, Medication Affordability & Patent Integrity Act; S 3014, Ensuring Timely Access to Generics Act; S 3822, the Break Up Big Medicine Act Policies to address the expiration of the enhanced Advanced Premium Tax Credits; Policies to improve transparency in hospital and insurer costs and finances; Policies to streamline pediatric patient access to subspecialist care via telemedicine; Policies to protect patients and consumers from junk insurance, including short-term limited duration insurance; Policies related to modernization of clinical trials; Policies related to the 2027 FDA user fee agreements; Implementation of the No Surprises Act; Policies related to oversight of insurance agents and brokers; Oversight and patient impact of the 340B program; Policies related to consolidation within the healthcare sector;

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

Government targets: Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Justice, Dept of (DOJ), 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

Affordable Care Act and Extending Enhanced APTCs (H.R. 247; S. 46), Individual Market/ACA exchanges; Fraudulent Enrollments in Qualified Health Plans (S. 976, HR 2079), Behavioral Health, Employer-Provided Health Coverage; Surprise Billing (S. 2420, H.R. 4710); Cybersecurity; Health IT, Health Care Innovation, Transparency & PBMs (S. 891, H.R. 6703), PBM Compensation (H.R. 7895), Prescription Drugs (S. 1954, S. 1096, S.1040), Price Transparency (S. 2355, H.R. 9393, H.R. 9397, H.R. 9645, H.R. 9390), Prior Authorization (H.R. 9396), 340B, Insulin (S. 4189), Corporate Practice of Medicine, Anticompetitive Contracting (H.R. 6248, S. 4027).

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

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

Medicare Advantage supplemental dental benefits, including benefit transparency, encounter data, marketing, beneficiary understanding of coverage, alignment of advertised benefits with actual coverage, consumer protections, surprise billing, provider directory accuracy, and oversight of dental benefit administration. CMS Notice of Benefit and Payment Parameters for 2027 and CMS RFI on the essential health benefits framework and typical employer standard, including pediatric oral health EHB, adult dental coverage, stand-alone dental plans, riders, carve-outs, and state flexibility.t H.R. 1521, Dental and Optometric Care (DOC) Access Act S. 1677/H.R. 3277, Ensuring Lasting Smiles Act (ELSA) S. 1164/H.R. 1397, Increasing Access to Dental Insurance Act H.R. 7931, Improving Dental Administration Act ERISA preemption and dental benefit plan accountability, including noncovered services, network leasing, assignment of benefits, virtual credit cards, prior authorization, retroactive denials, downcoding, prompt payment, and application of state dental insurance reforms to self-funded plans. H.R. 5582, Patients Deserve Price Tags Act H.R. 9177, Clear Healthcare Expense Cost Knowledge Act of 2026 H.R. 9397, Premium Transparency Act H.R. 9396, Prior Authorization Accountability Act

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

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

Issues: ACA Healthcare tax credits; Transparency in coverage; Surprise Billing; 2025 Proposed NBPP/Individual Market/ACA exchanges; Prior Authorization; Hospital Consolidation; Employer-provided health coverage; Cyber Attack/ Cyber Security; Community Health + Maternal Health; Hospital Billing; Anti-tiering, Anti-steering; Artificial Intelligence; Individual Market Reforms and eAPTC Extension; Healthcare Affordability; Preventative Care Bills: S.4027 - Healthy Competition for Better Care Act To ban anticompetitive terms in facility and insurance contracts that limit access to higher quality, lower cost care. Sponsor: Sen. Husted, Jon [R-OH] H.R.6248 - Healthy Competition for Better Care Act To ban anticompetitive terms in facility and insurance contracts that limit access to higher quality, lower cost care. Sponsor: Rep. Arrington, Jodey C. [R-TX-19] H.R.4710 - No Surprises Act Enforcement Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to increase penalties for group health plans and health insurance issuers for practices that violate balance billing requirements, and for other purposes. Sponsor: Rep. Murphy, Gregory F. [R-NC-3] S.2420 - No Surprises Act Enforcement Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to increase penalties for group health plans, health insurance issuers, and nonparticipating providers or facilities for practices that violate balance billing requirements, and for other purposes. Sponsor: Sen. Marshall, Roger [R-KS] S.2355 - Patients Deserve Price Tags Act To amend the Public Health Service Act to provide for hospital and insurer price transparency. Sponsor: Sen. Marshall, Roger [R-KS] H.R.8684 - Transparency in Billing Act of 2026 To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes. Sponsor: Rep. Foxx, Virginia [R-NC-5] H.R.2493 - Improving Care in Rural America Reauthorization Act of 2025 This bill reauthorizes through FY2030 grant programs administered by the Health Resources and Services Administration (HRSA) that provide funding to health care service providers and related entities in rural areas. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R.3419 - To amend the Public Health Service Act to reauthorize the telehealth network and telehealth resource centers grant programs. To amend the Public Health Service Act to reauthorize the telehealth network and telehealth resource centers grant programs. Sponsor: Rep. Valadao, David G. [R-CA-22] H.R.9393 - Lower Costs, More Transparency Act of 2026 To promote price transparency in the health care sector. Sponsor: Rep. Guthrie, Brett [R-KY-2] H.R.9397 - Premium Transparency Act To amend title XXVII of the Public Health Service Act and title XVIII of the Social Security Act to ensure health insurer accountability through publishing of overhead costs and claim payments, and to direct the Secretary of Health and Human Services to issue guidance on the provision of certain insurance information. Sponsor: Rep. Pfluger, August [R-TX-11] H.R.9117 - Clear Healthcare Expense Cost Knowledge Act (CHECK Act) To promote the availability of certain healthcare information, and for other purposes. Sponsor: Rep. Langworthy, Nicholas A. [R-NY-23] H.R.9390 - Prices on the Wall Act of 2026 To amend title XXVII of the Public Health Service Act to require certain facilities to post prices on the walls. Sponsor: Rep. Miller-Meeks, Mariannette [R-IA-1] H.R.9396 - Prior Authorization Accountability Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require the displaying of claim denial rates. Sponsor: Rep. Goldman, Craig A. [R-TX-12] H.R.2041 - Hidden Fee Disclosure Act of 2025 To amend the Employee Retirement Income Security Act of 1974 to clarify and strengthen the application of certain employer-sponsored health plan disclosure requirements. Sponsor: Rep. Courtney, Joe [D-CT-2] H.R. 8209 - School Based-Health Centers Reauthorization Act To amend the Public Health Service Act to reauthorize the school-based health centers grant program. Sponsor: Rep. Tonko, Paul [D-NY-20] H.R.9389 - Nutrition Education and Chronic Disease Prevention in Community Health Centers Act of 2026 To amend the Public Health Service Act to authorize funding for nutrition education and chronic disease prevention at federally qualified health centers, and for other purposes. Sponsor: Rep. Harshbarger, Diana [R-TN-1] H.R. 8201 - Expanding Community Access to Health Services Act To amend Public Health Service Act to require community health centers to provide behavioral and mental health and substance use disorder services, and for other purposes. Sponsor: Rep. Lee, Susie [D-NV-3] S.380 - Rural Obstetrics Readiness Act To improve obstetric emergency care. Sponsor: Sen. Hassan, Margaret Wood [D-NH] H.R.1254 - Rural Obstetrics Readiness Act To improve obstetric emergency care. Sponsor: Rep. Kelly, Robin L. [D-IL-2] H.R.3302 - Healthy Start Reauthorization Act of 2025 To amend the Public Health Service Act to reauthorize the Healthy Start Initiative. Sponsor: Rep. Ocasio-Cortez, Alexandria [D-NY-14] S.3799 - Healthy Start Reauthorization Act of 2026 To amend the Public Health Service Act to reauthorize the Healthy Start Initiative. Sponsor: Sen. Marshall, Roger [R-KS] H.R.7973 - Momnibus Act To end preventable maternal mortality, severe maternal morbidity, and maternal health disparities in the United States, and for other purposes. Sponsor: Rep. Underwood, Lauren [D-IL-14] S.4694 - Maternal Health for Veterans Act To amend title 38, United States Code, to require the Secretary of Veterans Affairs to carry out a maternity care coordination program, and for other purposes. Sponsor: Sen. Duckworth, Tammy [D-IL]

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

HR 247 / S 46, Health Care Affordability Act; S 2420, No Surprises Act Enforcement Act; HR 3521, the Clinical Trial Modernization Act; HR 5526, Biosimilar Red Tape Elimination Act; HR 5582, S 2355, the Patients Deserve Price Tags Act; HR 6248 / S 4027, Healthy Competition for Better Care Act HR 6485 / S 43, Skinny Labels, Big Savings Act; HR 6867 / S 3562, NIH Clinical Trial Integrity Act; HR 7895, the PBM Kickback Prohibition Act; HR 8908, the STOP GAMES Act; HR 9393, Lower Costs, More Transparency Act; HR 9396, the Prior Authorization Accountability Act; HR 9397, the Premium Transparency Act; HR 9661, Expedited Access to Biosimilars Act; S 1041, Affordable Prescriptions for Patients Act; S 1095, Stop STALLING Act; S 1096, Preserve Access to Affordable Generics & Biosimilars Act S 1097, Interagency Patent Coordination & Improvements Act; S 2658, Medication Affordability & Patent Integrity Act; S 3014, Ensuring Timely Access to Generics Act; S 4509, Patients Before Monopolies Act; Policies to address the expiration of the enhanced Advanced Premium Tax Credits; Policies to improve transparency in hospital and insurer costs and finances; Policies to streamline pediatric patient access to subspecialist care via telemedicine; Policies to protect patients and consumers from junk insurance, including short-term limited duration insurance; Policies related to the modernization of clinical trials; Policies related to the 2027 FDA user fee agreements; Implementation of the No Surprises Act; Policies related to oversight of insurance agents and brokers; Oversight and patient impact of the 340B program;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Tracking -a federal district court vacated a Health Resources and Services Administration (HRSA) policy restricting 340B disproportionate share hospitals (DSHs) from using group purchasing organizations (GPOs) alongside replenishment models for outpatient drugs, concluding the agency failed to provide adequate justification under the Administrative Procedure Act. share hospitals (DSHs) from using group purchasing organizations (GPOs) alongside replenishment models for outpatient drugs, concluding the agency failed to provide adequate justification under the Administrative Procedure Act. Tracking Bills - S. 3206 Transgender Health Care Access Act, S. 2709 and HR 5081 Telehealth Modernization Act, HR 6468 Rural Residency Placement & Development Act of 2025 - the area is challenged with med students match with this region which challenges the ability to recruit new health care professionals to remain in the area. HR5821 - Rural Hospital Fairness Act, S891 - Bipartisan Health Act, S526 PBM Transparency Act - provides for full transparency in drug pricing to ensure any savings go back to patients - the Federal Trade Commission will complete a 6(b) study examining the effects of consolidation on pricing in the PBM industry, as well as other potentially abusive behavior by PBMs. The bill instructs the FTC to provide policy recommendations to Congress to improve competition and protect consumers. The hospital supports any mechanism for drug price transparency for patients. S527 - Prescription Pricing for People Act of 2025 - A study by FTC to study role of intermediaries (PBMs) in pharm. supply chain and provide recommendations for improvement of costs to patients. S927 Protecing Pharmacies in Medicaid Act - PBMs charge Medicaid more than they pay pharmacies for a particular drug, increases corporate profits while driving up costs for Medicaid. PBMs use of spread pricing has also been linked to the increasing failure rate for independent pharmacies, which provide a critical source of health care and community for rural communities. HR267 Health Care Transparency Act - statutory authority for requirements for hospitals and health insurance plans to disclose certain information about the costs for items and services. We need to ensure requirements are within appropriate information to be disclosed - challenged with varied reimbursement rates. HR 2214 - DRUG Act. The bill is impacting prescription drug costs, access, and manufacturing practices. These include the Inflation Reduction Act's provisions for Medicare Part D, amendments to the Federal Sentencing Guidelines, and potential changes related to PBMs and direct-to-consumer advertising. Supporting best and most affordable care for patients. Tracking House Bills on price transaparency, drug controls, community care H.R. 9393 - Lower Costs, More Transparency Act of 2026 (Guthrie, Pallone): Codifies existing price transparency rules for hospitals and health plans American Hospital Association. H.R. 9390 - Prices on the Wall Act of 2026 (Miller-Meeks): Requires hospitals to post service pricing physically on their walls American Hospital Association. H.R. 9397 - Premium Transparency Act (Pfluger, Moran): Mandates insurers to disclose how much of premiums go toward healthcare costs subscriber.politicopro.com. H.R. 9396 - Prior Authorization Accountability Act (Goldman-TX): Improves transparency and consistency in prior authorization for Medicare Advantage plans American Hospital Association. H.R. 5243 - Medicare Advantage Data Transparency Amendment: Increases data transparency for supplemental benefits under Medicare Advantage House Committee on Energy and Commerce. H.R. 9395 - Transparency in Medicare Advantage Steering Act (Ocasio-Cortez): Enhances oversight and transparency in Medicare Advantage steering House Committee on Energy and Commerce. Access to Care & Community Health H.R. 8201 - Expanding Community Access to Health Services Act (Lee-NV): Requires community health centers to provide behavioral health and substance use disorder services, with related funding AACOM. H.R. 9389 - Nutrition Education and Chronic Disease Prevention in Community Health Centers Act of 2026 (Harshbarger): Expands nutrition education and chronic disease prevention services at Federally Qualified Health Centers AACOM. H.R. 3514 - Improving Seniors Timely Access to Care Act of 2025 (Kelly, DelBene): Reduces variation in prior authorization methods for Medicare Advantage plans American Hospital Association. Illicit Drug Control H.R. 1266 - Combatting Illicit Xylazine Act (Panetta, Pfluger): Places xylazine on the controlled substances list subscriber.politicopro.com. H.R. 7970 - STOP Nitazenes Act (Latta): Places nitazenes on the controlled substances list subscriber.politicopro.com. H.R. 2004 - Tylers Law (Lieu, Latta): Expands naloxone access and overdose prevention measures House Committee on Energy and Commerce. H.R. 1561 - ALERT Communities Act (Crockett, Gooden): Supports community-based overdose prevention and response House Committee on Energy and Commerce. H.R. 7994 - HERO Act (Ruiz): Enhances harm reduction and overdose prevention services House Committee on Energy and Commerce. H.R. 5880 - Fight Illicit Pill Presses Act (Hageman, Stansbury) & H.R. 8005 - Stop Pills That Kill Act (Evans): Target illicit drug manufacturing and distribution House Committee on Energy and Commerce. H.R. 7184 - PRESS Act (McDowell): Addresses illicit drug production and distribution

Client expense: Not reported · Firm income: $24,000

Government targets: HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), SENATE

ACA Healthcare tax credits; Transparency in coverage; Surprise Billing; 2025 Proposed NBPP/Individual Market/ACA exchanges; Prior Authorization; Hospital Consolidation; Employer-provided health coverage; Cyber Attack/ Cyber Security; Community Health + Maternal Health; Hospital Billing; Anti-tiering, Anti-steering; Artificial Intelligence; Individual Market Reforms and eAPTC Extension; Healthcare Affordability; Preventative Care S.4027 - Healthy Competition for Better Care Act To ban anticompetitive terms in facility and insurance contracts that limit access to higher quality, lower cost care. Sponsor: Sen. Husted, Jon [R-OH] H.R.6248 - Healthy Competition for Better Care Act To ban anticompetitive terms in facility and insurance contracts that limit access to higher quality, lower cost care. Sponsor: Rep. Arrington, Jodey C. [R-TX-19] H.R.4710 - No Surprises Act Enforcement Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to increase penalties for group health plans and health insurance issuers for practices that violate balance billing requirements, and for other purposes. Sponsor: Rep. Murphy, Gregory F. [R-NC-3] S.2420 - No Surprises Act Enforcement Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to increase penalties for group health plans, health insurance issuers, and nonparticipating providers or facilities for practices that violate balance billing requirements, and for other purposes. Sponsor: Sen. Marshall, Roger [R-KS] S.2355 - Patients Deserve Price Tags Act To amend the Public Health Service Act to provide for hospital and insurer price transparency. Sponsor: Sen. Marshall, Roger [R-KS] H.R.8684 - Transparency in Billing Act of 2026 To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes. Sponsor: Rep. Foxx, Virginia [R-NC-5] H.R.2493 - Improving Care in Rural America Reauthorization Act of 2025 This bill reauthorizes through FY2030 grant programs administered by the Health Resources and Services Administration (HRSA) that provide funding to health care service providers and related entities in rural areas. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R.3419 - To amend the Public Health Service Act to reauthorize the telehealth network and telehealth resource centers grant programs. To amend the Public Health Service Act to reauthorize the telehealth network and telehealth resource centers grant programs. Sponsor: Rep. Valadao, David G. [R-CA-22] H.R.9393 - Lower Costs, More Transparency Act of 2026 To promote price transparency in the health care sector. Sponsor: Rep. Guthrie, Brett [R-KY-2] H.R.9397 - Premium Transparency Act To amend title XXVII of the Public Health Service Act and title XVIII of the Social Security Act to ensure health insurer accountability through publishing of overhead costs and claim payments, and to direct the Secretary of Health and Human Services to issue guidance on the provision of certain insurance information. Sponsor: Rep. Pfluger, August [R-TX-11] H.R.9117 - Clear Healthcare Expense Cost Knowledge Act (CHECK Act) To promote the availability of certain healthcare information, and for other purposes. Sponsor: Rep. Langworthy, Nicholas A. [R-NY-23] H.R.9390 - Prices on the Wall Act of 2026 To amend title XXVII of the Public Health Service Act to require certain facilities to post prices on the walls. Sponsor: Rep. Miller-Meeks, Mariannette [R-IA-1] H.R.9396 - Prior Authorization Accountability Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require the displaying of claim denial rates. Sponsor: Rep. Goldman, Craig A. [R-TX-12] H.R.2041 - Hidden Fee Disclosure Act of 2025 To amend the Employee Retirement Income Security Act of 1974 to clarify and strengthen the application of certain employer-sponsored health plan disclosure requirements. Sponsor: Rep. Courtney, Joe [D-CT-2] H.R. 8209 - School Based-Health Centers Reauthorization Act To amend the Public Health Service Act to reauthorize the school-based health centers grant program. Sponsor: Rep. Tonko, Paul [D-NY-20] H.R.9389 - Nutrition Education and Chronic Disease Prevention in Community Health Centers Act of 2026 To amend the Public Health Service Act to authorize funding for nutrition education and chronic disease prevention at federally qualified health centers, and for other purposes. Sponsor: Rep. Harshbarger, Diana [R-TN-1] H.R. 8201 - Expanding Community Access to Health Services Act To amend Public Health Service Act to require community health centers to provide behavioral and mental health and substance use disorder services, and for other purposes. Sponsor: Rep. Lee, Susie [D-NV-3] S.380 - Rural Obstetrics Readiness Act To improve obstetric emergency care. Sponsor: Sen. Hassan, Margaret Wood [D-NH] H.R.1254 - Rural Obstetrics Readiness Act To improve obstetric emergency care. Sponsor: Rep. Kelly, Robin L. [D-IL-2] H.R.3302 - Healthy Start Reauthorization Act of 2025 To amend the Public Health Service Act to reauthorize the Healthy Start Initiative. Sponsor: Rep. Ocasio-Cortez, Alexandria [D-NY-14] S.3799 - Healthy Start Reauthorization Act of 2026 To amend the Public Health Service Act to reauthorize the Healthy Start Initiative. Sponsor: Sen. Marshall, Roger [R-KS] H.R.7973 - Momnibus Act To end preventable maternal mortality, severe maternal morbidity, and maternal health disparities in the United States, and for other purposes. Sponsor: Rep. Underwood, Lauren [D-IL-14] S.4694 - Maternal Health for Veterans Act To amend title 38, United States Code, to require the Secretary of Veterans Affairs to carry out a maternity care coordination program, and for other purposes. Sponsor: Sen. Duckworth, Tammy [D-IL]

Client expense: $990,000 · 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

Affordable Care Act and Extending Enhanced APTCs (H.R. 247; S. 46), 2026 Proposed NBPP/Individual Market/ACA exchanges; Fraudulent Enrollments in Qualified Health Plans (S. 976, HR 2079), Behavioral Health, Employer-Provided Health Coverage; Surprise Billing (S. 2420, H.R. 4710); Cybersecurity; Health IT, Health Care Innovation, Transparency & PBMs (S. 891, H.R. 6703), PBM Compensation (H.R. 7895), Prescription Drugs (S. 1954, S. 1096, S. 1096, S.1040) Price Transparency (S. 2355, H.R. 9393, H.R. 9397), Prior Authorization (H.R. 9396), 340B.

Client expense: $700,000 · Firm income: Not reported

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

Issues: ACA Healthcare tax credits; Transparency in coverage; Surprise Billing; 2025 Proposed NBPP/Individual Market/ACA exchanges; Prior Authorization; Hospital Consolidation; Employer-provided health coverage; Cyber Attack/ Cyber Security; Community Health + Maternal Health; Hospital Billing; Anti-tiering, Anti-steering; Artificial Intelligence; Individual Market Reforms and eAPTC Extension; Healthcare Affordability; Preventative Care Bills: S.4027 - Healthy Competition for Better Care Act To ban anticompetitive terms in facility and insurance contracts that limit access to higher quality, lower cost care. Sponsor: Sen. Husted, Jon [R-OH] H.R.6248 - Healthy Competition for Better Care Act To ban anticompetitive terms in facility and insurance contracts that limit access to higher quality, lower cost care. Sponsor: Rep. Arrington, Jodey C. [R-TX-19] H.R.4710 - No Surprises Act Enforcement Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to increase penalties for group health plans and health insurance issuers for practices that violate balance billing requirements, and for other purposes. Sponsor: Rep. Murphy, Gregory F. [R-NC-3] S.2420 - No Surprises Act Enforcement Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to increase penalties for group health plans, health insurance issuers, and nonparticipating providers or facilities for practices that violate balance billing requirements, and for other purposes. Sponsor: Sen. Marshall, Roger [R-KS] S.2355 - Patients Deserve Price Tags Act To amend the Public Health Service Act to provide for hospital and insurer price transparency. Sponsor: Sen. Marshall, Roger [R-KS] H.R.8684 - Transparency in Billing Act of 2026 To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes. Sponsor: Rep. Foxx, Virginia [R-NC-5] H.R.2493 - Improving Care in Rural America Reauthorization Act of 2025 This bill reauthorizes through FY2030 grant programs administered by the Health Resources and Services Administration (HRSA) that provide funding to health care service providers and related entities in rural areas. Sponsor: Rep. Carter, Earl L. "Buddy" [R-GA-1] H.R.9393 - Lower Costs, More Transparency Act of 2026 To promote price transparency in the health care sector. Sponsor: Rep. Guthrie, Brett [R-KY-2] H.R.9397 - Premium Transparency Act To amend title XXVII of the Public Health Service Act and title XVIII of the Social Security Act to ensure health insurer accountability through publishing of overhead costs and claim payments, and to direct the Secretary of Health and Human Services to issue guidance on the provision of certain insurance information. Sponsor: Rep. Pfluger, August [R-TX-11] H.R.9117 - Clear Healthcare Expense Cost Knowledge Act (CHECK Act) To promote the availability of certain healthcare information, and for other purposes. Sponsor: Rep. Langworthy, Nicholas A. [R-NY-23] H.R.9390 - Prices on the Wall Act of 2026 To amend title XXVII of the Public Health Service Act to require certain facilities to post prices on the walls. Sponsor: Rep. Miller-Meeks, Mariannette [R-IA-1] H.R.9396 - Prior Authorization Accountability Act To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require the displaying of claim denial rates. Sponsor: Rep. Goldman, Craig A. [R-TX-12] H.R.2041 - Hidden Fee Disclosure Act of 2025 To amend the Employee Retirement Income Security Act of 1974 to clarify and strengthen the application of certain employer-sponsored health plan disclosure requirements. Sponsor: Rep. Courtney, Joe [D-CT-2]

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE