Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015

Healthcare Price Transparency Rules for Hospitals 340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes. The Senate Committee on Health, Education, Labor and Pensions (HELP) June 26 passed the Lower Health Care Costs Act of 2019 (S.1895) Congress should act now to delay the Medicaid DSH cuts that are scheduled to go into effect Nov. 22.

Client expense: Not reported · Firm income: Not reported

Healthcare Price Transparency Rules for Hospitals 340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes

Client expense: Not reported · Firm income: Not reported

Healthcare Price Transparency Rules for Hospitals 340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes

Client expense: Not reported · Firm income: Not reported

Healthcare Price Transparency Rules for Hospitals 340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

340B Medicare DSH Medicare Physician Payment (MACRA) H.R. 365 The Primary Care Enhancement Act S. 898/H.R. 2141 Conrad State 30 and Physician Access Reauthorization Act S. 1130 Rural Emergency Acute Care Hospital (REACH) Act S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA) H.R. 4392 To provide that the provision of the Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs final regulation relating to changes in the payment amount for certain drugs and biologicals purchased under the 340B drug discount program shall have no force or effect, and for other purposes.

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA)

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016 H.R. 1628 Better Care Reconciliation Act (BCRA)

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act H.R 1628: American Health Care Act S. 872 / H.R. 1955: Rural Hospital Access Act S. 377: Medicare Ambulance Access, Fraud Prevention and Reform Act H.R. 1156: Patient Access to Higher Quality Health Care Act of 2017 H.R. 2: Medicare Access and CHIP Reauthorization Act of 2016

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 3590 (P.L. No: 111-148): The Patient Protection and Affordable Care Act: concerns regarding readmissions, value based purchasing, medicare and medicaid disproportionate share cuts under ACA regulations, Common Rule HR 1343/ S688: Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015 HR6: 21st Century Cures Act 340b Mega Guidance Rule from HRSA Common Rule on Human Subjects

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 3712, S. 2173, Improving Access to Mental Health Act, Issues relating to reimbursement for clinical social workers, access to mental health services for residents of skilled nursing facilities, and reimbursement for health and behavior assessment and intervention. H.R. 1343, S. 688, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, Issues pertaining to programs that support older adults and geriatrics training and workforce.

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

Government targets: HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE

Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and to extend non-enforcement for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibility: advocating for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program,that Stage 3 not begin until no sooner than 2019 and that meaningful use requirements for hospitals and CAHs align with those for eligible clinicians in MACRA; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support S 629 and H.R. 1784, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Urged limitations on Recovery Audit Contractors (RACs)that includes financial penalties for inaccurate audit decisions; Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 976 and HR 2513 Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process; Support S. 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, a bill for improved transparency of information about certified EHRs; Advocate to improve interoperability of electronic health records; Letter to CMS urging use of existing authority to bring flexibility to the EHR Incentive Program and discussion about needed flexibility; Support H.R. 5164, Rural Hospital Regulatory Relief Act, a bill to extend the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals; Support S. 3129/H.R. 5613, legislation to extend through CY2016, the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals.

Client expense: $4,050,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and to extend non-enforcement for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibility: advocating for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program,that Stage 3 not begin until no sooner than 2019 and that meaningful use requirements for hospitals and CAHs align with those for eligible clinicians in MACRA; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support S 629 and H.R. 1784, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Urged limitations on Recovery Audit Contractors (RACs)that includes financial penalties for inaccurate audit decisions; Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 976 and HR 2513 Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process; Support S. 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, a bill for improved transparency of information about certified EHRs; Advocate to improve interoperability of electronic health records; Letter to CMS urging use of existing authority to bring flexibility to the EHR Incentive Program and discussion about needed flexibility; Support H.R. 5164, Rural Hospital Regulatory Relief Act, a bill to extend the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals; Support S. 3129/H.R. 5613, legislation to extend through CY2016, the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals.

Client expense: $4,690,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Medicare payments for Graduate Medical Education Proposed changes to Medicare hospital reimbursement policies Proposed cuts and policy changes to Medicare Advantage insurance plans H.R. 1343/S. 688, "Establishing Beneficiary Equity in the Hospital Readmissions Program Act" H.R. 3292, "Medicare IME Pool Act of 2015" H.R. 5273, "Helping Hospitals Improve Patient Care Act" H.R. 34, "21st Century Cures Act" - provisions related to Medicare payments to hospitals

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Proposed changes to Medicare hospital reimbursement policy Health care policy H.R. 1343/S. 688, "Establishing Beneficiary Equity in the Hospital Readmissions Program Act" H.R. 34, "21st Century Cures Act"

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2124, S. 1148, Resident Physician Shortage Reduction Act of 2015, Issues pertaining to the training of residents. H.R. 4774, Training Tomorrow's Doctors Today Act, Issues pertaining to the training of residents. Issues pertaining to protecting funding for direct graduate medical education and indirect medical education. H.R. 5273, Helping Hospitals Improve Patient Care Act, Issues pertaining to hospital outpatient departments payments for off-campus departments. H.R. 1343, S. 688, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, Issues pertaining to adjustment for socioeconomic status in the hospital re-admissions program. Issues related to the proposed Medicare Part B Drug Model. Issues related to the implementation of MACRA. Issues pertaining to the implementation of provisions regarding the treatment of off-campus hospital departments and site neutral payments. Issues pertaining to protecting Medicaid. Issues pertaining to protecting Disproportionate Share Hospital Payments. Issues pertaining to the protection of reimbursements for safety net hospitals. Issues pertaining to the CMS Center for Medicare and Medicaid Innovation and the University of Illinois Coordination of HealthCare for Complex Kids Program. Issues pertaining to the 340B drug pricing program.

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

Government targets: Defense, Dept of (DOD), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Natl Science Foundation (NSF), SENATE, Treasury, Dept of

H.R. 2124/S. 1148, Resident Physician Shortage Reduction Act of 2015 Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments H.R. 4774, The Training Tomorrows Doctors Today Act Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments. Increases transparency and accountability measures. Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose inclusion of Medicare add-on payments in Hospital-Acquired Condition (HAC) program. Issue: Oppose Medicare hospital cuts as offsets for physician payment reform Issue: Support delay of Enforcement of new Centers for Medicare and Medicaid Services inpatient criteria (e.g., "Two-Midnight" rule) in FY 2016 Inpatient Prospective Payment System (IPPS) final rule. H.R. 4732/S.2671, Advancing Medical Resident Training in Community Hospitals Act Issue: Support Medicare Graduate Medical Education (GME) per resident amount technical corrections and administrative relief. H.R. 5273, Helping Hospitals Improve Patient Care Act of 2016 Issue: Support incorporating sociodemographic status Hospital Readmissions Reduction Program and addressing mid-build, off-campus outpatient departments under development at the time of enactment of the Bipartisan Budget Act of 2015. H.R. 1343/S. 688, Establishing Beneficiary Equity in the Hospital Readmissions Program Act of 2015 Issue: Support inclusion of socioeconomic status as part of hospital readmissions program. H.R. 3288, Strengthening DSH and Medicare through Subsidy Recapture and Payment Reform Act of 2015 Issue: Alter DSH payment methodology and increase DSH spending in non-Medicaid expansion states S. 2787, the States Achieve Medicaid Expansion (SAME) Act Issue: Support legislation providing three full years of federal Medicaid matching funding to states that expand Medicaid H.R. 3292, Medicare IME Pool Act of 2015 Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. H.R. 3291, Medicare Crosswalk Hospital Code Development Act of 2015 Issue: Create a crosswalk between Medicare Part A and Part B payments P.L. 114-10, Medicare Access and CHIP Reauthorization Act of 2015. Issues: Support repeal of Medicare's sustainable growth rate (SGR) formula; Medicare physician payment reform; extension of the Childrens Health Insurance Program (CHIP); and extension of mandatory funding for the National Health Service Corps (NHSC). H.R. 1117, Creating Access to Residency Education Act of 2015 Issue: Create CMS grant program for new residency programs. Issue: Development and implementation of new Medicare Disproportionate Share Hospital (DSH) formula required under the ACA. Draft Hospital Improvements for Payment (HIP) Act of 2014 Issues: Support repeal of CMS Two-Midnights Rule, extending RAC audit moratorium for short stays, and permanent bundle program. Issue: Oppose further delays in the implementation of the ICD-10 system Issue: Support inclusion of socioeconomic status as part of hospital readmissions program including support for adoption of National Quality Forum (NQF) recommendations. Issue: Support allowing providers in new delivery models (e.g., ACOs, bundled payments, etc.) to access medical records with information on substance use disorders H.R. 6088, Hospital Quality Rating Transparency Act of 2016 Issue: delay release of CMS Hospital Compare Star Ratings to give stakeholders time to work together to address concerns with methodology. Submitted comments to: --CMS on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule, including the Merit-Based Incentive Payment Systems (MIPS) and Alternative Payment Model (APM) Incentive --CMS on key proposals issued in the Episode Payment Models (EPMs) proposed rule

Client expense: $687,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Agriculture, Dept of (USDA), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Education, Dept of, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), Veterans Affairs, Dept of (VA), White House Office

Socioeconomic adjustment of the hospital readmission reduction program (H.R. 1343/S. 688, H.R. 5273/H.R. 34 - 21st Century Cures Act) Medicare audit contractor program reforms (H.R. 2156, S. 2368) Rural hospital policies (H.R. 663 / S. 332, H.R. 169/S. 258, H.R. 1611/S. 257, S. 1461/H.R. 2878, H.R. 5164, H.R. 5613, CAH cost-based reimbursement) Telehealth, interoperability, health information technology (H.R. 6/H.R. 34 - 21st Century Cures Act, S. 2511, S. 2484/H.R. 4442) Post-Acute Care policies (H.R. 3298), home health prior authorization S. 2108, H.R. 5713 Health Care and Medicaid financing reform (Better Way white paper, Empowering Patients First Act, Patient CARE Act, H.R. 5284/S. 2985) Graduate Medical Education policy (H.R. 2124, S. 1148, H.R 3292, H.R. 6333) HR 976, HR 2513 DSH payment Bundled payment programs Clinical lab payment policy MACRA implementation NOTICE Act implementation Sec 603 Bipartisan Budget Act / site neutral payment policies (H.R. 5273/H.R. 34 - 21st Century Cures Act) Stark Law reforms H.R. 4428, H.R. 6399 Star Ratings Medicare Part B drug payment model Medicare Advantage policy

Client expense: $70,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicaid funding for disproportionate share hospitals; 340B drug discount program; H.R. 1343, S.688: Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, regarding the hospital readmission program under Medicare; development of legislation to create partnership opportunities for essential hospitals; Medicare funding for hospital outpatient departments.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2124, S. 1148, Resident Physician Shortage Reduction Act of 2015, Issues pertaining to the training of residents. H.R. 4774, Training Tomorrow's Doctors Today Act, Issues pertaining to the training of residents. Issues pertaining to protecting funding for direct graduate medical education and indirect medical education. H.R. 5273, Helping Hospitals Improve Patient Care Act, Issues pertaining to hospital outpatient departments payments for off-campus departments. H.R. 1343, S. 688, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, Issues pertaining to adjustment for socioeconomic status in the hospital readmissions program. Issues relating to the proposed Medicare Part B Drug Model. Issues relating to the implementation of MACRA. Issues pertaining to the implementation of provisions regarding the treatment of off-campus hospital departments and site neutral payments. Issues pertaining to protecting Medicaid. Issues pertaining to protecting Disproportionate Share Hospital Payments. Issues pertaining to the protection of reimbursements for safety net hospitals. Issues pertaining to the CMS Center for Medicare and Medicaid Innovation and the University of Illinois Coordination of HealthCare for Complex Kids Program.

Client expense: Not reported · Firm income: $70,000

Government targets: HOUSE OF REPRESENTATIVES, Natl Science Foundation (NSF), SENATE

President's Budget, FY2016, Medicare and Medicaid hospital reimbursement issues. Health care reform, Hospital related issues and initiatives. Public Law 111-148, The Patient Protection and Affordable Care Act, Hospital related issues and initiatives. H.R.4872, Health Care and Education Reconciliation Act of 2010, Hospital related issues and initiatives. S.688/S.R.1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, Hospital related issues. 340B Drug Discount Program related issues Recovery Audit Contractors Public Law 114-74, Bipartisan Budget Act of 2015, HOPD offsets; and Tax section 1115 Medicaid waiver CMS Hospital Compare Star Ratings Medicaid 1115 Waiver H.R.5273, Helping Hospitals Improve Patient CARE Act of 2016 Public Law 114-255, 21st Century Cures Act, Hospital related issues and initiatives

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.3292, Medicare IME Pool Act of 2015. H.R.1343/S.688, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015. H.R.1021, Protecting the Integrity of Medicare Act of 2015. H.R.2124/S.1148, Resident Physician Shortage Reduction Act of 2015. H.R.4774, Training Tomorrow's Doctors Today Act. H.R.4732/S.2671, Advancing Medical Resident Training in Community Hospitals Act of 2016. H.R.5273, Helping Hospitals Improve Patient Care Act of 2016. H.R.34, 21st Century Cures Act (P.L.114-255). Affordable Care Act (P.L.111-148). Medicare funding for graduate medical education. Medicare reimbursement for hospital outpatient services. Short inpatient hospital stay/Two Midnight Rule. Laboratory-Developed Tests (LDTs).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and to extend non-enforcement for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibility: advocating for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program,that Stage 3 not begin until no sooner than 2019 and that meaningful use requirements for hospitals and CAHs align with those for eligible clinicians in MACRA; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support S 629 and H.R. 1784, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Urged limitations on Recovery Audit Contractors (RACs)that includes financial penalties for inaccurate audit decisions; Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 976 and HR 2513 Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process; Support S. 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, a bill for improved transparency of information about certified EHRs; Advocate to improve interoperability of electronic health records; Letter to CMS urging use of existing authority to bring flexibility to the EHR Incentive Program and discussion about needed flexibility; Support H.R. 5164, Rural Hospital Regulatory Relief Act, a bill to extend the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals; Support S. 3129/H.R. 5613, legislation to extend through CY2016, the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals.

Client expense: $4,970,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

H.R. 2, Medicare Access and CHIP Reauthorization Act of 2015; H.R. 1343/S. 688, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015; H.R. 1526, Medicare Audit Improvement Act of 2015; Medicare and Medicaid reimbursement; CMS/HHS on health insurance marketplace; S. 298/H.R. 546, ACE Kids Act; Helping Hospitals Improve Patient Care Act (H.R. 5273; Preserving Patient Access to Post-Acute Hospital Care Act (H.R. 4650/S. 2108); 21st Century Cures Act (H.R. 34).

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

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

H.R. 2513 "PACE Act of 2015" - Oppose efforts to repeal certain provisions relating to the limitation on the Medicare exception to the prohibition on certain physician referrals for hospitals and to transparency reports and reporting of physician ownership or investment interests. Bad Debt Payments to Hospitals - Lawmakers have proposed lowering the amount of Medicare Bad Debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital. Oppose any effort to lower such payments. Direct and Indirect Graduate Medical Education Payments - Lawmakers have proposed changes to the way that hospitals are reimbursed for the costs of training physicians and other medical professionals. Oppose any reductions to such payments. H.R. 663/S.332 "Rural Hospital Access Act of 2015" - Advocate for the extension the Medicare Dependent Hospital (MDH) and current Low-Volume Hospital (LVH) programs. Oppose any additional site neutral cuts. Oppose the proposal of lowering Medicare reimbursements to Inpatient Rehabilitation Facilities. Sequestration - against extending the Medicare Sequester and oppose Medicare sequester increase and extension as an offset. Price Transparency - advocate for meaningful price transparency for consumers by ensuring they have access to out of pocket price information. H.R. 5273 "Helping Hospitals Improve Patient Care Act of 2016" - Advocated for targeted, appropriate Hospital Outpatient Department under development language in the House Ways and Means package including LTCH provision. Advocated for Medicaid expansion and the role hospitals have in caring for patients in Medicaid populations. Part B Demo - Opposed administration's proposed Part B Drug Demo. Advocated for limits to CMMI Pilots. H.R. 6226 "Pre-Claims Undermine Seniors Health Act" - Support delay of pre-claim review for home health services. H.R. 1343/S. 688 "Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015" - SES risk adjustment for hospital payment and readmissions. H.R. 3298 "Medicare Post-Acute Care Value-Based Purchasing Act of 2015" - Provided comments on Medicare Post-Acute Care Value-Based Purchasing Act of 2015. Advocated for restoration of hospital Medicare cuts if Affordable Care Act is repealed.

Client expense: $730,000 · Firm income: Not reported

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

HR 1343/ S. 688 Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015. Issues pertaining to Hospitals Outpatient Department (HOPD) provisions in the 2015 Bipartisan Budget Act. HR 5273 Helping Hospitals Improve Patient Care Act of 2016, issues relating to HOPD. HR 6088 Hospital Quality Rating Transparency Act of 2016, issues regarding Star ratings

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

Government targets: Defense, Dept of (DOD), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

Issues pertaining to Medicaid reform, block grant proposals, per capita caps Medicare and Medicaid Graduate Medical Education Medicaid provider taxes Medicare bad debt payments Medicare and Medicaid payment H.R.2 the Medicare Access and CHIP Reauthorization Act of 2015, all provisions H.R.1343/S.688 Establishing Equity in the Hospital Readmissions Program Act of 2015, all provisions Medicaid Waivers Medicaid Expansion Issues Medicaid disproportionate share hospital payments Medicare disproportionate share hospital payments Medicare hospital readmissions program Funding for the Children's Health Insurance Program Medicaid primary care payment parity Issues related to Medicaid reform including Medicaid block grants and per capita caps Medicare evaluation and management codes and other Medicare outpatient codes/ Medicare site neutral documents Meaningful Use stage 2 and 3 Medicare Shared Savings Program Legislation related to chronic care treatment H.R. 3291 Medicare Crosswalk Hospital Code Development Act Medicaid data and transparency Medicaid Managed Care Policies/ rulemaking Medicaid supplemental payments Medicare Site Neutral payments for hospital outpatient departments H.R.4442/S.2484 Connect for Health Act H.R.3309 Flex-It 2 Act H.R.5542 Medicaid and CHIP Quality Improvement Act S. 2438 Medicaid and CHIP Quality Improvement Act Hospital Star Rating: Methodology H.R.5273 Helping Hospitals Improve Patient Care Act H.R. 3024 Review of certain estimate for determining additional Medicare payments S. 2228 Review of Certain Medicare Payment determinations for DSH Hospitals Legislation related to health care disparities H.R. 31 21st Century Cures, Provisions related to Medicare payments to hospitals CMS OPPS final rule on HOPD grandfather sites relocation

Client expense: $280,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Physician payment policy including implementation of H.R.2, the Medicare Access and CHIP Reauthorization Act of 2015 and S.737, the Ensuring Access to Primary Care for Women and Children Act; electronic health record incentive program policy; value-based payment modifier policy; hospital readmissions program policy, including H.R.1343 and S.688; policies related to health information technology, including S.2141; H.R.4848, the Healthy Inpatient Procedures Act of 2016; policies related to mental health, including H.R.2646, The Helping Families in Mental Health Crisis Act and S.2680, The Mental Health Reform Act of 2016; and policies related to opioid abuse.

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

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

S. 688 Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015. All provisions. H.R. 1343 Establishing Beneficiary Equity in Hospital Readmission Program Act of 2015. All provisions. Advance Notice of Methodological Changes for Calendar Year (CY) 2016 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter. All Provisions. P.L. 111-148 and P.L. 111-152 Affordable Care Act. All provisions related to implementation of health care reform including the Medicare and Medicaid programs, tax and insurance policies, graduate medical education, biomedical research, public and preventative health measures, and other policies concerning hospitals, physicians, health plans, employers and individuals. H.R. 2156 - Medicare Audit Improvement Act of 2015. All provisions. S. 1148 - The Resident Physician Shortage Reduction Act. All provisions. H.R. 2124 - The Resident Physician Shortage Reduction Act. All provisions. H.R. 3292 - Medicare IME Pool Act of 2015. H.R. 3288 - The Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015. H.R. 3291- The Medicare Crosswalk Hospital Code Development Act of 2015. H.R. 4428 - Fair Medicare Hospital Payments Act CMS Hospital Compare star ratings - All provisions Comments invited by House Energy and Commerce Committee concerning Section 603 of the Bipartisan Budget Act of 2015, P.L. 114-74 - Site Neutral payment policy P.L. 114-10 - Medicare Access and CHIP Reauthorization Act of 2015 - Centers for Medicare and Medicaid Proposed Rule. All provisions Centers for Medicare and Medicaid Services Proposed Medicare Part B Drug Payment Model All provisions. H.R. 5723 - Helping Hospital Improve Patient Care Act of 2016. All provisions. Centers for Medicare and Medicaid Services Outpatient Prospective Payment System proposed rule for calendar year 2017 implementing Section 603 of the Bipartisan Budget Act of 2015, "Treatment of Off-Campus Outpatient Departments of a Provider" - All provisions. H.R. 34 - 21st Century Cures Act, All Provisions UNOS Liver Allocation and Transplantation Policy

Client expense: $160,000 · Firm income: Not reported

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

S. 688 Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015. All provisions. H.R. 1343 Establishing Beneficiary Equity in Hospital Readmission Program Act of 2015. All provisions. Advance Notice of Methodological Changes for Calendar Year (CY) 2016 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter. All Provisions. P.L. 111-148 and P.L. 111-152 Affordable Care Act. All provisions related to implementation of health care reform including the Medicare and Medicaid programs, tax and insurance policies, graduate medical education, biomedical research, public and preventative health measures, and other policies concerning hospitals, physicians, health plans, employers and individuals. H.R. 6 - 21st Century Cures Act. All provisions. S. 1148 - The Resident Physician Shortage Reduction Act. All provisions. H.R. 2124 - The Resident Physician Shortage Reduction Act. All provisions. S. 2742 - The committee approved the Promoting Biomedical Research and Public Health for Patients Act S. 2700 - The FDA and NIH Workforce Authorities Modernization Act S. 185 - The Promise for Antiobiotics and Therapeutics for Health Act S. 2713 - The Advancing Precision Medicine Act of 2016 S. 2745 - The Advancing NIH Strategic Planning and Representation in Medical Research Act S. 2511 - Improving Health Information Technology Act P.L. 114-10 - Medicare Access and CHIP Reauthorization Act of 2015 - Centers for Medicare and Medicaid Proposed Rule. All provisions Centers for Medicare and Medicaid Services Proposed Medicare Part B Drug Payment Model All provisions. S. 524 - Comprehensive Addition and Recovery Act . All provisions. H.R. 5723 - Helping Hospital Improve Patient Care Act of 2016. All provisions. Centers for Medicare and Medicaid Services Outpatient Prospective Payment System proposed rule for calendar year 2017 implementing Section 603 of the Bipartisan Budget Act of 2015, "Treatment of Off-Campus Outpatient Departments of a Provider" - All provisions. H.R. 34 - 21st Century Cures Act, All Provisions UNOS Liver Allocation and Transplantation Policy

Client expense: $160,000 · Firm income: Not reported

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

Issues related to consumer privacy and consumer marketing, including S. 688, H.R. 580 and other potential privacy legislation; issues related to data security and data breach, including S. 177, H.R. 2205, H.R. 1770 and other potential data security and data breach legislation.

Client expense: $350,000 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Consumer Financial Protection Bureau (CFPB), Federal Housing Finance Agency (FHFA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Natl Technical Information Service, Office of the Comptroller of the Currency (OCC), SENATE, Social Security Administration (SSA), Treasury, Dept of

Graduate Medical Education (GME) issues (including Resident Physician Shortage Reduction Act (H.R.2124/S.1148) - support); provided comments to Congress in response to Energy and Commerce Committee request for input on GME; amendments to the Medicare hospital re-admissions penalty program methodology (providing SES adjustments, fixing the formula flaw), H.R.1343/S.688 - support; proposals to amend the 2 midnight policy - support; hospital issues included in President Obama's FY 16 budget - oppose; hospital issues included in H.R.2, the Medicare Access and CHIP Re-authorization Act of 2015 - support; legislation to create a comprehensive Medicare home infusion benefit (H.R.605/S.275) - support; Strengthening Medicare Advantage through Innovation and Transparency for Seniors (H.R.2570) - oppose; Medicare Inpatient Prospective Payment System FY 2016 proposed rule (CMS 1632-P) - detailed comment letter; legislation to improve the recovery audit contractor program (H.R.2156); Audit and Appeal Fairness, Integrity and Reforms in Medicare Act (AFIRM) - provided comments to the Senate Finance Committee; Ensuring Seniors Access to Local Pharmacies Act of 2015 (H.R.793/S.1190) - support; Pharmacy and Medically Underserved Areas Enhancement Act (H.R.592/S.314) - support; MAC Transparency Act (H.R.244) - support; Medication Therapy Management Act (S.776) - support; CMS-4159-F2 - comments on daily dispensing fees; Medicare Independence at Home Medical Practice Demonstration Improvement Act of 2015 (P.L.114-39) - support; provided comments on the proposed Medicare outpatient prospective payment system rule (CMS-1633-P); Medicare IME Pool Act of 2015 (H.R.3292) - oppose; Strengthening DSH and Medicare through Subsidy Recapture and Payment Reform Act (H.R.3288) - oppose; Medicare Crosswalk Hospital Code Development Act (H.R. 3291) - oppose; sign-on letter to CMS urging it to reconsider negative update for CY 2016 (CMS-1633-P) - support; proposed Medicare and Medicaid cuts as offsets to pay for budget increases, raising the debt ceiling, etc. - oppose; site neutral hospital outpatient cuts and other hospital related provisions included in the Bipartisan Budget Act of 2015 (H.R. 1314) - oppose; legislative proposals (H.R. 5273)and Congressional letters to amend the Bipartisan Budget Acts site neutral hospital outpatient payment cut to grandfather sites under development as well as other legislative changes (support) - advocated for their inclusion in the Consolidated Appropriations Act of 2016 (Omnibus legislation/Senate amendment to H.R. 2029); provided comments to Congress regarding provisions in the Mental Health Reform Act of 2015 (S. 1945), that would reform how health care information for substance abuse patients is shared; met with HHS officials on Medicare and Medicaid issues of importance to the Commonwealth of Puerto Rico and Puerto Rican health care providers; submitted comments on Medicare and Medicaid Programs: Reform of Requirements for Long-Term Care Facilities (CMS-3260-P); Stopping Medication Abuse and Protecting Seniors Act of 2015 (S.1913) - support (with some concerns about pharmacy lock-in policy); hospital issues included in House FY 17 budget - oppose; hosptial issues included in President Obama's FY 17 budget proposal - oppose; provided comments in response to Energy and Commerce Committee request for input on hospital site-neutral issues; Medicaid provisions included in the Common Sense Savings Act of 2016 (H.R.4725) - oppose; provided comments to CMS and Congress regarding the Hospital Compare Star Ratings for hospitals - support for delay and fixing measures; The Fair Medicare Hospital Payments Act of 2016 (H.R. 4428) - oppose; provided comments to CMS on hospital site-neutral proposals - argued for flexibility in the anticipated OPPS proposed rule; provided comments to CMS on the FY 17 IPPS proposed rule (CMS-1655-P) with a focus on opposition to the proposed Medicare DSH policy and provided input to Capitol Hill and the Administration;submitted comments on Medicaid Program,Covered Outpatient Drugs (CMS-2345-FC); asked Congressional members to urge CMS to finalize its 2014 proposed guidance to Part D drug plans and PBMs regarding consistent reporting of Direct and Indirect Remuneration (DIR); Improving Transparency & Accuracy in Medicare Part D Spending (S.3308/H.R.5957) - support; testified at House Ways and Means Health Subcommittee hearing entitled "Incentivizing Quality Outcomes in Medicare Part A" in support of streamlining hospital measures and reporting; provided comments regarding the Medicare OPPS CY2017 proposed rule (81 FR 45603), in particular in opposition to implementation of site-neutral proposals; provided comments on Merit Based Incentive Payment System (MIPS)and Alternative Payment Models (APMs) under MACRA 2015 (81 FR 28161); discussions with CMS regarding priority categories for redistribution of Medicare-funded residency slots; discussions with CMS to encourage consistency in hospital surveys; submitted comments on the Part B Drug Payment Model proposed rule (CMS-1670-P) - serious concerns; submitted comments on the SNF PPS proposed rule (CMS-1645-P) - serious concerns; Texas proposed Medicaid State Plan Amendment (15-005) in response to the CMS Covered Outpatient Drug Rule (CMS-2345-FC) - concerns; submitted comments to CMS about its proposal to expand testing of mandatory, risk-based bundled payments for acute episodes of care - oppose; 21st Century Cures Act (H.R. 34, now P.L.114-255) provisions that apply to site neutral, readmissions, and other hospital reimbursement issue - support.

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

S.688/H.R.1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015. S.1148/H.R.2124, The Resident Physician Shortage Reduction Act of 2015. Issues related to hospital and related provider reimbursement, outpatient hospital payment restrictions, disproportionate share hospitals, graduate medical education and delivery system reforms.

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

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

Provider access to substance use claims data, efforts to oppose site-neutral Medicare payments, S.688 - the Establishing Beneficiary Equity in the Hospital Readmission Program Act, H.R.2156 - the Medicare Audit Improvement Act, S.1148, the Resident Physician Shortage Reduction Act, H.R. 1604, the Affordable Care Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 192, Older Americans Act Reauthorization Act - entire bill H.R. 731, the Justice and Mental Health Collaboration Act - entire bill S. 933, the Comprehensive Justice and Mental Health Act - entire bill H.R. 988, the Elder Justice ActReauthorization Act - entire bill S. 1169, the Juvenile Justice and Delinquency Prevention Reauthorization Act - entire bill H.R. 1343/S. 688, the Establishing Beneficiary Equity in the Hospital Readmission Program Act - entire bill S. 1513, the Second Chance Act Reauthorization Act - entire bill H.R. 1865/S. 1423, the Central Coast Heritage Protection Act - entire bill S. 1964, the Family Stability & Kinship Care Act - entire bill S. 1879, the Interior Improvement Act - entire bill S. 1893, the Mental Health Awareness and Improvement Act - entire bill S. 1945, the Mental Health Reform Act - entire bill H.R. 2197, the Youth PROMISE Act - entire bill S. 2533/H.R. 5247, the California Long-Term Provisions for Water Supply and Short-Term Provisions for Emergency Drought Relief Act - entire bill S. 2565, the Protecting Families Affected By Substance Abuse Act - entire bill S. 2577/ H.R. 4602, the Justice For All Act Reauthorization Act of 2016 - entire bill H.R. 2646, the Helping Families in Mental Crisis Act - entire bill H.R. 2952, the Improving Employment Outcomes of TANF Recipients Act, - entire bill H.R. 3025, the Wildfire Airspace Protection Act - entire bill H.R. 3153, the Saint Francis Dam Memorial and Castaic Wilderness Act - entire bill S. 3270, the Elder Abuse Prevention and Prosecution Act - entire bill H.R. 3700, the Housing Opportunity Through Modernization Act - entire bill H.R. 4201, the Restoring the Partnership for County Health Care Costs Act - entire bill H.R. 4441, the Aviation Innovation, Reform, and Reauthorization Act - Airport Improvement Program/ Contract Tower Program; drone interference with wild fire fighting H.R. 4676, the Preventing Crimes Against Veterans Act - entire bill H.R. 4472/S. 2574, Modernizing the Interstate Placement of Children in Foster Care Act - entire bill H.R. 4724, the Reducing Duplicative and Ineffective Federal Funding Act - entire bill H.R. 4725, the Common Sense Savings Act - entire bill H.R. 5244, the Saint Francis Dam Memorial Act - entire bill H.R. 5273, the Helping Hospitals Improve Patient Care Act - entire bill H.R. 5456/S. 3065, the Family First Prevention Services Act - entire bill H.R. 5046, the Comprehensive Opioid Abuse Reduction Act - entire bill H.R. 5244, the Saint Francis Dam Disaster National Memorial Act - entire bill H.R. 5467, the Rim of the Valley Corridor Preservation Act - entire bill H.R. 5963, the Supporting Youth Opportunity and Preventing Delinquency Act H.R. 5054/S. 5296, FY 2017 Agriculture Appropriations - Agricultural Pests, APHIS funding, WIC H.R. 5393/S. 2837, FY 2017 Commerce, Justice, State Appropriations - funding for local law enforcement activities, including youth delinquency prevention, local law enforcement technology needs, domestic abuse programs, drug treatment, SCAAP, and the Southwest Border Prosecution Initiative H.R. 5055/S. 2804/H.R. 2028, FY 2017 Energy and Water Appropriations -Funding for Army Corps of Engineers projects H.R. 5634/S. 3001, FY 2017 Homeland Security Appropriations - local homeland security and disaster preparedness activities, including public safety, public health, emergency management personnel, communications infrastructure, Assistance to Firefighters Grant program, and Emergency Management Performance Grants H.R. 5538/S. 3068, FY 2017 Interior Appropriations - funding for EPA Section 103 & 105 air grants; Payments in Lieu of Taxes S. 3040, FY 2017 Labor, Health and Human Services Appropriations - funding for CDC State & Local Capacity, Bioterrorism Hospital Program, MMRS, MCH, ADAP, TB Control, family planning, substance abuse block grants, preventative health, safety net grants, nutritional services for older Americans, LSTA, Funding for Community Services and Social Services Block Grants, oral health funding H.R. 5394/S. 2844, FY 2017 Transportation, HUD Appropriations bill - CDBG, HOME Investment Partnerships, Homeless assistance grants, HOPWA, Elderly Housing, Airport Improvement Program, Contract Tower Program Federally Qualified Health Centers Managed care under the Medicaid and CHIP programs Temporary Assistance to Needy Families (TANF) Reauthorization 340B Hospital Drug program

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

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

H.R. 211, the Reducing Environmental Barriers to Unified Infrastructure and Land Development (REBUILD) Act - entire bill S. 414, the California Desert Conservation and Recreation Act - entire bill S. 517, the Secure Rural Schools and Payment in Lieu of Taxes Act - entire bill H.R. 731, the Justice and Mental Health Collaboration Act - entire bill S. 933, the Comprehensive Justice and Mental Health Act - entire bill H.R. 988, the Elder Justice Act Reauthorization Act - entire bill S. 1169, the Juvenile Justice and Delinquency Prevention Reauthorization Act - entire bill H.R. 1211/S. 1588, the Mental Health in Schools Act - entire bill H.R. 1343/S. 688, the Establishing Beneficiary Equity in the Hospital Readmission Program Act - entire bill S. 1439/H.R. 3160, the Foster Youth Independence Act - entire bill S. 1513, the Second Chance Act Reauthorization Act - entire bill H.R. 1854/S. 993, the Comprehensive Justice and Mental Health Act - entire bill S. 1879, the Interior Improvement Act - entire bill S. 1893, the Mental Health Awareness and Improvement Act - entire bill S. 1945, the Mental Health Reform Act - entire bill H.R. 2197, the Youth PROMISE Act - entire bill S. 2533/H.R. 5247, the California Long-Term Provisions for Water Supply and Short-Term Provisions for Emergency Drought Relief Act - entire bill S. 2565, the Protecting Families Affected By Substance Abuse Act - entire bill S. 2577/H.R. 4602, the Justice For All Act Reauthorization Act of 2016 - entire bill H.R. 2646, the Helping Families in Mental Crisis Act - entire bill H.R. 2663, the Public Land Renewable Energy Development Act - entire bill H.R. 2952, the Improving Employment Outcomes of TANF Recipients Act - entire bill H.R. 3025, the Wildfire Airspace Protection Act - entire bill S. 3270, the Elder Abuse Prevention and Prosecution Act - entire bill H.R. 3700, the Housing Opportunity Through Modernization Act - entire bill H.R. 4076, the Treat Act - entire bill H.R. 4201, the Restoring the Partnership for County Health Care Costs Act - entire bill H.R. 4441, the Aviation Innovation, Reform, and Reauthorization Act - Airport Improvement Program; drone interference with wild fire fighting H.R. 4472/S. 2574, the Modernizing the Interstate Placement of Children in Foster Care Act - entire bill H.R. 4724, the Reducing Duplicative and Ineffective Federal Funding Act - entire bill H.R. 4725, the Common Sense Savings Act - entire bill H.R. 5046, the Comprehensive Opioid Abuse Reduction Act of 2016 - entire bill H.R. 5273, the Helping Hospitals Improve Patient Care Act - entire bill H.R. 5963, the Supporting Youth Opportunity and Preventing Deilnquency Act - entire bill H.R. 5456/S. 3065, the Family First Prevention Services Act - entire bill H.R. 5054/S. 5296, FY 2017 Agriculture Appropriations - Agricultural Pests, APHIS funding, WIC H.R. 5393/S. 2837, FY 2017 Commerce, Justice, State Appropriations - funding for local law enforcement activities, including youth delinquency prevention, local law enforcement technology needs, domestic abuse programs, drug treatment, SCAAP, and the Southwest Border Prosecution Initiative. H.R. 5055/S. 2804/H.R. 2028, FY 2017 Energy and Water Appropriations - funding for the Salton Sea H.R. 5634/S. 3001, FY 2017 Homeland Security Appropriations - local homeland security and disaster preparedness activities, including public safety, public health, emergency management personnel, communications infrastructure, Assistance to Firefighters Grant program, and Emergency Management Performance Grants H.R. 5538/S. 3068, FY 2017 Interior Appropriations - Section 6, Cooperative Endangered Species Conservation Fund, Payments in Lieu of Taxes S. 3040, FY 2017 Labor, Health and Human Services Appropriations - funding for CDC State & Local Capacity, Bioterrorism Hospital Program, MMRS, DMAT, MCH, Ryan White Title I, TB Control, family planning, substance abuse block grants, preventative health, nutrition services for older Americans, Federally Designated Health Professional Shortage Areas (HPSA), LSTA, Funding for Community Services and Social Services Block Grants H.R. 5394/S. 2844, FY 2017 Transportation, HUD Appropriations bill - CDBG, Section 8, HOME Investment Partnerships, homeless assistance, HOPWA, Elderly Housing, Airport Improvement Program funding. Base Closure and Realignment Commission (BRAC) EB-5 Visa Program reform Endangered Species Act/Habitat Conservation Intercept of Federal Tax Refunds for Delinquent Fines Older Americans Act reauthorization Salton Sea Restoration Project Temporary Assistance to Needy Families (TANF) Reauthorization Trans-Pacific Partnership - support for continued progress on negotiation and ratification by Congress 340B Hospital Drug program

Client expense: Not reported · Firm income: $45,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 257 / H.R. 1611: Protecting Access to Rural Therapy Services Act S. 258 / H.R. 169: Critical Access Hospital Relief Act of 2015 H.R. 672 / S. 607: Rural Community Hospital Demonstration Extension Act of 2015 S. 1135: Hospital Payment Fairness Act H.R. 1479: Repeal of the Obamacare Bay State Boondoggle Act S. 1648: Rural Emergency Acute Care Hospital Act H.R. 3225: Save Rural Hospitals Act H.R. 1343 / S. 688: Establishing Beneficiary Equity in the Hospital Readmission Program Act S. 1148 / H.R. 2124: Resident Physician Shortage Reduction Act S. 2484 / H.R. 4442: CONNECT for Health Act H.R. 2156: Medicare Audit Improvement Act H.R. 5164: Rural Hospital Regulatory Relief Act S. 3435: Craig Thomas Rural Hospital and Provider Equity Act of 2016 H.R. 5406: Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act H.R. 34: 21st Century Cures Act H.R. 3298: Medicare Post-Acute Care Value-Based Purchasing Act

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 3590 (P.L. No: 111-148): The Patient Protection and Affordable Care Act: concerns regarding readmissions, value based purchasing, medicare and medicaid disproportionate share cuts under ACA regulations, Common Rule HR 1343/ S688: Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015 HR6: 21st Century Cures Act 340b Mega Guidance Rule from HRSA Common Rule on Human Subjects

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues pertaining to star-ratings for hospitals on the hospital compare website. H.R. 2124, S. 1148, Resident Physician Shortage Reduction Act of 2015, Issues pertaining to the training of residents. H.R. 4774, Training Tomorrow's Doctors Today Act, Issues pertaining to the training of residents. Issues pertaining to protecting funding for direct graduate medical education and indirect medical education. H.R. 5273, Helping Hospitals Improve Patient Care Act, Issues pertaining to hospital outpatient departments payments for off-campus departments. H.R. 1343, S. 688, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, Issues pertaining to adjustment for socioeconomic status in the hospital readmissions program. Issues relating to the proposed Medicare Part B Drug Model. Issues relating to the implementation of MACRA. Issues pertaining to the implementation of provisions regarding the treatment of off-campus hospital departments and site neutral payments. Issues pertaining to the protection of reimbursements for safety net hospitals.

Client expense: Not reported · Firm income: $70,000

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Natl Science Foundation (NSF), SENATE

S. 192, Older Americans Act Reauthorization Act - entire bill H.R. 731, the Justice and Mental Health Collaboration Act - entire bill S. 933, the Comprehensive Justice and Mental Health Act - entire bill H.R. 988, the Elder Justice ActReauthorization Act - entire bill S. 1169, the Juvenile Justice and Delinquency Prevention Reauthorization Act - entire bill H.R. 1343/S. 688, the Establishing Beneficiary Equity in the Hospital Readmission Program Act - entire bill S. 1513, the Second Chance Act Reauthorization Act - entire bill H.R. 1865/S. 1423, the Central Coast Heritage Protection Act - entire bill S. 1964, the Family Stability & Kinship Care Act - entire bill S. 1879, the Interior Improvement Act - entire bill S. 1893, the Mental Health Awareness and Improvement Act - entire bill S. 1945, the Mental Health Reform Act - entire bill H.R. 2197, the Youth PROMISE Act - entire bill S. 2533/H.R. 5247, the California Long-Term Provisions for Water Supply and Short-Term Provisions for Emergency Drought Relief Act - entire bill S. 2565, the Protecting Families Affected By Substance Abuse Act - entire bill S. 2577/ H.R. 4602, the Justice For All Act Reauthorization Act of 2016 - entire bill H.R. 2646, the Helping Families in Mental Crisis Act - entire bill H.R. 2952, the Improving Employment Outcomes of TANF Recipients Act, - entire bill H.R. 3025, the Wildfire Airspace Protection Act - entire bill H.R. 3153, the Saint Francis Dam Memorial and Castaic Wilderness Act - entire bill S. 3270, the Elder Abuse Prevention and Prosecution Act - entire bill H.R. 3700, the Housing Opportunity Through Modernization Act - entire bill H.R. 4201, the Restoring the Partnership for County Health Care Costs Act - entire bill H.R. 4441, the Aviation Innovation, Reform, and Reauthorization Act - Airport Improvement Program/ Contract Tower Program; drone interference with wild fire fighting H.R. 4676, the Preventing Crimes Against Veterans Act - entire bill H.R. 4472/S. 2574, Modernizing the Interstate Placement of Children in Foster Care Act - entire bill H.R. 4724, the Reducing Duplicative and Ineffective Federal Funding Act - entire bill H.R. 4725, the Common Sense Savings Act - entire bill H.R. 5244, the Saint Francis Dam Memorial Act - entire bill H.R. 5273, the Helping Hospitals Improve Patient Care Act - entire bill H.R. 5456/S. 3065, the Family First Prevention Services Act - entire bill H.R. 5046, the Comprehensive Opioid Abuse Reduction Act - entire bill H.R. 5244, the Saint Francis Dam Disaster National Memorial Act - entire bill H.R. 5467, the Rim of the Valley Corridor Preservation Act - entire bill H.R. 5963, the Supporting Youth Opportunity and Preventing Delinquency Act H.R. 5054/S. 5296, FY 2017 Agriculture Appropriations - Agricultural Pests, APHIS funding, WIC H.R. 5393/S. 2837, FY 2017 Commerce, Justice, State Appropriations - funding for local law enforcement activities, including youth delinquency prevention, local law enforcement technology needs, domestic abuse programs, drug treatment, SCAAP, and the Southwest Border Prosecution Initiative H.R. 5055/S. 2804/H.R. 2028, FY 2017 Energy and Water Appropriations -Funding for Army Corps of Engineers projects H.R. 5634/S. 3001, FY 2017 Homeland Security Appropriations - local homeland security and disaster preparedness activities, including public safety, public health, emergency management personnel, communications infrastructure, Assistance to Firefighters Grant program, and Emergency Management Performance Grants H.R. 5538/S. 3068, FY 2017 Interior Appropriations - funding for EPA Section 103 & 105 air grants; Payments in Lieu of Taxes S. 3040, FY 2017 Labor, Health and Human Services Appropriations - funding for CDC State & Local Capacity, Bioterrorism Hospital Program, MMRS, MCH, ADAP, TB Control, family planning, substance abuse block grants, preventative health, safety net grants, nutritional services for older Americans, LSTA, Funding for Community Services and Social Services Block Grants, oral health funding H.R. 5394/S. 2844, FY 2017 Transportation, HUD Appropriations bill - CDBG, HOME Investment Partnerships, Homeless assistance grants, HOPWA, Elderly Housing, Airport Improvement Program, Contract Tower Program Federally Qualified Health Centers Managed care under the Medicaid and CHIP programs Temporary Assistance to Needy Families (TANF) Reauthorization 340B Hospital Drug program

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

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

H.R. 211, the Reducing Environmental Barriers to Unified Infrastructure and Land Development (REBUILD) Act - entire bill S. 414, the California Desert Conservation and Recreation Act - entire bill S. 517, the Secure Rural Schools and Payment in Lieu of Taxes Act - entire bill H.R. 731, the Justice and Mental Health Collaboration Act - entire bill S. 933, the Comprehensive Justice and Mental Health Act - entire bill H.R. 988, the Elder Justice Act Reauthorization Act - entire bill S. 1169, the Juvenile Justice and Delinquency Prevention Reauthorization Act - entire bill H.R. 1211/S. 1588, the Mental Health in Schools Act - entire bill H.R. 1343/S. 688, the Establishing Beneficiary Equity in the Hospital Readmission Program Act - entire bill S. 1439/H.R. 3160, the Foster Youth Independence Act - entire bill S. 1513, the Second Chance Act Reauthorization Act - entire bill H.R. 1854/S. 993, the Comprehensive Justice and Mental Health Act - entire bill S. 1879, the Interior Improvement Act - entire bill S. 1893, the Mental Health Awareness and Improvement Act - entire bill S. 1945, the Mental Health Reform Act - entire bill H.R. 2197, the Youth PROMISE Act - entire bill S. 2533/H.R. 5247, the California Long-Term Provisions for Water Supply and Short-Term Provisions for Emergency Drought Relief Act - entire bill S. 2565, the Protecting Families Affected By Substance Abuse Act - entire bill S. 2577/H.R. 4602, the Justice For All Act Reauthorization Act of 2016 - entire bill H.R. 2646, the Helping Families in Mental Crisis Act - entire bill H.R. 2663, the Public Land Renewable Energy Development Act - entire bill H.R. 2952, the Improving Employment Outcomes of TANF Recipients Act - entire bill H.R. 3025, the Wildfire Airspace Protection Act - entire bill S. 3270, the Elder Abuse Prevention and Prosecution Act - entire bill H.R. 3700, the Housing Opportunity Through Modernization Act - entire bill H.R. 4076, the Treat Act - entire bill H.R. 4201, the Restoring the Partnership for County Health Care Costs Act - entire bill H.R. 4441, the Aviation Innovation, Reform, and Reauthorization Act - Airport Improvement Program; drone interference with wild fire fighting H.R. 4472/S. 2574, the Modernizing the Interstate Placement of Children in Foster Care Act - entire bill H.R. 4724, the Reducing Duplicative and Ineffective Federal Funding Act - entire bill H.R. 4725, the Common Sense Savings Act - entire bill H.R. 5046, the Comprehensive Opioid Abuse Reduction Act of 2016 - entire bill H.R. 5273, the Helping Hospitals Improve Patient Care Act - entire bill H.R. 5963, the Supporting Youth Opportunity and Preventing Deilnquency Act - entire bill H.R. 5456/S. 3065, the Family First Prevention Services Act - entire bill H.R. 5054/S. 5296, FY 2017 Agriculture Appropriations - Agricultural Pests, APHIS funding, WIC H.R. 5393/S. 2837, FY 2017 Commerce, Justice, State Appropriations - funding for local law enforcement activities, including youth delinquency prevention, local law enforcement technology needs, domestic abuse programs, drug treatment, SCAAP, and the Southwest Border Prosecution Initiative. H.R. 5055/S. 2804/H.R. 2028, FY 2017 Energy and Water Appropriations - funding for the Salton Sea H.R. 5634/S. 3001, FY 2017 Homeland Security Appropriations - local homeland security and disaster preparedness activities, including public safety, public health, emergency management personnel, communications infrastructure, Assistance to Firefighters Grant program, and Emergency Management Performance Grants H.R. 5538/S. 3068, FY 2017 Interior Appropriations - Section 6, Cooperative Endangered Species Conservation Fund, Payments in Lieu of Taxes S. 3040, FY 2017 Labor, Health and Human Services Appropriations - funding for CDC State & Local Capacity, Bioterrorism Hospital Program, MMRS, DMAT, MCH, Ryan White Title I, TB Control, family planning, substance abuse block grants, preventative health, nutrition services for older Americans, Federally Designated Health Professional Shortage Areas (HPSA), LSTA, Funding for Community Services and Social Services Block Grants H.R. 5394/S. 2844, FY 2017 Transportation, HUD Appropriations bill - CDBG, Section 8, HOME Investment Partnerships, homeless assistance, HOPWA, Elderly Housing, Airport Improvement Program funding. Base Closure and Realignment Commission (BRAC) EB-5 Visa Program reform Endangered Species Act/Habitat Conservation Intercept of Federal Tax Refunds for Delinquent Fines Older Americans Act reauthorization Salton Sea Restoration Project Temporary Assistance to Needy Families (TANF) Reauthorization Trans-Pacific Partnership - support for continued progress on negotiation and ratification by Congress 340B Hospital Drug program

Client expense: Not reported · Firm income: $45,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues pertaining to star-ratings for hospitals on the hospital compare website. H.R. 2124, S. 1148, Resident Physician Shortage Reduction Act of 2015, Issues pertaining to the training of residents. H.R. 4774, Training Tomorrow's Doctors Today Act, Issues pertaining to the training of residents. Issues pertaining to protecting funding for direct graduate medical education and indirect medical education. H.R. 5273, Helping Hospitals Improve Patient Care Act, Issues pertaining to hospital outpatient departments payments for off-campus departments. Issues pertaining to the 340B drug pricing program. H.R. 1343, S. 688, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, Issues pertaining to adjustment for socioeconomic status in the hospital re-admissions program. Issues related to the proposed Medicare Part B Drug Model. Issues related to the implementation of MACRA. Issues pertaining to the implementation of provisions regarding the treatment of off-campus hospital departments and site neutral payments. Issues pertaining to the protection of reimbursements for safety net hospitals.

Client expense: $160,000 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Natl Science Foundation (NSF), SENATE

Support HR 672 and S 607, Rural Community Hospital (RCH) Demonstration Extension Act of 2015, a bill that will extend the demonstration for five more years, will ensure that RCH continues to help Americas communities in many ways, especially by allowing hospitals to expand and improve the services rural communities need. Also enables hospitals with fewer than 51 beds to test the feasibility of cost-based reimbursement. Affects 23 small, rural hospitals nationwide. Demo included in MMA, extended and expanded in ACA and Budget neutral; Support HR 663 and S 332, Rural Hospital Access Act of 2015, a bill that would make permanent both the Medicare-dependent Hospital (MDH) program and the enhanced low-volume Medicare adjustment for prospective payment system (PPS) hospitals, which are vital programs for rural hospitals and the patients and communities they serve; Support S 257 and HR 1611, Protecting Access to Rural Therapy Services (PARTs)Act of 2015, a bill that would provide hospitals relief from the Centers for Medicare & Medicaid Services (CMS) regulations with respect to direct supervision of outpatient therapeutic services; Support HR 270,Flexibility in Health IT Reporting (Flex-IT) Act of 2015, a bill that requires the Centers for Medicare & Medicaid Services (CMS) to make a necessary adjustment to how it implements the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and to extend non-enforcement for the Medicare direct supervision requirement for therapeutic hospital outpatient services for CAHs and rural hospitals ; Meaningful use flexibility: advocating for a shorter meaningful use reporting period and other flexibilities that would increase hospitals ability to meet Stage 2 and move forward with the program,that Stage 3 not begin until no sooner than 2019 and that meaningful use requirements for hospitals and CAHs align with those for eligible clinicians in MACRA; Support S. 377 and HR 745, Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2015, a bill to amend title XVIII of the Social Security Act to increase access to ambulance services under the Medicare program and to reform payments for such services under such program; Support S. 688 and HR 1343, Establishing Beneficiary Equity in the Hospital Readmission Program Act of 2015, a bill to amend title XVIII of the Social Security Act to adjust the Medicare hospital readmission reduction program to respond to patient disparities; Support S 629 and H.R. 1784, Making the Education of Nurses Dependable for Schools Act, a bill to enable hospital-based nursing programs that are affiliated with a hospital to maintain payments under the Medicare program to hospitals for the costs of such programs; Urged limitations on Recovery Audit Contractors (RACs)that includes financial penalties for inaccurate audit decisions; Provide input to CMS on implementation of quality measures required under the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014; Analyze and develop suggested changes to the Personalize Your Care Act of 2015, a bill that would provide coverage of voluntary advance care planning consultation under Medicare and Medicaid; Oppose HR 2895, Medicare Patient Access to Cancer Treatment Act of 2015, a bill that would establish parity under the Medicare program for ambulatory cancer care services furnished in the hospital outpatient department and the physician office setting; Oppose HR 976 and HR 2513 Promoting Access, Competition, and Equity Act of 2015(PACE) Act of 2015, a bill to allow an increase in, and expansion of, physician-owned hospitals eligible for Medicare reimbursement; Support S 1148 and HR 2124Resident Physician Shortage Reduction Act of 2015, a bill to increase the number of Medicare-supported physician residency slots; Urged SFC Chronic Care Working Group to consider expanding access to telehealth, removing legal barriers to clinical integration, and better engaging beneficiaries in their health and health care;Testified at the Observation status, Improving competition in Medicare and Prompt payment hearings; Support HR 2156, Medicare Audit Improvement Act of 2015, a bill to amend title XVIII of the Social Security Act to reform the practices of recovery audit contractors under the Medicare program; Discuss S. 861, Preventing and Reducing Improper Medicare and Medicaid Expenditures Act of 2015 or the PRIME Act of 2015 with the Senate Finance Committee to reform the Medicare audits and appeals process; Support S. 2141 Transparent Ratings on Usability and Security to Transform Information Technology (TRUST IT) Act, a bill for improved transparency of information about certified EHRs; Advocate to improve interoperability of electronic health records; Letter to CMS urging use of existing authority to bring flexibility to the EHR Incentive Program and discussion about needed flexibility; Support H.R. 5164, Rural Hospital Regulatory Relief Act, a bill to extend the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals; Support S. 3129/H.R. 5613, legislation to extend through CY2016, the enforcement moratorium on CMS direct supervision policy for CAHs and small, rural hospitals.

Client expense: $4,050,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Federal Communications Commission (FCC), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office