Assault Weapons Ban of 2017

Various issues relating to the Arms Export Control Act; U.S.C Chapter 18; firearm technology; 27 CFR 555.11; firearm bans and sales; ammunition bans and restrictions; reporting requirements for the Securities and Exchange Commission concerning firearms manufacturers; proposed restrictions on firearms dealers; undetectable firearms; and related matters. H.R.1137, H.R.2033, H.R.2380, S.1541, H.R.3947, H.R.3962, S.1915, S.1916, H.R.3986, H.R.3999, H.R.4064, S.2095, H.R.4344, S.2150, H.R.4721, H.R.4765, H.R.5077, H.R.5087, H.R.5103, H.R.5106, H.R.5271, S.2627, H.R.5383, H.R.5410, H.R.5560, H.R.6109, H.R.6296, H.R.6297, S.3211, H.R.6624, H.R.6643, S.3300, S.3304, H.R.6649, H.R.6654, H.R. 7016, H.R. 7027, H.R. 7115

Client expense: $810,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Bureau of Alcohol Tobacco Firearms & Explosives, Bureau of Land Management (BLM), Defense, Dept of (DOD), Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, Interior, Dept of (DOI), Natl Park Service (NPS), SENATE, State, Dept of (DOS), U.S. Fish & Wildlife Service (USFWS), U.S. Forest Service

Preserve Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes. Improve Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Veterans Care: Regarding the VA Mission Act of 2018 (H.R. 5674), the College urged Congress to ensure that veterans have access to timely, contiguous care across the spectrum of health care services, with coordination and management of that care in the hands of a primary clinician or clinical care team; that the expansion of care to non-VHA facilities does not come at the cost of maintaining or improving existing VHA services or infrastructure; and that recruitment and retention of clinicians to the VHA is valued appropriately, including reimbursement for services provided; Advocated with Congress on the need for adequate funding for the VHA for FY2019 and the long-term. Expand Coverage and Stabilizing the Insurance Market: Congress should work to help stabilize the individual health insurance market and expand coverage. Specifically by develop and introduce comprehensive market stabilization legislation that includes reinsurance options to help stabilize the markets; Expanding cost-sharing assistance eligibility to purchase insurance in the exchanges as well as increase the level of premium tax credits and cost sharing subsidies offered to purchase a qualified health plan; Introducing legislation that would block the expansion of access to short-term health plans or Association Health Plans that allow insurers to charge more to individuals with pre-existing conditions and permit them to exclude from coverage essential medical care; Supporting $690 million in discretionary funding for federal exchanges within CMS Program Operations as part of the FY2019 Labor, Health and Human Services, and Education Appropriations bill. Reduce Unnecessary Administrative Tasks on Physicians and Patients: Congress should accelerate its efforts to reduce administrative burdens on clinicians and patients, including: Passing the Standardizing Electronic Prior Authorization for Safe Prescribing Act (H.R. 4841), which standardizes electronic prior authorization for prescription drugs under Medicare Part D. Adopt even greater harmonization of such standards across the health care industry; Passing the CONNECTIONS Act (H.R. 5812) by Reps. Griffith (R-VA) and Pallone (D-NJ) that would authorize CDC grants to state-run PDMPs to improve data collection and integration into physician clinical workflow specifically, of controlled substances overdose prevention and surveillance activities; Urging health care committees in Congress with jurisdiction over Medicare to exercise their oversight authority of CMS effort to overhaul clinical documentation guidelines with input from practicing clinicians; Passing the Improving Access to Medicare Coverage Act of 2017 (S. 568/H.R. 1421), which deems patients under observation as inpatients for the purposes of satisfying the Medicare 3-day inpatient stay requirement. Health Information Technology (HIT): The College provided feedback on the Centers for Disease Control and Prevention (CDC) Request for Information (RFI) Regarding a National Test Collaborative (NTC), which sought approaches for developing a NTC that would allow for the field testing of health information technology (HIT) in a live clinical setting; expressed concern that building an entirely new testing network will be prohibitively difficult and execution could go wrong unless it is carefully designed, piloted, and tested. Emailing and conference calling with every level of every organization is labor intensive and getting participants engaged in this process will be an enormous effort; urged the need to address the patient privacy issues associated with production settings. These privacy issues may cause concern amongst hospitals and may prevent them from wanting to participate unless addressed; recommended that CDC consider building a CDC-Vendor-End User communication methodology that may be a more manageable undertaking utilizing existing infrastructures. Such a system could allow for CDC to notify EHR vendors who would notify product users when they receive an alert or guidance from CDC, using a process similar to how software updates are released. This approach does not require the sharing of protected health information nor does it require direct access into the production system. Reduce Prescription Drug Costs: Congress should increase transparency and accountability in prescription drug pricing and improve access to lower-cost generic medications by passing the Drug Price Transparency in Communications Act (S. 2157), which would require drug companies to disclose the Wholesale Acquisition Cost of an Rx in Direct-to-Consumer Advertising. Representatives should introduce the companion bill; Passing the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2017 (S. 974/H.R. 2212), which would improve patient access to alternative low-cost prescription drugs and biological products by preventing prescription drug manufacturers from misusing the FDAs Risk Evaluation and Mitigation Strategies (REMS) process to make it difficult for competing generics to be brought to the market; Passing the Medicare Prescription Drug Price Negotiation Act of 2017 (S. 41/H.R. 242), which would grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for high�cost drugs and biologics covered under Part D; Passing the Fair Accountability and Innovative Research (FAIR) Pricing Act (S. 1131/H.R. 2439), which would require drug manufacturers to disclose and provide more information about planned drug price increases, including R&D costs. Fund Workforce, Medical and Health Services Research, Public Health Initiatives: Congress should ensure funding in FY 2019 for federal programs/initiatives designed to support primary care and reject funding rescissions that would harm childrens health coverage or CMS Innovation Center. This includes funding the Primary Care and Training Enhancement (PCTE) at $71 million in order to maintain and expand the pipeline for individuals training in primary care; Funding the National Health Service Corps (NHSC) at least at $415 million in total program funding to fund scholarships and loan repayment to health care professionals to help expand the countrys primary care workforce and meet the health care needs of underserved communities; Funding the Centers for Disease Control and Prevention (CDC) and Prevention and Public Health Fund (PPHF) at $8.45 billion; including PPHF funding at $805 million; Funding the Agency for Healthcare Research and Quality (AHRQ) at $454 million, restoring the agency to its FY2010 enacted level adjusting for inflation after cuts in FY2016 and FY2017 and a small increase in FY2018 so it can help clinicians help patients by making evidence-informed decisions, fund research that serves as the evidence engine for much of the private sectors work to keep patients safe; Funding the National Institutes of Health (NIH) at $39 billion so that this nations biomedical research can continue to fund cures for disease and maintain the U.S. standing as the world leader in medical and biomedical research. Promote Continued Action to Address the Epidemic of Opioid Use: Congress should pass a comprehensive legislative package to improve prevention, education, treatment and recovery for those suffering from opioid-related addictions, including: Providing for sufficient and increased funding to address the opioid epidemic, building and expanding upon the $4.65 billion in the omnibus bill approved by Congress, with at least $1 billion for programs as authorized by CARA 2.0; Expanding access and coverage for medication assisted treatment (methadone, buprenorphine, and naltrexone to prevent opioid and substance use disorders; Rejecting any proposal to impose a three day prescribing limit for initial opioid prescriptions to ensure that doctors have appropriate flexibility to determine the proper duration of each opioid prescription; Passing the Comprehensive Addiction and Recovery Act 2.0 of 2018 (S. 2456/H.R. 5311) as a step toward a more comprehensive opioids-related package. Reduce Firearms-Related Injury and Death: Congress should pass the Assault Weapons Ban of 2018 (S. 2095/H.R. 5077), which would ban the sale of high velocity, rapid file assault rifles and large capacity ammunition magazines and bump stocks; Pass the Brady Background Expansion Act (S. 2009), to expand background checks to virtually all firearm sales in the United States; Pass the Stop Illegal Trafficking in Firearms Act of 2017 (S. 1185), and the Stop Straw Purchases Act (H.R. 5134). Both would increase penalties for individuals who unlawfully purchase firearms for other persons who are prohibited from possessing firearms (known as straw purchasers); Support $50 million in funding for the CDC to conduct such research; Pass S. 834/H.R. 1832 that authorizes funding for the CDC to conduct such research. Make Graduate Medical Education (GME) Funding More Effective: Congress should develop and pass legislation to reform GME to prioritize funding toward physician specialties where millions of patients lack access, including internal medicine specialists trained in comprehensive primary care, to: Increase the number of GME slots by at least 3,000 per year over five years for specialties facing shortages, including internal medicine, as contained in the Resident Physician Shortage Reduction Act of 2017 (S. 1301/H.R. 2267); Combine DGME/IME into a single, more functional program; broaden the GME financing structure to include all payers; Allocate GME funds transparently and to activities that further the educational mission of teaching and training residents/fellows with input from practicing clinicians and in collaboration with their professional organizations; Support continued adequate funding for the VHA and its substantial contributions to the ongoing training of the next generation of physicians. 2019 Physician Fee Schedule (PFS) and Quality Payment Program (QPP): Commented on CMS final rule on the 2019 PFS and QPP including - Urged additional refinements are needed to the final E/M documentation and payment policies to provide for immediate documentation relief, ensure the needs of complex patients are appropriately addressed, and avert negative downstream consequences; supports separate payment for technology-based communication services but urges the Agency to reconsider patient cost sharing and burdensome consent polices which may prevent uptake of these critical services; appreciates the burden relief that will result from allowing physicians to delegate Appropriate Use Criteria (AUC) consultations to appropriate clinical staff, but reiterates need to reimburse clinicians for the additional time required to conduct these consultations and pilot testing AUC in limited clinical priority areas before deploying on a larger scale to prevent widespread payment disruptions. With regard to QPP, urged greater simplifying of MIPS scoring by basing point values for individual measures on their relative value to the total MIPS score, taking every opportunity to award cross category credit, and instituting a consistent minimum 90-day reporting period across all categories; develop more Advanced APMs, particularly for small and specialty practices; opposes the use of cost measures that are deemed unreliable or inaccurate and urges CMS not to increase the weight of the Cost Category until every measure meets rigorous reliability and accuracy standards; reduce overall number of quality measures and use only those deemed valid, relevant, and reliable, such as those recommended by ACPs Performance Measurement Committee. Public Charge: The College provided comments on the Department of Homeland Securitys Notice of Proposed Rulemaking: Inadmissibility on Public Charge Grounds (DHS Docket No. USCIS-2010-0012). ACP oppose the DHS proposed rule on public charge because if finalized it would put the health of millions of children and families at risk. The proposed changes would expand the number of programs that the federal government would consider in public charge determinations to include Medicaid, the Medicare Part D Low-Income Subsidy Program, the Supplemental Nutrition Assistance Program, and potentially the Childrens Health Insurance Program (CHIP), among others. By widening public charge determinations in this way, the proposed rule would make it much more likely that lawfully present immigrants and those seeking to lawfully immigrate to the U.S. could be denied lawful permanent resident status, be denied visas, or even be deported, merely on the basis of seeking essential health, nutrition, and housing services for themselves or their families. The proposed rule would undermine the physician-patient relationship and disrupt care continuity, and it is antithetical to the Colleges mission to ensure meaningful access to health care for our patients. Immigrant Children and Pregnant Women in U.S. Custody: The College commented to the U.S. Department of Homeland Security that conditions in the U.S. Customs and Border Protection (CBP) custody are inconsistent with evidence-based recommendations for appropriate care and treatment of children and pregnant women. As such, they are not appropriate for children or pregnant women. ACP calls for a full, transparent, and public investigation of Jakelin Caal Maquins (from Guatemala) death and the circumstances surrounding it, as well as any other deaths that may have occurred in CBP or Immigration and Customs Enforcement custody. The College strongly urges the Department of Homeland Security (DHS) to implement specific meaningful steps to ensure that all children and pregnant women in CBP custody receive appropriate medical and mental health screening and necessary follow-up care by trained providers.

Preserve Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes. Improve Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Veterans Care: Regarding the VA Mission Act of 2018 (H.R. 5674), the College urged Congress to ensure that veterans have access to timely, contiguous care across the spectrum of health care services, with coordination and management of that care in the hands of a primary clinician or clinical care team; that the expansion of care to non-VHA facilities does not come at the cost of maintaining or improving existing VHA services or infrastructure; and that recruitment and retention of clinicians to the VHA is valued appropriately, including reimbursement for services provided; Advocated with Congress on the need for adequate funding for the VHA for FY2019 and the long-term. Expand Coverage and Stabilizing the Insurance Market: Congress should work to help stabilize the individual health insurance market and expand coverage. Specifically by develop and introduce comprehensive market stabilization legislation that includes reinsurance options to help stabilize the markets; Expanding cost-sharing assistance eligibility to purchase insurance in the exchanges as well as increase the level of premium tax credits and cost sharing subsidies offered to purchase a qualified health plan; Introducing legislation that would block the expansion of access to short-term health plans or Association Health Plans that allow insurers to charge more to individuals with pre-existing conditions and permit them to exclude from coverage essential medical care; Supporting $690 million in discretionary funding for federal exchanges within CMS Program Operations as part of the FY2019 Labor, Health and Human Services, and Education Appropriations bill. Reduce Unnecessary Administrative Tasks on Physicians and Patients: Congress should accelerate its efforts to reduce administrative burdens on clinicians and patients, including: Passing the Standardizing Electronic Prior Authorization for Safe Prescribing Act (H.R. 4841), which standardizes electronic prior authorization for prescription drugs under Medicare Part D. Adopt even greater harmonization of such standards across the health care industry; Passing the CONNECTIONS Act (H.R. 5812) by Reps. Griffith (R-VA) and Pallone (D-NJ) that would authorize CDC grants to state-run PDMPs to improve data collection and integration into physician clinical workflow specifically, of controlled substances overdose prevention and surveillance activities; Urging health care committees in Congress with jurisdiction over Medicare to exercise their oversight authority of CMS effort to overhaul clinical documentation guidelines with input from practicing clinicians; Passing the Improving Access to Medicare Coverage Act of 2017 (S. 568/H.R. 1421), which deems patients under observation as inpatients for the purposes of satisfying the Medicare 3-day inpatient stay requirement. Health Information Technology (HIT): The College provided feedback on the Centers for Disease Control and Prevention (CDC) Request for Information (RFI) Regarding a National Test Collaborative (NTC), which sought approaches for developing a NTC that would allow for the field testing of health information technology (HIT) in a live clinical setting; expressed concern that building an entirely new testing network will be prohibitively difficult and execution could go wrong unless it is carefully designed, piloted, and tested. Emailing and conference calling with every level of every organization is labor intensive and getting participants engaged in this process will be an enormous effort; urged the need to address the patient privacy issues associated with production settings. These privacy issues may cause concern amongst hospitals and may prevent them from wanting to participate unless addressed; recommended that CDC consider building a CDC-Vendor-End User communication methodology that may be a more manageable undertaking utilizing existing infrastructures. Such a system could allow for CDC to notify EHR vendors who would notify product users when they receive an alert or guidance from CDC, using a process similar to how software updates are released. This approach does not require the sharing of protected health information nor does it require direct access into the production system. Reduce Prescription Drug Costs: Congress should increase transparency and accountability in prescription drug pricing and improve access to lower-cost generic medications by passing the Drug Price Transparency in Communications Act (S. 2157), which would require drug companies to disclose the Wholesale Acquisition Cost of an Rx in Direct-to-Consumer Advertising. Representatives should introduce the companion bill; Passing the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2017 (S. 974/H.R. 2212), which would improve patient access to alternative low-cost prescription drugs and biological products by preventing prescription drug manufacturers from misusing the FDAs Risk Evaluation and Mitigation Strategies (REMS) process to make it difficult for competing generics to be brought to the market; Passing the Medicare Prescription Drug Price Negotiation Act of 2017 (S. 41/H.R. 242), which would grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for high�cost drugs and biologics covered under Part D; Passing the Fair Accountability and Innovative Research (FAIR) Pricing Act (S. 1131/H.R. 2439), which would require drug manufacturers to disclose and provide more information about planned drug price increases, including R&D costs. Fund Workforce, Medical and Health Services Research, Public Health Initiatives: Congress should ensure funding in FY 2019 for federal programs/initiatives designed to support primary care and reject funding rescissions that would harm childrens health coverage or CMS Innovation Center. This includes funding the Primary Care and Training Enhancement (PCTE) at $71 million in order to maintain and expand the pipeline for individuals training in primary care; Funding the National Health Service Corps (NHSC) at least at $415 million in total program funding to fund scholarships and loan repayment to health care professionals to help expand the countrys primary care workforce and meet the health care needs of underserved communities; Funding the Centers for Disease Control and Prevention (CDC) and Prevention and Public Health Fund (PPHF) at $8.45 billion; including PPHF funding at $805 million; Funding the Agency for Healthcare Research and Quality (AHRQ) at $454 million, restoring the agency to its FY2010 enacted level adjusting for inflation after cuts in FY2016 and FY2017 and a small increase in FY2018 so it can help clinicians help patients by making evidence-informed decisions, fund research that serves as the evidence engine for much of the private sectors work to keep patients safe; Funding the National Institutes of Health (NIH) at $39 billion so that this nations biomedical research can continue to fund cures for disease and maintain the U.S. standing as the world leader in medical and biomedical research. Promote Continued Action to Address the Epidemic of Opioid Use: Congress should pass a comprehensive legislative package to improve prevention, education, treatment and recovery for those suffering from opioid-related addictions, including: Providing for sufficient and increased funding to address the opioid epidemic, building and expanding upon the $4.65 billion in the omnibus bill approved by Congress, with at least $1 billion for programs as authorized by CARA 2.0; Expanding access and coverage for medication assisted treatment (methadone, buprenorphine, and naltrexone to prevent opioid and substance use disorders; Rejecting any proposal to impose a three day prescribing limit for initial opioid prescriptions to ensure that doctors have appropriate flexibility to determine the proper duration of each opioid prescription; Passing the Comprehensive Addiction and Recovery Act 2.0 of 2018 (S. 2456/H.R. 5311) as a step toward a more comprehensive opioids-related package. Reduce Firearms-Related Injury and Death: Congress should pass the Assault Weapons Ban of 2018 (S. 2095/H.R. 5077), which would ban the sale of high velocity, rapid file assault rifles and large capacity ammunition magazines and bump stocks; Pass the Brady Background Expansion Act (S. 2009), to expand background checks to virtually all firearm sales in the United States; Pass the Stop Illegal Trafficking in Firearms Act of 2017 (S. 1185), and the Stop Straw Purchases Act (H.R. 5134). Both would increase penalties for individuals who unlawfully purchase firearms for other persons who are prohibited from possessing firearms (known as straw purchasers); Support $50 million in funding for the CDC to conduct such research; Pass S. 834/H.R. 1832 that authorizes funding for the CDC to conduct such research. Make Graduate Medical Education (GME) Funding More Effective: Congress should develop and pass legislation to reform GME to prioritize funding toward physician specialties where millions of patients lack access, including internal medicine specialists trained in comprehensive primary care, to: Increase the number of GME slots by at least 3,000 per year over five years for specialties facing shortages, including internal medicine, as contained in the Resident Physician Shortage Reduction Act of 2017 (S. 1301/H.R. 2267); Combine DGME/IME into a single, more functional program; broaden the GME financing structure to include all payers; Allocate GME funds transparently and to activities that further the educational mission of teaching and training residents/fellows with input from practicing clinicians and in collaboration with their professional organizations; Support continued adequate funding for the VHA and its substantial contributions to the ongoing training of the next generation of physicians. 2019 Physician Fee Schedule (PFS) and Quality Payment Program (QPP): Commented on CMS final rule on the 2019 PFS and QPP including - Urged additional refinements are needed to the final E/M documentation and payment policies to provide for immediate documentation relief, ensure the needs of complex patients are appropriately addressed, and avert negative downstream consequences; supports separate payment for technology-based communication services but urges the Agency to reconsider patient cost sharing and burdensome consent polices which may prevent uptake of these critical services; appreciates the burden relief that will result from allowing physicians to delegate Appropriate Use Criteria (AUC) consultations to appropriate clinical staff, but reiterates need to reimburse clinicians for the additional time required to conduct these consultations and pilot testing AUC in limited clinical priority areas before deploying on a larger scale to prevent widespread payment disruptions. With regard to QPP, urged greater simplifying of MIPS scoring by basing point values for individual measures on their relative value to the total MIPS score, taking every opportunity to award cross category credit, and instituting a consistent minimum 90-day reporting period across all categories; develop more Advanced APMs, particularly for small and specialty practices; opposes the use of cost measures that are deemed unreliable or inaccurate and urges CMS not to increase the weight of the Cost Category until every measure meets rigorous reliability and accuracy standards; reduce overall number of quality measures and use only those deemed valid, relevant, and reliable, such as those recommended by ACPs Performance Measurement Committee. Public Charge: The College provided comments on the Department of Homeland Securitys Notice of Proposed Rulemaking: Inadmissibility on Public Charge Grounds (DHS Docket No. USCIS-2010-0012). ACP oppose the DHS proposed rule on public charge because if finalized it would put the health of millions of children and families at risk. The proposed changes would expand the number of programs that the federal government would consider in public charge determinations to include Medicaid, the Medicare Part D Low-Income Subsidy Program, the Supplemental Nutrition Assistance Program, and potentially the Childrens Health Insurance Program (CHIP), among others. By widening public charge determinations in this way, the proposed rule would make it much more likely that lawfully present immigrants and those seeking to lawfully immigrate to the U.S. could be denied lawful permanent resident status, be denied visas, or even be deported, merely on the basis of seeking essential health, nutrition, and housing services for themselves or their families. The proposed rule would undermine the physician-patient relationship and disrupt care continuity, and it is antithetical to the Colleges mission to ensure meaningful access to health care for our patients. Immigrant Children and Pregnant Women in U.S. Custody: The College commented to the U.S. Department of Homeland Security that conditions in the U.S. Customs and Border Protection (CBP) custody are inconsistent with evidence-based recommendations for appropriate care and treatment of children and pregnant women. As such, they are not appropriate for children or pregnant women. ACP calls for a full, transparent, and public investigation of Jakelin Caal Maquins (from Guatemala) death and the circumstances surrounding it, as well as any other deaths that may have occurred in CBP or Immigration and Customs Enforcement custody. The College strongly urges the Department of Homeland Security (DHS) to implement specific meaningful steps to ensure that all children and pregnant women in CBP custody receive appropriate medical and mental health screening and necessary follow-up care by trained providers.

SUPPORT S. 2009 - Background Check Expansion Act S. 1916 - Automatic Gunfire Prevention Act H.R. 4240 - Public Safety and Second Amendment rights Protection Act of 2017 S. 1992/H.R. 3361 - SECURE Firearm Storage Act H.R. 3947 - Automatic Gunfire Prevention Act H.R. 3984 - Equal Access to Justice for Victims of Gun Violence Act S 1939 - Equal Access to Justice for Victims of Gun Violence Act S. 834/H.R. 1832 - CDC gun research bills H.R. 1478 - Gun Violence Research Act H.R. 3207 - Zero Tolerance for Domestic Abuse Act S. 1539 - Protecting Domestic Violence and Stalking Victims Act of 2017 S. 1923/H.R. 3464 - Background Check Completion Act of 2017 S. 1945 & H.R. 4052 Keep Americans Safe Act S. 2095 Assault weapons Ban of 2017 H.R. 5087 Assault weapons Ban of 2018 S. 2521 Federal Extreme Risk Protection Order Act of 2018 S. 1212 Gun Violence Prevention Order Act of 2017 H.R. 2598 Gun Violence Restraining Order Act of 2017 H.R. 4471/S. 2492 NICS Denial Notification Act S. 2546 Make America Safe & Secure Act H.R. 6075 Keeping Gun Dealers Honest Act S.1324/H.R. 2841 Disarm Hate Act H.Con.Res.66 Expressing support for the designation of June 21 as National ASK (Asking Saves Kids) Day to promote childrens health and gun safety H.R. 1278 Ghost Guns Are Guns Act S. 3300/H.R. 6643 Untraceable Firearms Act of 2018 S. 2129 Military Domestic Violence Reporting Enhancement Act Provisions of H.R. 2810 and H.R. 5515 John S. McCain National Defense Authorization Act for FY2019 H.R. 6649 3D Printed Gun Safety Act of 2018 S. 3304 3D Printed Gun Safety Act of 2018 AGAINST H.R. 3668 Sportsmens Heritage and Recreational Enhancement (SHARE) Act H.R. 367/S. 59 Hearing Protection Act of 2017 H.R. 1181 Veterans 2nd Amendment Rights Protection Act S. 446/H.R. 38 Concealed Carry Reciprocity Act of 2017 H.R. 1976/S.1397 Protecting the Second Amendment Act

H.R. 34: Safe Students Act H.R. 38: Concealed Carry Reciprocity Act of 2017 H.R. 57: Accidental Firearms Transfers Reporting Act of 2017 H.R. 62: Gun Violence Reduction Resources Act of 2017 H.R. 163: Gun Manufacturers Accountability Act H.R. 256: Protect Our Military Families' 2nd Amendment Rights Act H.R. 358: To amend chapter 44 of title 18, United States Code, to more comprehensively address the interstate transportation of firearms or ammunition H.R. 367: Hearing Protection Act of 2017 S. 59: Hearing Protection Act of 2017 S. 80: A bill to protect the right of individuals to bear arms at water resources development projects H.R. 445: Buyback Our Safety Act H.R. 509: ATF Elimination Act S. 159: Firearms Manufacturers and Dealers Protection Act of 2017 S. 162: Second Amendment Enforcement Act of 2017 H.R. 613: Lieutenant Osvaldo Albarati Correctional Officer Self-Protection Act of 2017 H.R. 629: Veterans 2nd Amendment Protection Act S. 202: Social Security Beneficiary 2nd Amendment Rights Protection Act H.J.Res. 40: Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Social Security Administration relating to Implementation of the NICS Improvement Amendments Act of 2007 H.R. 810: Hadiya Pendleton and Nyasia Pryear-Yard Stop Illegal Trafficking in Firearms Act of 2017 H. Res. 90: Expressing the sense of the House of Representatives that gun violence is a public health issue and Congress should enact by the end of the 115th Congress comprehensive Federal legislation that protects the Second Amendment and keeps communities safe and healthy, including expanding enforceable background checks for all commercial gun sales, improving the mental health system in the United States, and making gun trafficking and straw purchasing a Federal crime H.R. 1045: Recreational Lands Self-Defense Act of 2017 H.R. 1047: Fairness in Firearm Testing Act H.R. 1079: Campus Gun Policy Transparency Act S. 394: Protect Our Military Families' 2nd Amendment Rights Act H.R. 1137: Collectible Firearms Protection Act H.R. 1181: Veterans 2nd Amendment Protection Act S. 446: Constitutional Concealed Carry Reciprocity Act of 2017 H.R. 1278: Ghost Guns Are Guns Act S. 533: Undetectable Firearms Modernization Act of 2017 H.R. 1475: Gun Trafficking Prevention Act of 2017 H.R. 1478: Gun Violence Research Act S. 618: Lawful Interstate Transportation of Firearms Act H.R. 1537: Second Amendment Enforcement Act of 2017 H.R. 1612: Gun Show Loophole Closing Act of 2017 H.R. 1692: Countering Illegal Firearms Trafficking to Mexico Act H.R. 1708: Firearm Risk Protection Act of 2017 S. 733: Sportsmen's Act H.R. 1832: To authorize the appropriation of funds to the Centers for Disease Control and Prevention for conducting or supporting research on firearms safety or gun violence prevention S. 834: A bill to authorize the appropriation of funds to the Centers for Disease Control and Prevention for conducting or supporting research on firearms safety or gun violence prevention H.R. 1976: Protecting the Second Amendment Act H.R. 1982: Mental Health Access and Gun Violence Prevention Act of 2017 H.R. 2033: Undetectable Firearms Modernization Act H.R. 2097: ATF Wrongful Reclassification Act H.R. 2098: Second Amendment Defense Act of 2017 H.R. 2380: Handgun Trigger Safety Act of 2017 S. 1084: Lieutenant Osvaldo Albarati Correctional Officer Self-Protection Act of 2017 S. 1185: Stop Illegal Trafficking in Firearms Act of 2017 H.R. 2598: Gun Violence Restraining Order Act of 2017 H.R. 2620: Lawful Purpose and Self Defense Act S. 1212: Gun Violence Prevention Order Act of 2017 S. 1214: Hunting, Fishing, and Recreational Shooting Protection Act H.R. 2670: Protecting Domestic Violence and Stalking Victims Act H.Res. 361: Supporting the goals and ideals of "National Gun Violence Awareness Day" and "National Gun Violence Awareness Month" H.Res. 367: Establishing the Select Committee on Gun Violence Prevention S. Res. 179: A resolution expressing support for the designation of June 2, 2017, as "National Gun Violence Awareness Day" and June 2017 as "National Gun Violence Awareness Month" H.Res. 373: Expressing support for the designation of June 2017 as "National Gun Violence Awareness Month" and calling on Congress to address gun violence H.R. 2784: Good Neighbor Gun Dealer Act H.R. 2810: National Defense Authorization Act for Fiscal Year 2018 H.R. 2841: Disarm Hate Act S. 1324: Disarm Hate Act H.R. 2909: DC Personal Protection Reciprocity Act H.R. 2940: Congressional Self-Defense Act H.R. 2945: Congressional Personal Safety Act H.R. 2951: To allow Members of Congress to carry a concealed handgun anywhere in the United States, with exceptions H.R. 2980: Protecting Gun Owners in Bankruptcy Act of 2017 S. 1387: Protecting the Second Amendment Act H.R. 3054: Veterans' Heritage Firearms Act of 2017 S. 1435: Veterans' Heritage Firearms Act of 2017 H.R. 3139: Hearing Protection Act of 2017 S. 1505: SHUSH Act S. 1541: A bill to modify the definition of an antique firearm. H.R. 3361: SECURE Firearm Storage Act H.R. 3458: MICRO Act H.R. 3464: Background Check Completion Act of 2017 H.R. 3576: SAGA Act H.R. 3613: Safer Neighborhoods Gun Buyback Act of 2017 H.R. 3668: SHARE Act H. Amdt. 378: Description: Amendment sought to reduce the funding level for the Bureau of Alcohol, Tobacco, Firearms and Explosives by five percent H. Amdt. 386: At the end of division C (before the short title), insert the following: Sec. XXXX. None of the funds made available by this Act to the Bureau of Alcohol, Tobacco, Firearms and Explosives H.R. 3790: Federal Firearms Licensee Protection Act S. 1854: Federal Firearms Licensee Protection Act of 2017 H.R. 3947: Automatic Gunfire Prevention Act H.R. 3962: Stop Online Ammunition Sales Act of 2017 S. 1915: Handgun Trigger Safety Act of 2017 S. 1916: Automatic Gunfire Prevention Act S. 1917: Sentencing Reform and Corrections Act of 2017 H.R. 3984: Equal Access to Justice for Victims of Gun Violence Act H.R. 3986: Stopping the Iron Pipeline Act of 2017 H.R. 3987: Protecting Americans from Gun Violence Act of 2017 S. 1923: Background Check Completion Act of 2017 S. 1939: Equal Access to Justice for Victims of Gun Violence Act S. 1945: Keep Americans Safe Act H.R. 3998: Protect America Act of 2017 H.R. 3999: To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes H.R. 4018: To provide for a 3-day waiting period before a person may receive a handgun, with exceptions H.R. 4025: Multiple Firearm Sales Reporting Modernization Act of 2017 H.R. 4052: Keep Americans Safe Act H.R. 4057: Denying Firearms and Explosives to Dangerous Terrorists Act of 2017 S. 1992: SECURE Firearm Storage Act S. 2009: Background Check Expansion Act H.R. 4142: Safer Communities Act of 2017 H.R. 4168: Closing the Bump-Stock Loophole Act H.R. 4183: Domestic Violence Records Reporting Improvement Act of 2017 H.R. 4192: Domestic Violence Gun Homicide Prevention Act of 2017 S. 2045: Domestic Violence Gun Homicide Prevention Act of 2017 H.R. 4240: Public Safety and Second Amendment Rights Protection Act of 2017 H.R. 4268: Gun Safety: Not Sorry Act of 2017 S. 2094: Domestic Violence Loophole Closure Act S. 2095: Assault Weapons Ban of 2017 H.R. 4342: Fire Sale Loophole Closing Act H.R. 4343: Unlawful Gun Buyer Alert Act H.R. 4344: End Purchase of Firearms by Dangerous Individuals Act of 2017 S. 2135: Fix NICS Act of 2017 H.R. 4434: Fix NICS Act of 2017 S. 2150: Imitation Firearms Safety Act of 2017 S. 2161: Hadiya Pendleton and Nyasia Pryear-Yard Gun Trafficking and Crime Prevention Act of 2017 H.R. 4471: NICS Denial Notification Act of 2017 H.R. 4477: Fix NICS Act of 2017 H. Res. 645: Providing for consideration of the bill (H.R. 38) to amend title 18, United States Code, to provide a means by which nonresidents of a State whose residents may carry concealed firearms may also do so in the State H.R. 4573: Gun Violence Research Act of 2017 H.R. 4721: Armor-Piercing Bullets Act of 2017 H.R. 4909: STOP School Violence Act of 2018 S. 2386: Veterans' Second Amendment Rights Restoration Act of 2018 H.R. 5077: Assault Weapons Ban of 2018 H.R. 5087: Assault Weapons Ban of 2018 H.R. 5090: Raise the Age Act H.R. 5103: Gun Violence Prevention and Safe Communities Act of 2018 H.R. 5106: Investor Choice Against Gun Proliferation Act H.R. 5112: SAFER Voter Act S. 2458: Terrorist Firearms Prevention Act S. 2470: Age 21 Act S. 2475: BUMP Act H.R. 5134: STOP Straw Purchases Act S. 2486: Safe Students Act H.R. 5161: To require the Surgeon General of the Public Health Service to submit to Congress an annual report on the effects of gun violence on public health. H.R. 5162: Firearm Safety Act of 2018 H.R. 5163: Keeping Guns from High-Risk Individuals Act S. 2492: NICS Denial Notification Act of 2018 S. 2495: STOP School Violence Act of 2018 S. 2502: Protecting Communities and Preserving the Second Amendment Act of 2018 H.R. 5225: Strengthening the National Instant Criminal Background Check System Act of 2018 S. 2521: Federal Extreme Risk Protection Order Act of 2018 H.R. 5271: Tiahrt Restrictions Repeal Act H.R. 5286: Mass Violence Prevention Reform Act S. 2546: MASS Act H.R. 5380: Securing Our Children Act of 2018 H.R. 5383: Ammunition Background Check Act of 2018 H.R. 5398: 21 to Buy Act S. 2607: Extreme Risk Protection Order and Violence Prevention Act of 2018 S. 2627: Ammunition Background Check Act of 2018 H.R. 5410: SAFER Now Act H.R. 5461: NICS Review Act of 2018 H.R. 5490: Handgun Purchaser Licensing Act S. 2662: Handgun Purchaser Licensing Act H.R. 5560: Defective Firearms Protection Act H.R. 5607: Handgun Licensing and Registration Act of 2018 H.R. 5720: Armed Prohibited Persons Act of 2018 H.R. 5652: State Access to Firearms Evading Revocation Act H.R. 5657: Gladys Ricart Gun Offender Registry Act H.R. 5682: FIRST STEP Act S. 2795: FIRST STEP Act H.R. 5941: Child Gun Access Prevention Act H.Res. 913: Expressing support for the goals and ideals of June 1 through June 3, 2018 as "National Gun Violence Awareness Weekend" and June 2018 as "National Gun Violence Awareness Month" S. 2974: Crime Gun Tracing Modernization Act S. Res. 524: A resolution expressing support for the designation of June 1 through June 3, 2018 as "National Gun Violence Awareness Weekend" and June 2018 as "National Gun Violence Awareness Month" H.Res. 920: Expressing support for the designation of June as National Gun Violence Awareness Month, and calling on Congress to address gun violence H.R. 6024: Blair Holt Firearm Owner Licensing and Record of Sale Act of 2018 S. 3002: Blair Holt Firearm Owner Licensing and Record of Sale Act of 2018 H.R. 6075: Keeping Gun Dealers Honest Act of 2018 S. 3135: Gun Owner Registration Information Protection Act H.R. 6278: AVERT Future Gun Violence Act H.R. 6297: Assault Weapons Ban and Regulatory Reform Act of 2018 H.Con.Res. 127: Condemning gun violence and its impact on youth by supporting the enactment of legislation to prevent future school and neighborhood shootings

Various issues relating to the Arms Export Control Act; U.S.C Chapter 18; firearm technology; 27 CFR 555.11; firearm bans and sales; ammunition bans and restrictions; reporting requirements for the Securities and Exchange Commission concerning firearms manufacturers; proposed restrictions on firearms dealers; undetectable firearms; and related matters. H.R.1137, H.R.2033, H.R.2380, S.1541, H.R.3947, H.R.3962, S.1915, S.1916, H.R.3986, H.R.3999, H.R.4064, S.2095, H.R.4344, S.2150, H.R.4721, H.R.4765, H.R.5077, H.R.5087, H.R.5103, H.R.5106, H.R.5271, S.2627, H.R.5383, H.R.5410, H.R.5560, H.R.6109, H.R.6296, H.R.6297, S.3211, H.R.6624, H.R.6643, S.3300, S.3304, H.R.6649, H.R.6654

Client expense: $2,100,000 · Firm income: Not reported

Preserve Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments; proposing specific alternatives to CMS Advancing Care Information program that replaced the Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Improvement Activities categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians. Improve Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their cost-sharing reduction subsidies (CSRs) and that those CSRs should be continued indefinitely as part of a larger bipartisan effort to stabilize the individual insurance market. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Veterans Care: Regarding the VA Mission Act of 2018 (H.R. 5674), the College urged Congress to ensure that veterans have access to timely, contiguous care across the spectrum of health care services, with coordination and management of that care in the hands of a primary clinician or clinical care team; that the expansion of care to non-VHA facilities does not come at the cost of maintaining or improving existing VHA services or infrastructure; and that recruitment and retention of clinicians to the VHA is valued appropriately, including reimbursement for services provided; Advocated with Congress on the need for adequate funding for the VHA for FY2019 and the long-term. Immigration: Voiced support to Congress on the need to pass the Development, Relief, and Education for Alien Minors (DREAM) Act of 2017, H.R. 3440. This legislation would establish a three-step pathway to U.S. citizenship through college, work, or the armed services for individuals who were born in another country and brought illegally to the U.S. at a young age (DREAMers). Clinical Labs: Commented to the Centers for Medicare and Medicaid Services (CMS) on issues pertaining to the Protecting Access to Medicare Act of 2014 (PAMA), specifically citing concerns about the potential impacts of PAMA on patient access to critical rapid clinical testing services offered to patients while they are receiving medical care in their physicians office; expressed further concerns about impending cuts on Jan. 1, 2018 for physician office-based testing services. Expand Coverage and Stabilizing the Insurance Market: Congress should work to help stabilize the individual health insurance market and expand coverage. Specifically by develop and introduce comprehensive market stabilization legislation that includes reinsurance options to help stabilize the markets; Expanding cost-sharing assistance eligibility to purchase insurance in the exchanges as well as increase the level of premium tax credits and cost sharing subsidies offered to purchase a qualified health plan; Introducing legislation that would block the expansion of access to short-term health plans or Association Health Plans that allow insurers to charge more to individuals with pre-existing conditions and permit them to exclude from coverage essential medical care; Supporting $690 million in discretionary funding for federal exchanges within CMS Program Operations as part of the FY2019 Labor, Health and Human Services, and Education Appropriations bill. Reduce Unnecessary Administrative Tasks on Physicians and Patients: Congress should accelerate its efforts to reduce administrative burdens on clinicians and patients, including: Passing the Standardizing Electronic Prior Authorization for Safe Prescribing Act (H.R. 4841), which standardizes electronic prior authorization for prescription drugs under Medicare Part D. Adopt even greater harmonization of such standards across the health care industry; Passing the CONNECTIONS Act (H.R. 5812) by Reps. Griffith (R-VA) and Pallone (D-NJ) that would authorize CDC grants to state-run PDMPs to improve data collection and integration into physician clinical workflow specifically, of controlled substances overdose prevention and surveillance activities; Urging health care committees in Congress with jurisdiction over Medicare to exercise their oversight authority of CMS effort to overhaul clinical documentation guidelines with input from practicing clinicians; Passing the Improving Access to Medicare Coverage Act of 2017 (S. 568/H.R. 1421), which deems patients under observation as inpatients for the purposes of satisfying the Medicare 3-day inpatient stay requirement. Reduce Prescription Drug Costs: Congress should increase transparency and accountability in prescription drug pricing and improve access to lower-cost generic medications by passing the Drug Price Transparency in Communications Act (S. 2157), which would require drug companies to disclose the Wholesale Acquisition Cost of an Rx in Direct-to-Consumer Advertising. Representatives should introduce the companion bill; Passing the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2017 (S. 974/H.R. 2212), which would improve patient access to alternative low-cost prescription drugs and biological products by preventing prescription drug manufacturers from misusing the FDAs Risk Evaluation and Mitigation Strategies (REMS) process to make it difficult for competing generics to be brought to the market; Passing the Medicare Prescription Drug Price Negotiation Act of 2017 (S. 41/H.R. 242), which would grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for high�cost drugs and biologics covered under Part D; Passing the Fair Accountability and Innovative Research (FAIR) Pricing Act (S. 1131/H.R. 2439), which would require drug manufacturers to disclose and provide more information about planned drug price increases, including R&D costs. Fund Workforce, Medical and Health Services Research, Public Health Initiatives: Congress should ensure funding in FY 2019 for federal programs/initiatives designed to support primary care and reject funding rescissions that would harm childrens health coverage or CMS Innovation Center. This includes funding the Primary Care and Training Enhancement (PCTE) at $71 million in order to maintain and expand the pipeline for individuals training in primary care; Funding the National Health Service Corps (NHSC) at least at $415 million in total program funding to fund scholarships and loan repayment to health care professionals to help expand the countrys primary care workforce and meet the health care needs of underserved communities; Funding the Centers for Disease Control and Prevention (CDC) and Prevention and Public Health Fund (PPHF) at $8.45 billion; including PPHF funding at $805 million; Funding the Agency for Healthcare Research and Quality (AHRQ) at $454 million, restoring the agency to its FY2010 enacted level adjusting for inflation after cuts in FY2016 and FY2017 and a small increase in FY2018 so it can help clinicians help patients by making evidence-informed decisions, fund research that serves as the evidence engine for much of the private sectors work to keep patients safe; Funding the National Institutes of Health (NIH) at $39 billion so that this nations biomedical research can continue to fund cures for disease and maintain the U.S. standing as the world leader in medical and biomedical research. Promote Continued Action to Address the Epidemic of Opioid Use: Congress should pass a comprehensive legislative package to improve prevention, education, treatment and recovery for those suffering from opioid-related addictions, including: Providing for sufficient and increased funding to address the opioid epidemic, building and expanding upon the $4.65 billion in the omnibus bill approved by Congress, with at least $1 billion for programs as authorized by CARA 2.0; Expanding access and coverage for medication assisted treatment (methadone, buprenorphine, and naltrexone to prevent opioid and substance use disorders; Rejecting any proposal to impose a three day prescribing limit for initial opioid prescriptions to ensure that doctors have appropriate flexibility to determine the proper duration of each opioid prescription; Passing the Comprehensive Addiction and Recovery Act 2.0 of 2018 (S. 2456/H.R. 5311) as a step toward a more comprehensive opioids-related package. Reduce Firearms-Related Injury and Death: Congress should pass the Assault Weapons Ban of 2018 (S. 2095/H.R. 5077), which would ban the sale of high velocity, rapid file assault rifles and large capacity ammunition magazines and bump stocks; Pass the Brady Background Expansion Act (S. 2009), to expand background checks to virtually all firearm sales in the United States; Pass the Stop Illegal Trafficking in Firearms Act of 2017 (S. 1185), and the Stop Straw Purchases Act (H.R. 5134). Both would increase penalties for individuals who unlawfully purchase firearms for other persons who are prohibited from possessing firearms (known as straw purchasers); Repeal the Dickey amendment restricting firearms-related research by federal agencies and support $50 million in funding for the CDC to conduct such research; Pass S. 834/H.R. 1832 that authorizes funding for the CDC to conduct such research. Make Graduate Medical Education (GME) Funding More Effective: Congress should develop and pass legislation to reform GME to prioritize funding toward physician specialties where millions of patients lack access, including internal medicine specialists trained in comprehensive primary care, to: Increase the number of GME slots by at least 3,000 per year over five years for specialties facing shortages, including internal medicine, as contained in the Resident Physician Shortage Reduction Act of 2017 (S. 1301/H.R. 2267); Combine DGME/IME into a single, more functional program; broaden the GME financing structure to include all payers; Allocate GME funds transparently and to activities that further the educational mission of teaching and training residents/fellows with input from practicing clinicians and in collaboration with their professional organizations; Support continued adequate funding for the VHA and its substantial contributions to the ongoing training of the next generation of physicians. Title X Regulations: Commented to HHS in July on the proposed rule to revise Title X regulations (Title X of the Public Health Service Act) to ensure compliance with, and enhance implementation of, the statutory requirement that none of the funds appropriated for Title X may be used in programs where pregnancy termination is a method of family planning and related statutory requirements. The College asserts that women should have sufficient access to evidence-based family planning and sexual health information and the full range of medically accepted forms of contraception. The College opposes government restrictions that would erode or abrogate a woman's right to continue or discontinue a pregnancy. The College opposes any legislation or regulations that limit access to comprehensive reproductive health care by putting medically unnecessary restrictions on health care professionals or facilities. Kentucky Health Waiver: The College commented to CMS on Kentuckys Health Waiver expressing concern that: it would impose a substantial monthly premium on Medicaid beneficiaries; would also create a six-month lock-out period for certain enrollees who do not pay their premiums on time, which is unduly harsh; that proposed work requirements will impose an unnecessary and unjustified burden on patients to document that they are eligible for an exemption and an unnecessary and unjustified burden on physicians who may be asked to attest that their patients have an exempted medical condition. 2019 Physician Fee Schedule and Quality Payment Program: Advocated to CMS that: cognitive care of more complex patients must be recognized with higher allowed payment rates than less complex care patients; supports the overall direction of CMS's proposal to reduce the burden of documentation for E/M services, but strongly disagrees that such improvements should be contingent on acceptance of the proposal to pay a single flat fee for levels 2-5; CMS not establish a regulatory deadline (e.g. January 1, 2019 or January 1, 2020) for finalizing and implementing its flat fee E/M proposals or possible alternatives that change how E/M services would be paid; calls on CMS to move forward with implementation of their proposal to simplify E/M documentation requirements effective January 1, 2019, while alternatives to the flat fee structure are being developed and pilot-tested; supports implementation on January 1, 2019 of proposals to pay for virtual check-ins, other telehealth and technology-based services, and prolonged face-to-face visits. Short-Term Health Plans: Urged Congress to support the joint resolutions disapproving of the rule related to short-term, limited-duration insurance, as published in the federal register on August 3, 2018, that such rule shall have no force or effect.

Preserve Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments; proposing specific alternatives to CMS Advancing Care Information program that replaced the Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Improvement Activities categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians. Improve Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their cost-sharing reduction subsidies (CSRs) and that those CSRs should be continued indefinitely as part of a larger bipartisan effort to stabilize the individual insurance market. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Veterans Care: Regarding the VA Mission Act of 2018 (H.R. 5674), the College urged Congress to ensure that veterans have access to timely, contiguous care across the spectrum of health care services, with coordination and management of that care in the hands of a primary clinician or clinical care team; that the expansion of care to non-VHA facilities does not come at the cost of maintaining or improving existing VHA services or infrastructure; and that recruitment and retention of clinicians to the VHA is valued appropriately, including reimbursement for services provided; Advocated with Congress on the need for adequate funding for the VHA for FY2019 and the long-term. Immigration: Voiced support to Congress on the need to pass the Development, Relief, and Education for Alien Minors (DREAM) Act of 2017, H.R. 3440. This legislation would establish a three-step pathway to U.S. citizenship through college, work, or the armed services for individuals who were born in another country and brought illegally to the U.S. at a young age (DREAMers). Clinical Labs: Commented to the Centers for Medicare and Medicaid Services (CMS) on issues pertaining to the Protecting Access to Medicare Act of 2014 (PAMA), specifically citing concerns about the potential impacts of PAMA on patient access to critical rapid clinical testing services offered to patients while they are receiving medical care in their physicians office; expressed further concerns about impending cuts on Jan. 1, 2018 for physician office-based testing services. Expand Coverage and Stabilizing the Insurance Market: Congress should work to help stabilize the individual health insurance market and expand coverage. Specifically by develop and introduce comprehensive market stabilization legislation that includes reinsurance options to help stabilize the markets; Expanding cost-sharing assistance eligibility to purchase insurance in the exchanges as well as increase the level of premium tax credits and cost sharing subsidies offered to purchase a qualified health plan; Introducing legislation that would block the expansion of access to short-term health plans or Association Health Plans that allow insurers to charge more to individuals with pre-existing conditions and permit them to exclude from coverage essential medical care; Supporting $690 million in discretionary funding for federal exchanges within CMS Program Operations as part of the FY2019 Labor, Health and Human Services, and Education Appropriations bill. Reduce Unnecessary Administrative Tasks on Physicians and Patients: Congress should accelerate its efforts to reduce administrative burdens on clinicians and patients, including: Passing the Standardizing Electronic Prior Authorization for Safe Prescribing Act (H.R. 4841), which standardizes electronic prior authorization for prescription drugs under Medicare Part D. Adopt even greater harmonization of such standards across the health care industry; Passing the CONNECTIONS Act (H.R. 5812) by Reps. Griffith (R-VA) and Pallone (D-NJ) that would authorize CDC grants to state-run PDMPs to improve data collection and integration into physician clinical workflow specifically, of controlled substances overdose prevention and surveillance activities; Urging health care committees in Congress with jurisdiction over Medicare to exercise their oversight authority of CMS effort to overhaul clinical documentation guidelines with input from practicing clinicians; Passing the Improving Access to Medicare Coverage Act of 2017 (S. 568/H.R. 1421), which deems patients under observation as inpatients for the purposes of satisfying the Medicare 3-day inpatient stay requirement. Reduce Prescription Drug Costs: Congress should increase transparency and accountability in prescription drug pricing and improve access to lower-cost generic medications by passing the Drug Price Transparency in Communications Act (S. 2157), which would require drug companies to disclose the Wholesale Acquisition Cost of an Rx in Direct-to-Consumer Advertising. Representatives should introduce the companion bill; Passing the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2017 (S. 974/H.R. 2212), which would improve patient access to alternative low-cost prescription drugs and biological products by preventing prescription drug manufacturers from misusing the FDAs Risk Evaluation and Mitigation Strategies (REMS) process to make it difficult for competing generics to be brought to the market; Passing the Medicare Prescription Drug Price Negotiation Act of 2017 (S. 41/H.R. 242), which would grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for high�cost drugs and biologics covered under Part D; Passing the Fair Accountability and Innovative Research (FAIR) Pricing Act (S. 1131/H.R. 2439), which would require drug manufacturers to disclose and provide more information about planned drug price increases, including R&D costs. Fund Workforce, Medical and Health Services Research, Public Health Initiatives: Congress should ensure funding in FY 2019 for federal programs/initiatives designed to support primary care and reject funding rescissions that would harm childrens health coverage or CMS Innovation Center. This includes funding the Primary Care and Training Enhancement (PCTE) at $71 million in order to maintain and expand the pipeline for individuals training in primary care; Funding the National Health Service Corps (NHSC) at least at $415 million in total program funding to fund scholarships and loan repayment to health care professionals to help expand the countrys primary care workforce and meet the health care needs of underserved communities; Funding the Centers for Disease Control and Prevention (CDC) and Prevention and Public Health Fund (PPHF) at $8.45 billion; including PPHF funding at $805 million; Funding the Agency for Healthcare Research and Quality (AHRQ) at $454 million, restoring the agency to its FY2010 enacted level adjusting for inflation after cuts in FY2016 and FY2017 and a small increase in FY2018 so it can help clinicians help patients by making evidence-informed decisions, fund research that serves as the evidence engine for much of the private sectors work to keep patients safe; Funding the National Institutes of Health (NIH) at $39 billion so that this nations biomedical research can continue to fund cures for disease and maintain the U.S. standing as the world leader in medical and biomedical research. Promote Continued Action to Address the Epidemic of Opioid Use: Congress should pass a comprehensive legislative package to improve prevention, education, treatment and recovery for those suffering from opioid-related addictions, including: Providing for sufficient and increased funding to address the opioid epidemic, building and expanding upon the $4.65 billion in the omnibus bill approved by Congress, with at least $1 billion for programs as authorized by CARA 2.0; Expanding access and coverage for medication assisted treatment (methadone, buprenorphine, and naltrexone to prevent opioid and substance use disorders; Rejecting any proposal to impose a three day prescribing limit for initial opioid prescriptions to ensure that doctors have appropriate flexibility to determine the proper duration of each opioid prescription; Passing the Comprehensive Addiction and Recovery Act 2.0 of 2018 (S. 2456/H.R. 5311) as a step toward a more comprehensive opioids-related package. Reduce Firearms-Related Injury and Death: Congress should pass the Assault Weapons Ban of 2018 (S. 2095/H.R. 5077), which would ban the sale of high velocity, rapid file assault rifles and large capacity ammunition magazines and bump stocks; Pass the Brady Background Expansion Act (S. 2009), to expand background checks to virtually all firearm sales in the United States; Pass the Stop Illegal Trafficking in Firearms Act of 2017 (S. 1185), and the Stop Straw Purchases Act (H.R. 5134). Both would increase penalties for individuals who unlawfully purchase firearms for other persons who are prohibited from possessing firearms (known as straw purchasers); Repeal the Dickey amendment restricting firearms-related research by federal agencies and support $50 million in funding for the CDC to conduct such research; Pass S. 834/H.R. 1832 that authorizes funding for the CDC to conduct such research. Make Graduate Medical Education (GME) Funding More Effective: Congress should develop and pass legislation to reform GME to prioritize funding toward physician specialties where millions of patients lack access, including internal medicine specialists trained in comprehensive primary care, to: Increase the number of GME slots by at least 3,000 per year over five years for specialties facing shortages, including internal medicine, as contained in the Resident Physician Shortage Reduction Act of 2017 (S. 1301/H.R. 2267); Combine DGME/IME into a single, more functional program; broaden the GME financing structure to include all payers; Allocate GME funds transparently and to activities that further the educational mission of teaching and training residents/fellows with input from practicing clinicians and in collaboration with their professional organizations; Support continued adequate funding for the VHA and its substantial contributions to the ongoing training of the next generation of physicians. Title X Regulations: Commented to HHS in July on the proposed rule to revise Title X regulations (Title X of the Public Health Service Act) to ensure compliance with, and enhance implementation of, the statutory requirement that none of the funds appropriated for Title X may be used in programs where pregnancy termination is a method of family planning and related statutory requirements. The College asserts that women should have sufficient access to evidence-based family planning and sexual health information and the full range of medically accepted forms of contraception. The College opposes government restrictions that would erode or abrogate a woman's right to continue or discontinue a pregnancy. The College opposes any legislation or regulations that limit access to comprehensive reproductive health care by putting medically unnecessary restrictions on health care professionals or facilities. Kentucky Health Waiver: The College commented to CMS on Kentuckys Health Waiver expressing concern that: it would impose a substantial monthly premium on Medicaid beneficiaries; would also create a six-month lock-out period for certain enrollees who do not pay their premiums on time, which is unduly harsh; that proposed work requirements will impose an unnecessary and unjustified burden on patients to document that they are eligible for an exemption and an unnecessary and unjustified burden on physicians who may be asked to attest that their patients have an exempted medical condition. 2019 Physician Fee Schedule and Quality Payment Program: Advocated to CMS that: cognitive care of more complex patients must be recognized with higher allowed payment rates than less complex care patients; supports the overall direction of CMS's proposal to reduce the burden of documentation for E/M services, but strongly disagrees that such improvements should be contingent on acceptance of the proposal to pay a single flat fee for levels 2-5; CMS not establish a regulatory deadline (e.g. January 1, 2019 or January 1, 2020) for finalizing and implementing its flat fee E/M proposals or possible alternatives that change how E/M services would be paid; calls on CMS to move forward with implementation of their proposal to simplify E/M documentation requirements effective January 1, 2019, while alternatives to the flat fee structure are being developed and pilot-tested; supports implementation on January 1, 2019 of proposals to pay for virtual check-ins, other telehealth and technology-based services, and prolonged face-to-face visits. Short-Term Health Plans: Urged Congress to support the joint resolutions disapproving of the rule related to short-term, limited-duration insurance, as published in the federal register on August 3, 2018, that such rule shall have no force or effect.

Support the reauthorization of Byrne JAG grants Oppose the Department of Justices request for a new citizenship question on the 2020 Census Support full funding of critical juvenile justice and delinquency prevention programs in fiscal year 2019 Support proposals to build trust between law enforcement and the communities they serve. Support initiatives to standardize use of force policies for law enforcement. support ending racial and religious profiling. Support H.R. 1498 / S. 411 Support initiatives to study and eventually eliminate prosecutorial misconduct / bias. support the establishment of local effective and independent review boards of alleged law enforcement misconduct. Support requiring video surveillance of all law enforcement activities Support genuine sentencing reform to alleviate prison overcrowding, over-incarceration, and the overrepresentation of racial and ethnic minorities who are in prison. Support HR 4261 Support a commission to review all aspects of our national criminal justice system. Support H.R. 1886 / S.573 Support ending the ban on CDC Gun Research Support requiring universal background checks on all gun sales and transfers support a ban on the sale of all military-style semi-automatic assault guns and military high capacity ammunition clips (support HR 5078 / S. 2095 and S. 1945 Support tough new criminal penalties for straw purchasers and gun traffickers Support a ban on suspects on the terror watch list from purchasing firearms Support the Fix NICS Act (H.R. 4434 / S. 2135). Incentivize and assist states in improving their overall reporting to the National Instant Criminal Background Check System (NICS) Support sensitivity training of law enforcement & independent investigations of deadly force (HR 1870 / S 860)Support maintaining current law requiring background checks and permits for gun silencers. Support a ban on bump stocks machine-gun type firing and other conversion kits, accessories and parts Support allowing states to maintain and enforce their own concealed carry laws Support requiring the repeal of all state stand your ground laws, restoring the use of deadly force as a last resort Support microstamping or ballistic fingerprinting of all new firearms and ammunition sold in the U.S. support encouraging local jurisdictions to utilize their buyer power to create incentives for firearm manufacturers to employ countermarketing strategies to ensure that their retailers are using all available procedures to prevent illegal firearms diversion Support an abolishment of the death penalty Support the Second Chance Act reauthorization (HR 2899) Support the reauthorization and updating of the Juvenile Justice Delinquency Prevention Act(support HR 1809 / S 860 Support the reform of money bail (HR 4019 / S 1593) Support incentivizing states and local jurisdictions to fully and accurately report hate crimes (HR 1566 / S. 667) Support the removal of statues of Confederate soldiers from the U.S. Capital (support HR 3701 / S 1772) Support encouraqing states to decrease prison populations and keep crime down (support HR 3845 / S 1458) Support the Compensating Legacy Artists for their Songs, Service, and Important Contributions to Society (CLASSICS) Act (H.R. 3301/S. 2393), bipartisan and which ensures legacy musicians are compensated when their work is played on digital radio platforms. Oppose the nomination of Thomas Farr to the Federal Court for the Eastern District of North Carolina Oppose the policy of separating parents from children apprehended at the U.S. border Oppose the nomination of Andrew Oldham to the U.S. Court of Appeals for the Fifth Circuit Support DoJ leaders publicly recognizing and condemning the serious pattern of violence against transgender people in Jacksonville and the national problem it represents; we urge the Department to investigate these three killings as possible hate crimes and/or serial crimes, and offer all possible assistance to local authorities; we urge the Departments Community Relations Service to engage with local community members and officials to help them work together on these cases and address community concerns; and, we urge the Community Relations Service to support local community groups in providing appropriate training for local law enforcement on with respect to working with transgender people, and in improving relevant policies and procedures Oppose the use of risk assessment instruments in pretrial decision-making and establishing a set of principles for mitigating the harm that these tools may be causing in communities where they are already employed Oppose the nomination of Brett Kavanaugh to the US Supreme Court Oppose HR 6691, the Community Safety and Security Act as it recklessly pushes forward a definition of a crime of violence for political purposes. Oppose the continued delay by the US Department of Justice in meeting its obligation to enforce the Death in Custody Reporting Act of 2013 (DCRA). Support the mandatory collection of data on police-involved deaths. Support the DOJ going forth with the December 2016 compliance guidelines. Support requiring States to Proactively Report All In-Custody Deaths to DOJ. Support all States adopting Compliance Plans; support penalties for non-compliant states. Support the establishment of Clear Parameters that Define What is Reportable Under DCRA. Support the establishment of Guidelines for the Collection of Information on Decedents Disability Support S. 3435, Beyond the Box for Higher Education Act. The bill would provide guidance, training, and technical assistance for colleges and universities to remove criminal history questions from their admissions processes. Support the Protecting the Health and Wellness of Babies and Pregnant Women in Custody Act, which will ensure access to resources necessary to meet the unique needs of pregnant women; will ensure that the Bureau of Prisons captures accurate data on the health care needs of pregnant inmates; and will prohibit, in most circumstances, the use of restraints on pregnant and postpartum inmates. In addition to providing incentives to states who meet these needs Oppose H.R. 3487, which radically changes the law of diversity jurisdiction--the standard governing when a federal court may hear a case-from complete diversity to minimal diversity. Oppose H.R. 6730, Injunctive Authority Clarification Act of 2018, which would prevent national injunctions in most cases. Oppose H.R. 6754, Court Imbalance Restructure Concerning Updates to Impacted Tribunals Act of 2018 or the CIRCUIT Act of 2018, which would completely restructure the Court of Appeals for the Ninth Circuit. Oppose H.R. 6755, the Judiciary Reforms, Organization and Operational Modernization Act of 2018 or the Judiciary ROOM Act of 2018, which contains a vast number of changes to federal court structure and procedures, from medical examinations and codes of conduct for judges, to internet streaming and television broadcasts Support S. 2520 the Inmate Calling Technical Correction Act which reduces the exorbitant rates for telephone calls from prisons Oppose Brett Kavanaugh's Supreme Court nomination based on his record on consumer protection issues Oppose a provision in the House opioid bill requiring HHS to produce a report every 6 months, explaining why it has not produced the hair testing standard mandated in the FAST Act. Support legislation banning forced arbitration (individual, class and collective) in the employment context. Support H.R. 6086 / S. 3178, the Justice for Victims of Lynching Act, which would make lynching a hate crime. Support S. 3195, the Law Enforcement Trust and Integrity Act, which provides incentives for local police organizations to adopt performance-based standards to ensure that incidents of misconduct will be minimized through appropriate management, training and oversight protocols and that if such incidents do occur, that they are properly investigated Support H.R. 5075, the Ashanti Alert Act which is based on the popular and effective Amber Alert system, would, at the discretion of local law enforcement officials, be utilized to assist local and regional efforts to find missing adults, individuals between the ages of 19 and 65. Oppose Eric Dreibands nomination to serve as the next Assistant Attorney General for Civil Rights Oppose the nomination of the current State Solicitor General of Ohio, Eric Murphy, to a lifetime appointment on the Sixth Circuit Court of Appeals. Oppose the nomination of Chad Readler of Ohio to a lifetime appointment on the Sixth Circuit Court of Appeals. Oppose State Senator Mark Norris to be a U.S. District Judge for the Western District of Tennessee Support H.R. 6555, legislation to reauthorize and strengthen the Violence Against Women Act of 1994 (VAWA

Support ending the ban on and support funding for CDC Gun Research Support requiring universal background checks on all gun sales and transfers support a ban on the sale of all military-style semi-automatic assault guns and military high capacity ammunition clips (support HR 5078 / S. 2095 and S. 1945 Support tough new criminal penalties for straw purchasers and gun traffickers Support a ban on suspects on the terror watch list from purchasing firearms Support the Fix NICS Act (H.R. 4434 / S. 2135). Incentivize and assist states in improving their overall reporting to the National Instant Criminal Background Check System (NICS). Support maintaining current law requiring background checks and permits for gun silencers. Support a ban on bump stocks machine-gun type firing and other conversion kits, accessories and parts Support allowing states to maintain and enforce their own concealed carry laws Support requiring the repeal of all state stand your ground laws, restoring the use of deadly force as a last resort Support microstamping or ballistic fingerprinting of all new firearms and ammunition sold in the U.S. support encouraging local jurisdictions to utilize their buyer power to create incentives for firearm manufacturers to employ countermarketing strategies to ensure that their retailers are using all available procedures to prevent illegal firearms diversion Support Thompson (CA) resolution calling for consideration of legislation related to gun regulation

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

H.R.1137 - Collectible Firearms Protection Act - To amend the Arms Export Control Act to provide that certain firearms listed as curios or relics may be imported into the United States by a licensed importer without obtaining authorization from the Department of State or the Department of Defense, and for other purposes. H.R.2033 - Undetectable Firearms Modernization Act - To modernize the Undetectable Firearms Act of 1988. H.R.2380 - Handgun Trigger Safety Act of 2017 - To provide for the development and use of technology for personalized handguns, to require that all handguns manufactured or sold in, or imported into, the United States incorporate such technology, and for other purposes. S.1541 - A bill to modify the definition of an antique firearm. H.R.3947 - Automatic Gunfire Prevention Act- To prohibit the possession or transfer of certain firearm accessories, and for other purposes. H.R.3962 - Stop Online Ammunition Sales Act of 2017- To require face-to-face purchases of ammunition, to require licensing of ammunition dealers, and to require reporting regarding bulk purchases of ammunition. S.1915 - Handgun Trigger Safety Act of 2017- To provide for the development and use of technology for personalized handguns, to require that all handguns manufactured or sold in, or imported into, the United States incorporate such technology, and for other purposes. S.1916 - Automatic Gunfire Prevention Act- To prohibit the possession or transfer of certain firearm accessories, and for other purposes. H.R.3986 - Stopping the Iron Pipeline Act of 2017- To provide for the establishment of a national standard for incorporating a passive identification ability into all firearms sold in the United States. H.R.3999 - To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes.- To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes. H.R.4064 - To impose restrictions on the sale of binary explosives, and for other purposes.- To impose restrictions on the sale of binary explosives, and for other purposes. S.2095 - Assault Weapons Ban of 2017- To regulate assault weapons, to ensure that the right to keep and bear arms is not unlimited, and for other purposes. H.R.4344 - End Purchase of Firearms by Dangerous Individuals Act of 2017- To incentivize State reporting systems that allow mental health professionals to submit information on certain individuals deemed dangerous for purposes of prohibiting firearm possession by such individuals, and for other purposes. S.2150 - Imitation Firearms Safety Act of 2017- To improve requirements for entering into commerce of imitation firearms, and for other purposes. H.R.4721 - Armor-Piercing Bullets Act of 2017- To enact into law a framework for deciding whether certain projectiles are primarily intended for sporting purposes for purposes of determining whether the projectiles are armor piercing ammunition. Legislation related to instant background checks for firearms purchases, firearms attachments and mental health issues. FY 2019 Appropriations bills.

SUPPORT S. 2009 - Background Check Expansion Act S. 1916 - Automatic Gunfire Prevention Act H.R. 4240 - Public Safety and Second Amendment rights Protection Act of 2017 S. 1992/H.R. 3361 - SECURE Firearm Storage Act H.R. 3947 - Automatic Gunfire Prevention Act H.R. 3984 - Equal Access to Justice for Victims of Gun Violence Act S 1939 - Equal Access to Justice for Victims of Gun Violence Act S. 834/H.R. 1832 - CDC gun research bills H.R. 1478 - Gun Violence Research Act H.R. 3207 - Zero Tolerance for Domestic Abuse Act S. 1539 - Protecting Domestic Violence and Stalking Victims Act of 2017 S. 1923/H.R. 3464 - Background Check Completion Act of 2017 S. 1945 & H.R. 4052 Keep Americans Safe Act S. 2095 Assault weapons Ban of 2017 H.R. 5087 Assault weapons Ban of 2018 S. 2521 Federal Extreme Risk Protection Order Act of 2018 S. 1212 Gun Violence Prevention Order Act of 2017 H.R. 2598 Gun Violence Restraining Order Act of 2017 H.R. 4471/S. 2492 NICS Denial Notification Act S. 2546 Make America Safe & Secure Act H.R. 6075 Keeping Gun Dealers Honest Act S.1324/H.R. 2841 Disarm Hate Act H.Con.Res.66 Expressing support for the designation of June 21 as National ASK (Asking Saves Kids) Day to promote childrens health and gun safety H.R. 1278 Ghost Guns Are Guns Act S. 3300/H.R. 6643 Untraceable Firearms Act of 2018 S. 2129 Military Domestic Violence Reporting Enhancement Act Provisions of H.R. 2810 and H.R. 5515 John S. McCain National Defense Authorization Act for FY2019 H.R. 6649 3D Printed Gun Safety Act of 2018 S. 3304 3D Printed Gun Safety Act of 2018 RAISING CONCERNS WITH PROVISIONS/SEEKING AMDTS. S. 2607 Extreme Risk Protection Order and Violence Prevention Act AGAINST H.R. 3668 Sportsmens Heritage and Recreational Enhancement (SHARE) Act H.R. 367/S. 59 Hearing Protection Act of 2017 H.R. 1181 Veterans 2nd Amendment Rights Protection Act S. 446/H.R. 38 Concealed Carry Reciprocity Act of 2017 H.R. 1976/S.1397 Protecting the Second Amendment Act

Support the reauthorization of Byrne JAG grants Oppose the Department of Justices request for a new citizenship question on the 2020 Census Support full funding of critical juvenile justice and delinquency prevention programs in fiscal year 2019 Support S. 1917, with reservations about new mandatory minimums imposed by the bill Support a more robust response to the hate violence and groups that flourish on social media platforms, dont just focus on Muslim extremists Support the federal governments crucial role in spurring criminal justice innovation, as well as testing and replicating evidence-based practices nationwide by funding programs including the Office of Violence Against Women and the COPS program Support appropriating $95 million in FY2019 to the Department of Labor for its Reintegration of Ex-Offenders program Support an independent Community Relations Service (CRS); oppose the Trump proposal to move CRS under the Department of Justice Office of Civil Rights Oppose the Presidents proposal calling for increasing sentences for drug offenders, including the death penalty. S.1994, the CORRECTIONS Act, and H.R. 3356, the Prison Reform and Redemption Act, are not sentencing reform and should not be viewed as such. This legislation will not, alone, substantially alleviate prison overcrowding or mass incarceration Oppose mandatory arbitration clauses for investors; support the SEC protecting investors rights to bring securities class action lawsuits Support proposals to build trust between law enforcement and the communities they serve. Support initiatives to standardize use of force policies for law enforcement. support ending racial and religious profiling. Support H.R. 1498 / S. 411 Support initiatives to study and eventually eliminate prosecutorial misconduct / bias. support the establishment of local effective and independent review boards of alleged law enforcement misconduct. Support requiring video surveillance of all law enforcement activities Support genuine sentencing reform to alleviate prison overcrowding, over-incarceration, and the overrepresentation of racial and ethnic minorities who are in prison. Support HR 4261 Support a commission to review all aspects of our national criminal justice system. Support H.R. 1886 / S.573 Support ending the ban on CDC Gun Research Support requiring universal background checks on all gun sales and transfers support a ban on the sale of all military-style semi-automatic assault guns and military high capacity ammunition clips (support HR 5078 / S. 2095 and S. 1945 Support tough new criminal penalties for straw purchasers and gun traffickers Support a ban on suspects on the terror watch list from purchasing firearms Support the Fix NICS Act (H.R. 4434 / S. 2135). Incentivize and assist states in improving their overall reporting to the National Instant Criminal Background Check System (NICS) Support sensitivity training of law enforcement & independent investigations of deadly force (HR 1870 / S 860)Support maintaining current law requiring background checks and permits for gun silencers. Support a ban on bump stocks machine-gun type firing and other conversion kits, accessories and parts Support allowing states to maintain and enforce their own concealed carry laws Support requiring the repeal of all state stand your ground laws, restoring the use of deadly force as a last resort Support microstamping or ballistic fingerprinting of all new firearms and ammunition sold in the U.S. support encouraging local jurisdictions to utilize their buyer power to create incentives for firearm manufacturers to employ countermarketing strategies to ensure that their retailers are using all available procedures to prevent illegal firearms diversion Support an abolishment of the death penalty Support the Second Chance Act reauthorization (HR 2899) Support the reauthorization and updating of the Juvenile Justice Delinquency Prevention Act(support HR 1809 / S 860 Support the reform of money bail (HR 4019 / S 1593) Support incentivizing states and local jurisdictions to fully and accurately report hate crimes (HR 1566 / S. 667) Support the removal of statues of Confederate soldiers from the U.S. Capital (support HR 3701 / S 1772) Support encouraqing states to decrease prison populations and keep crime down (support HR 3845 / S 1458) Support the Compensating Legacy Artists for their Songs, Service, and Important Contributions to Society (CLASSICS) Act (H.R. 3301/S. 2393), bipartisan and which ensures legacy musicians are compensated when their work is played on digital radio platforms. Oppose the nomination of Thomas Farr to the Federal Court for the Eastern District of North Carolina Support the inclusion of provisions to: final federal legislation to: Curtail the ballooning number of federal regulatory crimes; eliminate federal criminal penalties for simple drug possession in state jurisdictions; promote targeted sentencing of drug offenders, ensuring that violent and career criminals and crime leaders and organizers are held accountable; update supervision policies to more effectively change the criminal behavior of the nearly 132,000 on probation and post-prison supervision; increase government transparency and accountability by requiring public disclosure of regulatory criminal offenses; allowing victims of regulatory over-criminalization to contact the inspector general; protecting against wrongful convictions; encourage judicial districts to open drug, veteran, mental health and other problem solving courts; reinvest the substantial savings by investing in communities, prevention, and intervention initiatives and state, local, and federal law enforcement and prosecutors reduce recidivism by using swift and certain responses so offenders know what will happen if they re-offend or act in a certain way; create a system of rewards and incentives for good behavior; and acknowledge that age matters by implementing smart, targeted geriatric release programs which can ensure heinous offenders remain behind bars while cutting down on costs and maintaining public safety. In any sentencing reform legislation. Oppose the Prison Reform and Redemption Act (H.R. 3356) or any mangers amendment that is considered during the mark up. Any effort to pass prison reform (or back-end reform) legislation without including sentencing reform (or front-end reform) will not meaningfully improve the federal system Oppose HR 2152, the Citizens Right to Know Act as it raises serious privacy concerns. Support HR 1437, the No Money Bail Act which would incentivize jurisdictions to reform their money bail systems using federal resources. Support full funding for JJDPA programs in FY2019 Oppose H.R. 5698, the Protect and Serve Act of 2018, which creates a new crime for offenses that target law enforcement officers Oppose S. 2794, the Protect and Serve Act of 2018, which creates a new crime for offenses that target law enforcement officials Oppose HR 5682, the First Step Act, because it does not address sentencing reform; because of the Overbroad List of Exclusions; because to provides for a Dangerous Risk Assessment; because of The Absence of Funding for Implementation; because of the Undetermined Human and Fiscal Impact; because it contains a Misplaced Incentive System; and because of the Overbroad Discretion Provided to Attorney General Sessions Oppose judicial nominations of Andrew Oldham, Wendy Vitter, J. Campbell Barker, Michael Truncale, and Mark Norris due to their records of opposing critical legal protections for immigrant families. Oppose any efforts to reduce the fentanyl and analogue quantities in 21 U.S.C. 841 and 960, or to increase the lengths of these mandatory minimum sentences. Oppose S. 2635, either as a stand-alone bill or an amendment, which would mandate increased mandatory minimum sentences for fentanyl possession or sale. Oppose the policy of separating parents from children apprehended at the U.S. border Oppose HR 2851, the Stop Importation and Trafficking of Synthetic Analogues Act (SISTA) which would give AG Sessions sweeping, largely unchecked new powers to schedule new drugs and incarcerate more people Support the Prison Rape Elimination Act (PREA) and oppose the recent policy changes to the Bureau of Prisons Transgender Offender Manual Support S. 1728, the Private Prison Information /act, which would require for-profit prisons and detention centers to comply with the Freedom of Information Act (FOIA) Oppose Michael Brennan's nomination to the U.S. Court of Appeals for the Seventh Circuit Oppose the nomination of Stuart Kyle Duncan to the U.S. Court of Appeals for the Fifth Circuit Oppose the nomination of Andrew Oldham to the U.S. Court of Appeals for the Fifth Circuit Support H. Res. 285, Expressing the sense of the United States House of Representatives that Congress and the President should empower the creation of police and community alliances designed to enhance and improve communication and collaboration between members of the law enforcment community and the public they serve oppose H.R. 5682, the FIRST STEP Act. This bill, while containing several worthwhile proposals, should not be mistaken for what is needed. The FIRST STEP Act is not sentencing reform, and the concern -- a very valid concern -that enactment of this legislation will allow some lawmakers to say that they have addressed our nations problem of over-incarceration leads the NAACP to oppose this legislation. While we understand the temptation to support legislation that endeavors to reform our prison system, we believe that this particular bill would do more harm than good and would have unintended consequences that ripple into the future.

Support ending the ban on and support funding for CDC Gun Research Support requiring universal background checks on all gun sales and transfers support a ban on the sale of all military-style semi-automatic assault guns and military high capacity ammunition clips (support HR 5078 / S. 2095 and S. 1945 Support tough new criminal penalties for straw purchasers and gun traffickers Support a ban on suspects on the terror watch list from purchasing firearms Support the Fix NICS Act (H.R. 4434 / S. 2135). Incentivize and assist states in improving their overall reporting to the National Instant Criminal Background Check System (NICS). Support maintaining current law requiring background checks and permits for gun silencers. Support a ban on bump stocks machine-gun type firing and other conversion kits, accessories and parts Support allowing states to maintain and enforce their own concealed carry laws Support requiring the repeal of all state stand your ground laws, restoring the use of deadly force as a last resort Support microstamping or ballistic fingerprinting of all new firearms and ammunition sold in the U.S. support encouraging local jurisdictions to utilize their buyer power to create incentives for firearm manufacturers to employ countermarketing strategies to ensure that their retailers are using all available procedures to prevent illegal firearms diversion Support Thompson (CA) resolution calling for consideration of legislation related to gun regulation

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

H.R. 34: Safe Students Act H.R. 38: Concealed Carry Reciprocity Act of 2017 H.R. 57: Accidental Firearms Transfers Reporting Act of 2017 H.R. 62: Gun Violence Reduction Resources Act of 2017 H.R. 163: Gun Manufacturers Accountability Act H.R. 256: Protect Our Military Families' 2nd Amendment Rights Act H.R. 358: To amend chapter 44 of title 18, United States Code, to more comprehensively address the interstate transportation of firearms or ammunition H.R. 367: Hearing Protection Act of 2017 S. 59: Hearing Protection Act of 2017 S. 80: A bill to protect the right of individuals to bear arms at water resources development projects H.R. 445: Buyback Our Safety Act H.R. 509: ATF Elimination Act S. 159: Firearms Manufacturers and Dealers Protection Act of 2017 S. 162: Second Amendment Enforcement Act of 2017 H.R. 613: Lieutenant Osvaldo Albarati Correctional Officer Self-Protection Act of 2017 H.R. 629: Veterans 2nd Amendment Protection Act S. 202: Social Security Beneficiary 2nd Amendment Rights Protection Act H.J.Res. 40: Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Social Security Administration relating to Implementation of the NICS Improvement Amendments Act of 2007 H.R. 810: Hadiya Pendleton and Nyasia Pryear-Yard Stop Illegal Trafficking in Firearms Act of 2017 H. Res. 90: Expressing the sense of the House of Representatives that gun violence is a public health issue and Congress should enact by the end of the 115th Congress comprehensive Federal legislation that protects the Second Amendment and keeps communities safe and healthy, including expanding enforceable background checks for all commercial gun sales, improving the mental health system in the United States, and making gun trafficking and straw purchasing a Federal crime H.R. 1045: Recreational Lands Self-Defense Act of 2017 H.R. 1047: Fairness in Firearm Testing Act H.R. 1079: Campus Gun Policy Transparency Act S. 394: Protect Our Military Families' 2nd Amendment Rights Act H.R. 1137: Collectible Firearms Protection Act H.R. 1181: Veterans 2nd Amendment Protection Act S. 446: Constitutional Concealed Carry Reciprocity Act of 2017 H.R. 1278: Ghost Guns Are Guns Act S. 533: Undetectable Firearms Modernization Act of 2017 H.R. 1475: Gun Trafficking Prevention Act of 2017 H.R. 1478: Gun Violence Research Act S. 618: Lawful Interstate Transportation of Firearms Act H.R. 1537: Second Amendment Enforcement Act of 2017 H.R. 1612: Gun Show Loophole Closing Act of 2017 H.R. 1692: Countering Illegal Firearms Trafficking to Mexico Act H.R. 1708: Firearm Risk Protection Act of 2017 S. 733: Sportsmen's Act H.R. 1832: To authorize the appropriation of funds to the Centers for Disease Control and Prevention for conducting or supporting research on firearms safety or gun violence prevention S. 834: A bill to authorize the appropriation of funds to the Centers for Disease Control and Prevention for conducting or supporting research on firearms safety or gun violence prevention H.R. 1976: Protecting the Second Amendment Act H.R. 1982: Mental Health Access and Gun Violence Prevention Act of 2017 H.R. 2033: Undetectable Firearms Modernization Act H.R. 2097: ATF Wrongful Reclassification Act H.R. 2098: Second Amendment Defense Act of 2017 H.R. 2380: Handgun Trigger Safety Act of 2017 S. 1084: Lieutenant Osvaldo Albarati Correctional Officer Self-Protection Act of 2017 S. 1185: Stop Illegal Trafficking in Firearms Act of 2017 H.R. 2598: Gun Violence Restraining Order Act of 2017 H.R. 2620: Lawful Purpose and Self Defense Act S. 1212: Gun Violence Prevention Order Act of 2017 S. 1214: Hunting, Fishing, and Recreational Shooting Protection Act H.R. 2670: Protecting Domestic Violence and Stalking Victims Act H.Res. 361: Supporting the goals and ideals of "National Gun Violence Awareness Day" and "National Gun Violence Awareness Month" H.Res. 367: Establishing the Select Committee on Gun Violence Prevention S. Res. 179: A resolution expressing support for the designation of June 2, 2017, as "National Gun Violence Awareness Day" and June 2017 as "National Gun Violence Awareness Month" H.Res. 373: Expressing support for the designation of June 2017 as "National Gun Violence Awareness Month" and calling on Congress to address gun violence H.R. 2784: Good Neighbor Gun Dealer Act H.R. 2810: National Defense Authorization Act for Fiscal Year 2018 H.R. 2841: Disarm Hate Act S. 1324: Disarm Hate Act H.R. 2909: DC Personal Protection Reciprocity Act H.R. 2940: Congressional Self-Defense Act H.R. 2945: Congressional Personal Safety Act H.R. 2951: To allow Members of Congress to carry a concealed handgun anywhere in the United States, with exceptions H.R. 2980: Protecting Gun Owners in Bankruptcy Act of 2017 S. 1387: Protecting the Second Amendment Act H.R. 3054: Veterans' Heritage Firearms Act of 2017 S. 1435: Veterans' Heritage Firearms Act of 2017 H.R. 3139: Hearing Protection Act of 2017 S. 1505: SHUSH Act S. 1541: A bill to modify the definition of an antique firearm. H.R. 3361: SECURE Firearm Storage Act H.R. 3458: MICRO Act H.R. 3464: Background Check Completion Act of 2017 H.R. 3576: SAGA Act H.R. 3613: Safer Neighborhoods Gun Buyback Act of 2017 H.R. 3668: SHARE Act H. Amdt. 378: Description: Amendment sought to reduce the funding level for the Bureau of Alcohol, Tobacco, Firearms and Explosives by five percent H. Amdt. 386: At the end of division C (before the short title), insert the following: Sec. XXXX. None of the funds made available by this Act to the Bureau of Alcohol, Tobacco, Firearms and Explosives H.R. 3790: Federal Firearms Licensee Protection Act S. 1854: Federal Firearms Licensee Protection Act of 2017 H.R. 3947: Automatic Gunfire Prevention Act H.R. 3962: Stop Online Ammunition Sales Act of 2017 S. 1915: Handgun Trigger Safety Act of 2017 S. 1916: Automatic Gunfire Prevention Act S. 1917: Sentencing Reform and Corrections Act of 2017 H.R. 3984: Equal Access to Justice for Victims of Gun Violence Act H.R. 3986: Stopping the Iron Pipeline Act of 2017 H.R. 3987: Protecting Americans from Gun Violence Act of 2017 S. 1923: Background Check Completion Act of 2017 S. 1939: Equal Access to Justice for Victims of Gun Violence Act S. 1945: Keep Americans Safe Act H.R. 3998: Protect America Act of 2017 H.R. 3999: To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes H.R. 4018: To provide for a 3-day waiting period before a person may receive a handgun, with exceptions H.R. 4025: Multiple Firearm Sales Reporting Modernization Act of 2017 H.R. 4052: Keep Americans Safe Act H.R. 4057: Denying Firearms and Explosives to Dangerous Terrorists Act of 2017 S. 1992: SECURE Firearm Storage Act S. 2009: Background Check Expansion Act H.R. 4142: Safer Communities Act of 2017 H.R. 4168: Closing the Bump-Stock Loophole Act H.R. 4183: Domestic Violence Records Reporting Improvement Act of 2017 H.R. 4192: Domestic Violence Gun Homicide Prevention Act of 2017 S. 2045: Domestic Violence Gun Homicide Prevention Act of 2017 H.R. 4240: Public Safety and Second Amendment Rights Protection Act of 2017 H.R. 4268: Gun Safety: Not Sorry Act of 2017 S. 2094: Domestic Violence Loophole Closure Act S. 2095: Assault Weapons Ban of 2017 H.R. 4342: Fire Sale Loophole Closing Act H.R. 4343: Unlawful Gun Buyer Alert Act H.R. 4344: End Purchase of Firearms by Dangerous Individuals Act of 2017 S. 2135: Fix NICS Act of 2017 H.R. 4434: Fix NICS Act of 2017 S. 2150: Imitation Firearms Safety Act of 2017 S. 2161: Hadiya Pendleton and Nyasia Pryear-Yard Gun Trafficking and Crime Prevention Act of 2017 H.R. 4471: NICS Denial Notification Act of 2017 H.R. 4477: Fix NICS Act of 2017 H. Res. 645: Providing for consideration of the bill (H.R. 38) to amend title 18, United States Code, to provide a means by which nonresidents of a State whose residents may carry concealed firearms may also do so in the State H.R. 4573: Gun Violence Research Act of 2017 H.R. 4721: Armor-Piercing Bullets Act of 2017 H.R. 4909: STOP School Violence Act of 2018 S. 2386: Veterans' Second Amendment Rights Restoration Act of 2018 H.R. 5077: Assault Weapons Ban of 2018 H.R. 5087: Assault Weapons Ban of 2018 H.R. 5090: Raise the Age Act H.R. 5103: Gun Violence Prevention and Safe Communities Act of 2018 H.R. 5106: Investor Choice Against Gun Proliferation Act H.R. 5112: SAFER Voter Act S. 2458: Terrorist Firearms Prevention Act S. 2470: Age 21 Act S. 2475: BUMP Act H.R. 5134: STOP Straw Purchases Act S. 2486: Safe Students Act H.R. 5161: To require the Surgeon General of the Public Health Service to submit to Congress an annual report on the effects of gun violence on public health. H.R. 5162: Firearm Safety Act of 2018 H.R. 5163: Keeping Guns from High-Risk Individuals Act S. 2492: NICS Denial Notification Act of 2018 S. 2495: STOP School Violence Act of 2018 S. 2502: Protecting Communities and Preserving the Second Amendment Act of 2018 H.R. 5225: Strengthening the National Instant Criminal Background Check System Act of 2018 S. 2521: Federal Extreme Risk Protection Order Act of 2018 H.R. 5271: Tiahrt Restrictions Repeal Act H.R. 5286: Mass Violence Prevention Reform Act S. 2546: MASS Act H.R. 5380: Securing Our Children Act of 2018 H.R. 5383: Ammunition Background Check Act of 2018 H.R. 5398: 21 to Buy Act S. 2607: Extreme Risk Protection Order and Violence Prevention Act of 2018 S. 2627: Ammunition Background Check Act of 2018 H.R. 5410: SAFER Now Act H.R. 5461: NICS Review Act of 2018 H.R. 5490: Handgun Purchaser Licensing Act S. 2662: Handgun Purchaser Licensing Act H.R. 5560: Defective Firearms Protection Act H.R. 5607: Handgun Licensing and Registration Act of 2018 H.R. 5720: Armed Prohibited Persons Act of 2018 H.R. 5652: State Access to Firearms Evading Revocation Act H.R. 5657: Gladys Ricart Gun Offender Registry Act H.R. 5682: FIRST STEP Act S. 2795: FIRST STEP Act H.R. 5941: Child Gun Access Prevention Act H.Res. 913: Expressing support for the goals and ideals of June 1 through June 3, 2018 as "National Gun Violence Awareness Weekend" and June 2018 as "National Gun Violence Awareness Month" S. 2974: Crime Gun Tracing Modernization Act S. Res. 524: A resolution expressing support for the designation of June 1 through June 3, 2018 as "National Gun Violence Awareness Weekend" and June 2018 as "National Gun Violence Awareness Month" H.Res. 920: Expressing support for the designation of June as National Gun Violence Awareness Month, and calling on Congress to address gun violence H.R. 6024: Blair Holt Firearm Owner Licensing and Record of Sale Act of 2018 S. 3002: Blair Holt Firearm Owner Licensing and Record of Sale Act of 2018 H.R. 6075: Keeping Gun Dealers Honest Act of 2018 S. 3135: Gun Owner Registration Information Protection Act H.R. 6278: AVERT Future Gun Violence Act H.R. 6297: Assault Weapons Ban and Regulatory Reform Act of 2018 H.Con.Res. 127: Condemning gun violence and its impact on youth by supporting the enactment of legislation to prevent future school and neighborhood shootings

H.R. 34: Safe Students Act H.R. 38: Concealed Carry Reciprocity Act of 2017 H.R. 57: Accidental Firearms Transfers Reporting Act of 2017 H.R. 62: Gun Violence Reduction Resources Act of 2017 H.R. 163: Gun Manufacturers Accountability Act H.R. 256: Protect Our Military Families' 2nd Amendment Rights Act H.R. 358: To amend chapter 44 of title 18, United States Code, to more comprehensively address the interstate transportation of firearms or ammunition H.R. 367: Hearing Protection Act of 2017 S. 59: Hearing Protection Act of 2017 S. 80: A bill to protect the right of individuals to bear arms at water resources development projects H.R. 445: Buyback Our Safety Act H.R. 509: ATF Elimination Act S. 159: Firearms Manufacturers and Dealers Protection Act of 2017 S. 162: Second Amendment Enforcement Act of 2017 H.R. 613: Lieutenant Osvaldo Albarati Correctional Officer Self-Protection Act of 2017 H.R. 629: Veterans 2nd Amendment Protection Act S. 202: Social Security Beneficiary 2nd Amendment Rights Protection Act H.J.Res. 40: Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Social Security Administration relating to Implementation of the NICS Improvement Amendments Act of 2007 H.R. 810: Hadiya Pendleton and Nyasia Pryear-Yard Stop Illegal Trafficking in Firearms Act of 2017 H. Res. 90: Expressing the sense of the House of Representatives that gun violence is a public health issue and Congress should enact by the end of the 115th Congress comprehensive Federal legislation that protects the Second Amendment and keeps communities safe and healthy, including expanding enforceable background checks for all commercial gun sales, improving the mental health system in the United States, and making gun trafficking and straw purchasing a Federal crime H.R. 1045: Recreational Lands Self-Defense Act of 2017 H.R. 1047: Fairness in Firearm Testing Act H.R. 1079: Campus Gun Policy Transparency Act S. 394: Protect Our Military Families' 2nd Amendment Rights Act H.R. 1137: Collectible Firearms Protection Act H.R. 1181: Veterans 2nd Amendment Protection Act S. 446: Constitutional Concealed Carry Reciprocity Act of 2017 H.R. 1278: Ghost Guns Are Guns Act S. 533: Undetectable Firearms Modernization Act of 2017 H.R. 1475: Gun Trafficking Prevention Act of 2017 H.R. 1478: Gun Violence Research Act S. 618: Lawful Interstate Transportation of Firearms Act H.R. 1537: Second Amendment Enforcement Act of 2017 H.R. 1612: Gun Show Loophole Closing Act of 2017 H.R. 1692: Countering Illegal Firearms Trafficking to Mexico Act H.R. 1708: Firearm Risk Protection Act of 2017 S. 733: Sportsmen's Act H.R. 1832: To authorize the appropriation of funds to the Centers for Disease Control and Prevention for conducting or supporting research on firearms safety or gun violence prevention S. 834: A bill to authorize the appropriation of funds to the Centers for Disease Control and Prevention for conducting or supporting research on firearms safety or gun violence prevention H.R. 1976: Protecting the Second Amendment Act H.R. 1982: Mental Health Access and Gun Violence Prevention Act of 2017 H.R. 2033: Undetectable Firearms Modernization Act H.R. 2097: ATF Wrongful Reclassification Act H.R. 2098: Second Amendment Defense Act of 2017 H.R. 2380: Handgun Trigger Safety Act of 2017 S. 1084: Lieutenant Osvaldo Albarati Correctional Officer Self-Protection Act of 2017 S. 1185: Stop Illegal Trafficking in Firearms Act of 2017 H.R. 2598: Gun Violence Restraining Order Act of 2017 H.R. 2620: Lawful Purpose and Self Defense Act S. 1212: Gun Violence Prevention Order Act of 2017 S. 1214: Hunting, Fishing, and Recreational Shooting Protection Act H.R. 2670: Protecting Domestic Violence and Stalking Victims Act H.Res. 361: Supporting the goals and ideals of "National Gun Violence Awareness Day" and "National Gun Violence Awareness Month" H.Res. 367: Establishing the Select Committee on Gun Violence Prevention S. Res. 179: A resolution expressing support for the designation of June 2, 2017, as "National Gun Violence Awareness Day" and June 2017 as "National Gun Violence Awareness Month" H.Res. 373: Expressing support for the designation of June 2017 as "National Gun Violence Awareness Month" and calling on Congress to address gun violence H.R. 2784: Good Neighbor Gun Dealer Act H.R. 2810: National Defense Authorization Act for Fiscal Year 2018 H.R. 2841: Disarm Hate Act S. 1324: Disarm Hate Act H.R. 2909: DC Personal Protection Reciprocity Act H.R. 2940: Congressional Self-Defense Act H.R. 2945: Congressional Personal Safety Act H.R. 2951: To allow Members of Congress to carry a concealed handgun anywhere in the United States, with exceptions H.R. 2980: Protecting Gun Owners in Bankruptcy Act of 2017 S. 1387: Protecting the Second Amendment Act H.R. 3054: Veterans' Heritage Firearms Act of 2017 S. 1435: Veterans' Heritage Firearms Act of 2017 H.R. 3139: Hearing Protection Act of 2017 S. 1505: SHUSH Act S. 1541: A bill to modify the definition of an antique firearm. H.R. 3361: SECURE Firearm Storage Act H.R. 3458: MICRO Act H.R. 3464: Background Check Completion Act of 2017 H.R. 3576: SAGA Act H.R. 3613: Safer Neighborhoods Gun Buyback Act of 2017 H.R. 3668: SHARE Act H. Amdt. 378: Description: Amendment sought to reduce the funding level for the Bureau of Alcohol, Tobacco, Firearms and Explosives by five percent H. Amdt. 386: At the end of division C (before the short title), insert the following: Sec. XXXX. None of the funds made available by this Act to the Bureau of Alcohol, Tobacco, Firearms and Explosives H.R. 3790: Federal Firearms Licensee Protection Act S. 1854: Federal Firearms Licensee Protection Act of 2017 H.R. 3947: Automatic Gunfire Prevention Act H.R. 3962: Stop Online Ammunition Sales Act of 2017 S. 1915: Handgun Trigger Safety Act of 2017 S. 1916: Automatic Gunfire Prevention Act S. 1917: Sentencing Reform and Corrections Act of 2017 H.R. 3984: Equal Access to Justice for Victims of Gun Violence Act H.R. 3986: Stopping the Iron Pipeline Act of 2017 H.R. 3987: Protecting Americans from Gun Violence Act of 2017 S. 1923: Background Check Completion Act of 2017 S. 1939: Equal Access to Justice for Victims of Gun Violence Act S. 1945: Keep Americans Safe Act H.R. 3998: Protect America Act of 2017 H.R. 3999: To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes H.R. 4018: To provide for a 3-day waiting period before a person may receive a handgun, with exceptions H.R. 4025: Multiple Firearm Sales Reporting Modernization Act of 2017 H.R. 4052: Keep Americans Safe Act H.R. 4057: Denying Firearms and Explosives to Dangerous Terrorists Act of 2017 S. 1992: SECURE Firearm Storage Act S. 2009: Background Check Expansion Act H.R. 4142: Safer Communities Act of 2017 H.R. 4168: Closing the Bump-Stock Loophole Act H.R. 4183: Domestic Violence Records Reporting Improvement Act of 2017 H.R. 4192: Domestic Violence Gun Homicide Prevention Act of 2017 S. 2045: Domestic Violence Gun Homicide Prevention Act of 2017 H.R. 4240: Public Safety and Second Amendment Rights Protection Act of 2017 H.R. 4268: Gun Safety: Not Sorry Act of 2017 S. 2094: Domestic Violence Loophole Closure Act S. 2095: Assault Weapons Ban of 2017 H.R. 4342: Fire Sale Loophole Closing Act H.R. 4343: Unlawful Gun Buyer Alert Act H.R. 4344: End Purchase of Firearms by Dangerous Individuals Act of 2017 S. 2135: Fix NICS Act of 2017 H.R. 4434: Fix NICS Act of 2017 S. 2150: Imitation Firearms Safety Act of 2017 S. 2161: Hadiya Pendleton and Nyasia Pryear-Yard Gun Trafficking and Crime Prevention Act of 2017 H.R. 4471: NICS Denial Notification Act of 2017 H.R. 4477: Fix NICS Act of 2017 H. Res. 645: Providing for consideration of the bill (H.R. 38) to amend title 18, United States Code, to provide a means by which nonresidents of a State whose residents may carry concealed firearms may also do so in the State H.R. 4573: Gun Violence Research Act of 2017 H.R. 4721: Armor-Piercing Bullets Act of 2017 H.R. 4909: STOP School Violence Act of 2018 S. 2386: Veterans' Second Amendment Rights Restoration Act of 2018 H.R. 5077: Assault Weapons Ban of 2018 H.R. 5087: Assault Weapons Ban of 2018 H.R. 5090: Raise the Age Act H.R. 5103: Gun Violence Prevention and Safe Communities Act of 2018 H.R. 5106: Investor Choice Against Gun Proliferation Act H.R. 5112: SAFER Voter Act S. 2458: Terrorist Firearms Prevention Act S. 2470: Age 21 Act S. 2475: BUMP Act H.R. 5134: STOP Straw Purchases Act S. 2486: Safe Students Act H.R. 5161: To require the Surgeon General of the Public Health Service to submit to Congress an annual report on the effects of gun violence on public health. H.R. 5162: Firearm Safety Act of 2018 H.R. 5163: Keeping Guns from High-Risk Individuals Act S. 2492: NICS Denial Notification Act of 2018 S. 2495: STOP School Violence Act of 2018 S. 2502: Protecting Communities and Preserving the Second Amendment Act of 2018 H.R. 5225: Strengthening the National Instant Criminal Background Check System Act of 2018 S. 2521: Federal Extreme Risk Protection Order Act of 2018 H.R. 5271: Tiahrt Restrictions Repeal Act H.R. 5286: Mass Violence Prevention Reform Act S. 2546: MASS Act H.R. 5380: Securing Our Children Act of 2018 H.R. 5383: Ammunition Background Check Act of 2018 H.R. 5398: 21 to Buy Act S. 2607: Extreme Risk Protection Order and Violence Prevention Act of 2018 S. 2627: Ammunition Background Check Act of 2018 H.R. 5410: SAFER Now Act

H.R.1137 - Collectible Firearms Protection Act - To amend the Arms Export Control Act to provide that certain firearms listed as curios or relics may be imported into the United States by a licensed importer without obtaining authorization from the Department of State or the Department of Defense, and for other purposes. H.R.2033 - Undetectable Firearms Modernization Act - To modernize the Undetectable Firearms Act of 1988. H.R.2380 - Handgun Trigger Safety Act of 2017 - To provide for the development and use of technology for personalized handguns, to require that all handguns manufactured or sold in, or imported into, the United States incorporate such technology, and for other purposes. S.1541 - A bill to modify the definition of an antique firearm. H.R.3947 - Automatic Gunfire Prevention Act- To prohibit the possession or transfer of certain firearm accessories, and for other purposes. H.R.3962 - Stop Online Ammunition Sales Act of 2017- To require face-to-face purchases of ammunition, to require licensing of ammunition dealers, and to require reporting regarding bulk purchases of ammunition. S.1915 - Handgun Trigger Safety Act of 2017- To provide for the development and use of technology for personalized handguns, to require that all handguns manufactured or sold in, or imported into, the United States incorporate such technology, and for other purposes. S.1916 - Automatic Gunfire Prevention Act- To prohibit the possession or transfer of certain firearm accessories, and for other purposes. H.R.3986 - Stopping the Iron Pipeline Act of 2017- To provide for the establishment of a national standard for incorporating a passive identification ability into all firearms sold in the United States. H.R.3999 - To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes.- To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes. H.R.4064 - To impose restrictions on the sale of binary explosives, and for other purposes.- To impose restrictions on the sale of binary explosives, and for other purposes. S.2095 - Assault Weapons Ban of 2017- To regulate assault weapons, to ensure that the right to keep and bear arms is not unlimited, and for other purposes. H.R.4344 - End Purchase of Firearms by Dangerous Individuals Act of 2017- To incentivize State reporting systems that allow mental health professionals to submit information on certain individuals deemed dangerous for purposes of prohibiting firearm possession by such individuals, and for other purposes. S.2150 - Imitation Firearms Safety Act of 2017- To improve requirements for entering into commerce of imitation firearms, and for other purposes. H.R.4721 - Armor-Piercing Bullets Act of 2017- To enact into law a framework for deciding whether certain projectiles are primarily intended for sporting purposes for purposes of determining whether the projectiles are armor piercing ammunition. Legislation related to instant background checks for firearms purchases, firearms attachments and mental health issues.

Firearms: H.R.1137 - Collectible Firearms Protection Act - To amend the Arms Export Control Act to provide that certain firearms listed as curios or relics may be imported into the United States by a licensed importer without obtaining authorization from the Department of State or the Department of Defense, and for other purposes. H.R.2033 - Undetectable Firearms Modernization Act - To modernize the Undetectable Firearms Act of 1988. H.R.2380 - Handgun Trigger Safety Act of 2017 - To provide for the development and use of technology for personalized handguns, to require that all handguns manufactured or sold in, or imported into, the United States incorporate such technology, and for other purposes. S.1541 - A bill to modify the definition of an antique firearm. H.R.3947 - Automatic Gunfire Prevention Act- To prohibit the possession or transfer of certain firearm accessories, and for other purposes. H.R.3962 - Stop Online Ammunition Sales Act of 2017- To require face-to-face purchases of ammunition, to require licensing of ammunition dealers, and to require reporting regarding bulk purchases of ammunition. S.1915 - Handgun Trigger Safety Act of 2017- To provide for the development and use of technology for personalized handguns, to require that all handguns manufactured or sold in, or imported into, the United States incorporate such technology, and for other purposes. S.1916 - Automatic Gunfire Prevention Act- To prohibit the possession or transfer of certain firearm accessories, and for other purposes. H.R.3986 - Stopping the Iron Pipeline Act of 2017- To provide for the establishment of a national standard for incorporating a passive identification ability into all firearms sold in the United States. H.R.3999 - To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes.- To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes. H.R.4064 - To impose restrictions on the sale of binary explosives, and for other purposes.- To impose restrictions on the sale of binary explosives, and for other purposes. S.2095 - Assault Weapons Ban of 2017- To regulate assault weapons, to ensure that the right to keep and bear arms is not unlimited, and for other purposes. H.R.4344 - End Purchase of Firearms by Dangerous Individuals Act of 2017- To incentivize State reporting systems that allow mental health professionals to submit information on certain individuals deemed dangerous for purposes of prohibiting firearm possession by such individuals, and for other purposes. S.2150 - Imitation Firearms Safety Act of 2017- To improve requirements for entering into commerce of imitation firearms, and for other purposes. H.R.4721 - Armor-Piercing Bullets Act of 2017- To enact into law a framework for deciding whether certain projectiles are primarily intended for sporting purposes for purposes of determining whether the projectiles are armor piercing ammunition. H.R.4765 - Prevent Crime and Terrorism Act of 2018- To amend the Arms Export Control Act to prohibit the removal of certain items under category I, II, or III of the United States Munitions List for purposes of transferring the item to or controlling the item under any portion of the Commerce Control List of dual-use items in the Export Administration Regulations. H.R.5077 - Assault Weapons Ban of 2018- To regulate assault weapons, to ensure that the right to keep and bear arms is not unlimited, and for other purposes. H.R.5087 - Assault Weapons Ban of 2018- To regulate the importation, manufacture, possession, sale or transfer of assault weapons, and for other purposes. H.R.5103 - Gun Violence Prevention and Safe Communities Act of 2018- To amend the Internal Revenue Code of 1986 to increase the excise tax and special occupational tax in respect of firearms and to increase the transfer tax on any other weapon, and for other purposes. H.R.5106 - Investor Choice Against Gun Proliferation Act- To amend the Securities Exchange Act of 1934 to require issuers to disclose in an annual report any substantial financial relationship with any manufacturer or dealer of firearms or ammunition. H.R.5271 - Tiahrt Restrictions Repeal Act- To repeal certain impediments to the administration of the firearms laws. S.2627 - A bill to appropriately restrict sales of ammunition - To appropriately restrict sales of ammunition. H.R.5383 - Ammunition Background Check Act of 2018- To prevent the purchase of ammunition by prohibited purchasers. H.R.5410 - SAFER Now Act - To improve public safety through sensible reforms to firearms regulations. H.R.5560 - Defective Firearms Protection Act- To amend the consumer product safety laws to repeal of exclusion of pistols, revolvers, and other firearms from the definition of consumer product under such laws. H.R.6109 - SAFETY Act- To amend the Internal Revenue Code of 1986 to provide an enhanced research credit for the development of smart gun technologies. H.R.6296 - To amend the Arms Export Control Act to modify certification and report requirements relating to sales of major defense equipment with respect to which nonrecurring costs of research, development, and production are waived or reduced under the Arms Export Control Act, and for other purposes.- To amend the Arms Export Control Act to modify certification and report requirements relating to sales of major defense equipment with respect to which nonrecurring costs of research, development, and production are waived or reduced under the Arms Export Control Act, and for other purposes. H.R.6297 - To regulate the importation, manufacture, possession, sale or transfer of assault weapons, and for other purposes.- To regulate the importation, manufacture, possession, sale or transfer of assault weapons, and for other purposes.

Preserve Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments; proposing specific alternatives to CMS Advancing Care Information program that replaced the Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Improvement Activities categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians. Improve Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their cost-sharing reduction subsidies (CSRs) and that those CSRs should be continued indefinitely as part of a larger bipartisan effort to stabilize the individual insurance market. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Maternal Health: Advocated for the Preventing Maternal Deaths Act, H.R. 1318, which supports state Maternal Mortality Review Committees, and promotes national information sharing through the Centers for Disease Control and Prevention (CDC), so that states can continue to learn from best practices and collaborate as needed. This bill will also put data to work through demonstration projects to eliminate disparities in maternal health outcomes. Veterans Care: Regarding the VA Mission Act of 2018 (H.R. 5674), the College urged Congress to ensure that veterans have access to timely, contiguous care across the spectrum of health care services, with coordination and management of that care in the hands of a primary clinician or clinical care team; that the expansion of care to non-VHA facilities does not come at the cost of maintaining or improving existing VHA services or infrastructure; and that recruitment and retention of clinicians to the VHA is valued appropriately, including reimbursement for services provided. Non-discrimination Protections: Urged the U.S. Department of Health and Human Services not to weaken nondiscrimination protections for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals under Section 1557 of the Affordable Care Act. Immigration: Voiced support to Congress on the need to pass the Development, Relief, and Education for Alien Minors (DREAM) Act of 2017, H.R. 3440. This legislation would establish a three-step pathway to U.S. citizenship through college, work, or the armed services for individuals who were born in another country and brought illegally to the U.S. at a young age (DREAMers). Clinical Labs: Commented to the Centers for Medicare and Medicaid Services (CMS) on issues pertaining to the Protecting Access to Medicare Act of 2014 (PAMA), specifically citing concerns about the potential impacts of PAMA on patient access to critical rapid clinical testing services offered to patients while they are receiving medical care in their physicians office; expressed further concerns about impending cuts on Jan. 1, 2018 for physician office-based testing services. Expand Coverage and Stabilizing the Insurance Market: Congress should work to help stabilize the individual health insurance market and expand coverage. Specifically by develop and introduce comprehensive market stabilization legislation that includes reinsurance options to help stabilize the markets; Expanding cost-sharing assistance eligibility to purchase insurance in the exchanges as well as increase the level of premium tax credits and cost sharing subsidies offered to purchase a qualified health plan; Introducing legislation that would block the expansion of access to short-term health plans or Association Health Plans that allow insurers to charge more to individuals with pre-existing conditions and permit them to exclude from coverage essential medical care; Supporting $690 million in discretionary funding for federal exchanges within CMS Program Operations as part of the FY2019 Labor, Health and Human Services, and Education Appropriations bill. Reduce Unnecessary Administrative Tasks on Physicians and Patients: Congress should accelerate its efforts to reduce administrative burdens on clinicians and patients, including: Passing the Standardizing Electronic Prior Authorization for Safe Prescribing Act (H.R. 4841), which standardizes electronic prior authorization for prescription drugs under Medicare Part D. Adopt even greater harmonization of such standards across the health care industry; Passing the CONNECTIONS Act (H.R. 5812) by Reps. Griffith (R-VA) and Pallone (D-NJ) that would authorize CDC grants to state-run PDMPs to improve data collection and integration into physician clinical workflow specifically, of controlled substances overdose prevention and surveillance activities; Urging health care committees in Congress with jurisdiction over Medicare to exercise their oversight authority of CMS effort to overhaul clinical documentation guidelines with input from practicing clinicians; Passing the Improving Access to Medicare Coverage Act of 2017 (S. 568/H.R. 1421), which deems patients under observation as inpatients for the purposes of satisfying the Medicare 3-day inpatient stay requirement. Reduce Prescription Drug Costs: Congress should increase transparency and accountability in prescription drug pricing and improve access to lower-cost generic medications by passing the Drug Price Transparency in Communications Act (S. 2157), which would require drug companies to disclose the Wholesale Acquisition Cost of an Rx in Direct-to-Consumer Advertising. Representatives should introduce the companion bill; Passing the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2017 (S. 974/H.R. 2212), which would improve patient access to alternative low-cost prescription drugs and biological products by preventing prescription drug manufacturers from misusing the FDAs Risk Evaluation and Mitigation Strategies (REMS) process to make it difficult for competing generics to be brought to the market; Passing the Medicare Prescription Drug Price Negotiation Act of 2017 (S. 41/H.R. 242), which would grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for high�cost drugs and biologics covered under Part D; Passing the Fair Accountability and Innovative Research (FAIR) Pricing Act (S. 1131/H.R. 2439), which would require drug manufacturers to disclose and provide more information about planned drug price increases, including R&D costs. Fund Workforce, Medical and Health Services Research, Public Health Initiatives: Congress should ensure funding in FY 2019 for federal programs/initiatives designed to support primary care and reject funding rescissions that would harm childrens health coverage or CMS Innovation Center. This includes funding the Primary Care and Training Enhancement (PCTE) at $71 million in order to maintain and expand the pipeline for individuals training in primary care; Funding the National Health Service Corps (NHSC) at least at $415 million in total program funding to fund scholarships and loan repayment to health care professionals to help expand the countrys primary care workforce and meet the health care needs of underserved communities; Funding the Centers for Disease Control and Prevention (CDC) and Prevention and Public Health Fund (PPHF) at $8.45 billion; including PPHF funding at $805 million; Funding the Agency for Healthcare Research and Quality (AHRQ) at $454 million, restoring the agency to its FY2010 enacted level adjusting for inflation after cuts in FY2016 and FY2017 and a small increase in FY2018 so it can help clinicians help patients by making evidence-informed decisions, fund research that serves as the evidence engine for much of the private sectors work to keep patients safe; Funding the National Institutes of Health (NIH) at $39 billion so that this nations biomedical research can continue to fund cures for disease and maintain the U.S. standing as the world leader in medical and biomedical research. Promote Continued Action to Address the Epidemic of Opioid Use: Congress should pass a comprehensive legislative package to improve prevention, education, treatment and recovery for those suffering from opioid-related addictions, including: Providing for sufficient and increased funding to address the opioid epidemic, building and expanding upon the $4.65 billion in the omnibus bill approved by Congress, with at least $1 billion for programs as authorized by CARA 2.0; Expanding access and coverage for medication assisted treatment (methadone, buprenorphine, and naltrexone to prevent opioid and substance use disorders; Rejecting any proposal to impose a three day prescribing limit for initial opioid prescriptions to ensure that doctors have appropriate flexibility to determine the proper duration of each opioid prescription; Passing the Comprehensive Addiction and Recovery Act 2.0 of 2018 (S. 2456/H.R. 5311) as a step toward a more comprehensive opioids-related package. Reduce Firearms-Related Injury and Death: Congress should pass the Assault Weapons Ban of 2018 (S. 2095/H.R. 5077), which would ban the sale of high velocity, rapid file assault rifles and large capacity ammunition magazines and bump stocks; Pass the Brady Background Expansion Act (S. 2009), to expand background checks to virtually all firearm sales in the United States; Pass the Stop Illegal Trafficking in Firearms Act of 2017 (S. 1185), and the Stop Straw Purchases Act (H.R. 5134). Both would increase penalties for individuals who unlawfully purchase firearms for other persons who are prohibited from possessing firearms (known as straw purchasers); Repeal the Dickey amendment restricting firearms-related research by federal agencies and support $50 million in funding for the CDC to conduct such research; Pass S. 834/H.R. 1832 that authorizes funding for the CDC to conduct such research. Make Graduate Medical Education (GME) Funding More Effective: Congress should develop and pass legislation to reform GME to prioritize funding toward physician specialties where millions of patients lack access, including internal medicine specialists trained in comprehensive primary care, to: Increase the number of GME slots by at least 3,000 per year over five years for specialties facing shortages, including internal medicine, as contained in the Resident Physician Shortage Reduction Act of 2017 (S. 1301/H.R. 2267); Combine DGME/IME into a single, more functional program; broaden the GME financing structure to include all payers; Allocate GME funds transparently and to activities that further the educational mission of teaching and training residents/fellows with input from practicing clinicians and in collaboration with their professional organizations; Support continued adequate funding for the VHA and its substantial contributions to the ongoing training of the next generation of physicians.

Preserve Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments; proposing specific alternatives to CMS Advancing Care Information program that replaced the Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Improvement Activities categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians. Improve Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their cost-sharing reduction subsidies (CSRs) and that those CSRs should be continued indefinitely as part of a larger bipartisan effort to stabilize the individual insurance market. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Maternal Health: Advocated for the Preventing Maternal Deaths Act, H.R. 1318, which supports state Maternal Mortality Review Committees, and promotes national information sharing through the Centers for Disease Control and Prevention (CDC), so that states can continue to learn from best practices and collaborate as needed. This bill will also put data to work through demonstration projects to eliminate disparities in maternal health outcomes. Veterans Care: Regarding the VA Mission Act of 2018 (H.R. 5674), the College urged Congress to ensure that veterans have access to timely, contiguous care across the spectrum of health care services, with coordination and management of that care in the hands of a primary clinician or clinical care team; that the expansion of care to non-VHA facilities does not come at the cost of maintaining or improving existing VHA services or infrastructure; and that recruitment and retention of clinicians to the VHA is valued appropriately, including reimbursement for services provided. Non-discrimination Protections: Urged the U.S. Department of Health and Human Services not to weaken nondiscrimination protections for lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals under Section 1557 of the Affordable Care Act. Immigration: Voiced support to Congress on the need to pass the Development, Relief, and Education for Alien Minors (DREAM) Act of 2017, H.R. 3440. This legislation would establish a three-step pathway to U.S. citizenship through college, work, or the armed services for individuals who were born in another country and brought illegally to the U.S. at a young age (DREAMers). Clinical Labs: Commented to the Centers for Medicare and Medicaid Services (CMS) on issues pertaining to the Protecting Access to Medicare Act of 2014 (PAMA), specifically citing concerns about the potential impacts of PAMA on patient access to critical rapid clinical testing services offered to patients while they are receiving medical care in their physicians office; expressed further concerns about impending cuts on Jan. 1, 2018 for physician office-based testing services. Expand Coverage and Stabilizing the Insurance Market: Congress should work to help stabilize the individual health insurance market and expand coverage. Specifically by develop and introduce comprehensive market stabilization legislation that includes reinsurance options to help stabilize the markets; Expanding cost-sharing assistance eligibility to purchase insurance in the exchanges as well as increase the level of premium tax credits and cost sharing subsidies offered to purchase a qualified health plan; Introducing legislation that would block the expansion of access to short-term health plans or Association Health Plans that allow insurers to charge more to individuals with pre-existing conditions and permit them to exclude from coverage essential medical care; Supporting $690 million in discretionary funding for federal exchanges within CMS Program Operations as part of the FY2019 Labor, Health and Human Services, and Education Appropriations bill. Reduce Unnecessary Administrative Tasks on Physicians and Patients: Congress should accelerate its efforts to reduce administrative burdens on clinicians and patients, including: Passing the Standardizing Electronic Prior Authorization for Safe Prescribing Act (H.R. 4841), which standardizes electronic prior authorization for prescription drugs under Medicare Part D. Adopt even greater harmonization of such standards across the health care industry; Passing the CONNECTIONS Act (H.R. 5812) by Reps. Griffith (R-VA) and Pallone (D-NJ) that would authorize CDC grants to state-run PDMPs to improve data collection and integration into physician clinical workflow specifically, of controlled substances overdose prevention and surveillance activities; Urging health care committees in Congress with jurisdiction over Medicare to exercise their oversight authority of CMS effort to overhaul clinical documentation guidelines with input from practicing clinicians; Passing the Improving Access to Medicare Coverage Act of 2017 (S. 568/H.R. 1421), which deems patients under observation as inpatients for the purposes of satisfying the Medicare 3-day inpatient stay requirement. Reduce Prescription Drug Costs: Congress should increase transparency and accountability in prescription drug pricing and improve access to lower-cost generic medications by passing the Drug Price Transparency in Communications Act (S. 2157), which would require drug companies to disclose the Wholesale Acquisition Cost of an Rx in Direct-to-Consumer Advertising. Representatives should introduce the companion bill; Passing the Creating and Restoring Equal Access to Equivalent Samples (CREATES) Act of 2017 (S. 974/H.R. 2212), which would improve patient access to alternative low-cost prescription drugs and biological products by preventing prescription drug manufacturers from misusing the FDAs Risk Evaluation and Mitigation Strategies (REMS) process to make it difficult for competing generics to be brought to the market; Passing the Medicare Prescription Drug Price Negotiation Act of 2017 (S. 41/H.R. 242), which would grant authority to the Secretary of HHS to negotiate prescription drug prices with manufacturers for high�cost drugs and biologics covered under Part D; Passing the Fair Accountability and Innovative Research (FAIR) Pricing Act (S. 1131/H.R. 2439), which would require drug manufacturers to disclose and provide more information about planned drug price increases, including R&D costs. Fund Workforce, Medical and Health Services Research, Public Health Initiatives: Congress should ensure funding in FY 2019 for federal programs/initiatives designed to support primary care and reject funding rescissions that would harm childrens health coverage or CMS Innovation Center. This includes funding the Primary Care and Training Enhancement (PCTE) at $71 million in order to maintain and expand the pipeline for individuals training in primary care; Funding the National Health Service Corps (NHSC) at least at $415 million in total program funding to fund scholarships and loan repayment to health care professionals to help expand the countrys primary care workforce and meet the health care needs of underserved communities; Funding the Centers for Disease Control and Prevention (CDC) and Prevention and Public Health Fund (PPHF) at $8.45 billion; including PPHF funding at $805 million; Funding the Agency for Healthcare Research and Quality (AHRQ) at $454 million, restoring the agency to its FY2010 enacted level adjusting for inflation after cuts in FY2016 and FY2017 and a small increase in FY2018 so it can help clinicians help patients by making evidence-informed decisions, fund research that serves as the evidence engine for much of the private sectors work to keep patients safe; Funding the National Institutes of Health (NIH) at $39 billion so that this nations biomedical research can continue to fund cures for disease and maintain the U.S. standing as the world leader in medical and biomedical research. Promote Continued Action to Address the Epidemic of Opioid Use: Congress should pass a comprehensive legislative package to improve prevention, education, treatment and recovery for those suffering from opioid-related addictions, including: Providing for sufficient and increased funding to address the opioid epidemic, building and expanding upon the $4.65 billion in the omnibus bill approved by Congress, with at least $1 billion for programs as authorized by CARA 2.0; Expanding access and coverage for medication assisted treatment (methadone, buprenorphine, and naltrexone to prevent opioid and substance use disorders; Rejecting any proposal to impose a three day prescribing limit for initial opioid prescriptions to ensure that doctors have appropriate flexibility to determine the proper duration of each opioid prescription; Passing the Comprehensive Addiction and Recovery Act 2.0 of 2018 (S. 2456/H.R. 5311) as a step toward a more comprehensive opioids-related package. Reduce Firearms-Related Injury and Death: Congress should pass the Assault Weapons Ban of 2018 (S. 2095/H.R. 5077), which would ban the sale of high velocity, rapid file assault rifles and large capacity ammunition magazines and bump stocks; Pass the Brady Background Expansion Act (S. 2009), to expand background checks to virtually all firearm sales in the United States; Pass the Stop Illegal Trafficking in Firearms Act of 2017 (S. 1185), and the Stop Straw Purchases Act (H.R. 5134). Both would increase penalties for individuals who unlawfully purchase firearms for other persons who are prohibited from possessing firearms (known as straw purchasers); Repeal the Dickey amendment restricting firearms-related research by federal agencies and support $50 million in funding for the CDC to conduct such research; Pass S. 834/H.R. 1832 that authorizes funding for the CDC to conduct such research. Make Graduate Medical Education (GME) Funding More Effective: Congress should develop and pass legislation to reform GME to prioritize funding toward physician specialties where millions of patients lack access, including internal medicine specialists trained in comprehensive primary care, to: Increase the number of GME slots by at least 3,000 per year over five years for specialties facing shortages, including internal medicine, as contained in the Resident Physician Shortage Reduction Act of 2017 (S. 1301/H.R. 2267); Combine DGME/IME into a single, more functional program; broaden the GME financing structure to include all payers; Allocate GME funds transparently and to activities that further the educational mission of teaching and training residents/fellows with input from practicing clinicians and in collaboration with their professional organizations; Support continued adequate funding for the VHA and its substantial contributions to the ongoing training of the next generation of physicians.

SUPPORT S. 2009 - Background Check Expansion Act S. 1916 - Automatic Gunfire Prevention Act H.R. 4240 - Public Safety and Second Amendment rights Protection Act of 2017 S. 1992/H.R. 3361 - SECURE Firearm Storage Act H.R. 3947 - Automatic Gunfire Prevention Act H.R. 3984 - Equal Access to Justice for Victims of Gun Violence Act S 1939 - Equal Access to Justice for Victims of Gun Violence Act S. 834/H.R. 1832 - CDC gun research bills H.R. 1478 - Gun Violence Research Act H.R. 3207 - Zero Tolerance for Domestic Abuse Act S. 1539 - Protecting Domestic Violence and Stalking Victims Act of 2017 S. 1923/H.R. 3464 - Background Check Completion Act of 2017 S. 1945 & H.R. 4052 Keep Americans Safe Act S. 2095 Assault weapons Ban of 2017 H.R. 5087 Assault weapons Ban of 2018 S. 2521 Federal Extreme Risk Protection Order Act of 2018 S. 1212 Gun Violence Prevention Order Act of 2017 H.R. 2598 Gun Violence Restraining Order Act of 2017 H.R. 4471/S. 2492 NICS Denial Notification Act S. 2546 Make America Safe & Secure Act H.R. 6075 Keeping Gun Dealers Honest Act S.1324/H.R. 2841 Disarm Hate Act H.Con.Res.66 Expressing support for the designation of June 21 as National ASK (Asking Saves Kids) Day to promote childrens health and gun safety RAISING CONCERNS WITH PROVISIONS/SEEKING AMDTS. S. 2607 Extreme Risk Protection Order and Violence Prevention Act AGAINST H.R. 3668 Sportsmens Heritage and Recreational Enhancement (SHARE) Act H.R. 367/S. 59 Hearing Protection Act of 2017 H.R. 1181 Veterans 2nd Amendment Rights Protection Act S. 446/H.R. 38 Concealed Carry Reciprocity Act of 2017 H.R. 1976/S.1397 Protecting the Second Amendment Act

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

Support ending the ban on CDC Gun Research Support requiring universal background checks on all gun sales and transfers support a ban on the sale of all military-style semi-automatic assault guns and military high capacity ammunition clips (support HR 5078 / S. 2095 and S. 1945 Support tough new criminal penalties for straw purchasers and gun traffickers Support a ban on suspects on the terror watch list from purchasing firearms Support the Fix NICS Act (H.R. 4434 / S. 2135). Incentivize and assist states in improving their overall reporting to the National Instant Criminal Background Check System (NICS). Support maintaining current law requiring background checks and permits for gun silencers. Support a ban on bump stocks machine-gun type firing and other conversion kits, accessories and parts Support allowing states to maintain and enforce their own concealed carry laws Support requiring the repeal of all state stand your ground laws, restoring the use of deadly force as a last resort Support microstamping or ballistic fingerprinting of all new firearms and ammunition sold in the U.S. support encouraging local jurisdictions to utilize their buyer power to create incentives for firearm manufacturers to employ countermarketing strategies to ensure that their retailers are using all available procedures to prevent illegal firearms diversion Support Thompson (CA) resolution calling for consideration of legislation related to gun regulation

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

Oppose the Justice Departments recent withdrawal of a number of guidance and technical assistance documents concerning the Americans with Disabilities Act (ADA) Support the reauthorization of Byrne JAG grants Oppose the Department of Justices request for a new citizenship question on the 2020 Census Support House-passed amendments regarding civil forfeiture in any year-long appropriations bill Support full funding of critical juvenile justice and delinquency prevention programs in fiscal year 2019 Support S. 1917, with reservations about new mandatory minimums imposed by the bill Support a more robust response to the hate violence and groups that flourish on social media platforms, dont just focus on Muslim extremists Support the federal governments crucial role in spurring criminal justice innovation, as well as testing and replicating evidence-based practices nationwide by funding programs including the Office of Violence Against Women and the COPS program Support appropriating $95 million in FY2019 to the Department of Labor for its Reintegration of Ex-Offenders program Support the FDICs proposals to changes to its policies governing the circumstances under which FDIC-regulated banks may hire people with prior criminal histories, with suggestions to improve / strengthen the proposal Support an independent Community Relations Service (CRS); oppose the Trump proposal to move CRS under the Department of Justice Office of Civil Rights Support S. 2520, the Inmate Calling Technical Corrections Act introduced by Senator Duckworth which allows the FCC to regulate prison phone rates. Strong concerns about HR 4909, the STOP (Students, Teachers, and Officers Preventing) School Violence Act which is misguided, duplicative, and may be harmful to all students. Oppose the legislation unless these concerns are met. Support the Comprehensive School Safety Initiative (CSSI), a research-focused initiative created in response to school violence Oppose HR 5028, which would exempt attorneys engaged in a lawsuits from the Fair Debt Collection Act. Support 2013 school discipline guidance, issued jointly by the Department of Education and the Department of Justice which clarifies schools responsibilities under civil rights laws to administer discipline in a nondiscriminatory manner and also provide educators information about alternatives to suspensions and ways to build positive school climates. Oppose the Presidents proposal calling for increasing sentences for drug offenders, including the death penalty. S.1994, the CORRECTIONS Act, and H.R. 3356, the Prison Reform and Redemption Act, are not sentencing reform and should not be viewed as such. This legislation will not, alone, substantially alleviate prison overcrowding or mass incarceration Oppose mandatory arbitration clauses for investors; support the SEC protecting investors rights to bring securities class action lawsuits Support proposals to build trust between law enforcement and the communities they serve. Support initiatives to standardize use of force policies for law enforcement. support ending racial and religious profiling. Support H.R. 1498 / S. 411 Support initiatives to study and eventually eliminate prosecutorial misconduct / bias. support the establishment of local effective and independent review boards of alleged law enforcement misconduct. Support requiring video surveillance of all law enforcement activities Support genuine sentencing reform to alleviate prison overcrowding, over-incarceration, and the overrepresentation of racial and ethnic minorities who are in prison. Support HR 4261 Support a commission to review all aspects of our national criminal justice system. Support H.R. 1886 / S.573 Support ending the ban on CDC Gun Research Support requiring universal background checks on all gun sales and transfers support a ban on the sale of all military-style semi-automatic assault guns and military high capacity ammunition clips (support HR 5078 / S. 2095 and S. 1945 Support tough new criminal penalties for straw purchasers and gun traffickers Support a ban on suspects on the terror watch list from purchasing firearms Support the Fix NICS Act (H.R. 4434 / S. 2135). Incentivize and assist states in improving their overall reporting to the National Instant Criminal Background Check System (NICS) Support sensitivity training of law enforcement & independent investigations of deadly force (HR 1870 / S 860)Support maintaining current law requiring background checks and permits for gun silencers. Support a ban on bump stocks machine-gun type firing and other conversion kits, accessories and parts Support allowing states to maintain and enforce their own concealed carry laws Support requiring the repeal of all state stand your ground laws, restoring the use of deadly force as a last resort Support microstamping or ballistic fingerprinting of all new firearms and ammunition sold in the U.S. support encouraging local jurisdictions to utilize their buyer power to create incentives for firearm manufacturers to employ countermarketing strategies to ensure that their retailers are using all available procedures to prevent illegal firearms diversion Support an abolishment of the death penalty Support the Second Chance Act reauthorization (HR 2899) Support the reauthorization and updating of the Juvenile Justice Delinquency Prevention Act(support HR 1809 / S 860 Support the reform of money bail (HR 4019 / S 1593) Support incentivizing states and local jurisdictions to fully and accurately report hate crimes (HR 1566 / S. 667) Support the removal of statues of Confederate soldiers from the U.S. Capital (support HR 3701 / S 1772) Support encouraqing states to decrease prison populations and keep crime down (support HR 3845 / S 1458) Support the Compensating Legacy Artists for their Songs, Service, and Important Contributions to Society (CLASSICS) Act (H.R. 3301/S. 2393), bipartisan and which ensures legacy musicians are compensated when their work is played on digital radio platforms. Oppose the nomination of Thomas Farr to the Federal Court for the Eastern District of North Carolina Support the inclusion of provisions to: final federal legislation to: Curtail the ballooning number of federal regulatory crimes; eliminate federal criminal penalties for simple drug possession in state jurisdictions; promote targeted sentencing of drug offenders, ensuring that violent and career criminals and crime leaders and organizers are held accountable; update supervision policies to more effectively change the criminal behavior of the nearly 132,000 on probation and post-prison supervision; increase government transparency and accountability by requiring public disclosure of regulatory criminal offenses; allowing victims of regulatory over-criminalization to contact the inspector general; protecting against wrongful convictions; encourage judicial districts to open drug, veteran, mental health and other problem solving courts; reinvest the substantial savings by investing in communities, prevention, and intervention initiatives and state, local, and federal law enforcement and prosecutors reduce recidivism by using swift and certain responses so offenders know what will happen if they re-offend or act in a certain way; create a system of rewards and incentives for good behavior; and acknowledge that age matters by implementing smart, targeted geriatric release programs which can ensure heinous offenders remain behind bars while cutting down on costs and maintaining public safety. In any sentencing reform legislation.

H.R.1137 - Collectible Firearms Protection Act - To amend the Arms Export Control Act to provide that certain firearms listed as curios or relics may be imported into the United States by a licensed importer without obtaining authorization from the Department of State or the Department of Defense, and for other purposes. H.R.2033 - Undetectable Firearms Modernization Act - To modernize the Undetectable Firearms Act of 1988. H.R.2380 - Handgun Trigger Safety Act of 2017 - To provide for the development and use of technology for personalized handguns, to require that all handguns manufactured or sold in, or imported into, the United States incorporate such technology, and for other purposes. S.1541 - A bill to modify the definition of an antique firearm. H.R.3947 - Automatic Gunfire Prevention Act- To prohibit the possession or transfer of certain firearm accessories, and for other purposes. H.R.3962 - Stop Online Ammunition Sales Act of 2017- To require face-to-face purchases of ammunition, to require licensing of ammunition dealers, and to require reporting regarding bulk purchases of ammunition. S.1915 - Handgun Trigger Safety Act of 2017- To provide for the development and use of technology for personalized handguns, to require that all handguns manufactured or sold in, or imported into, the United States incorporate such technology, and for other purposes. S.1916 - Automatic Gunfire Prevention Act- To prohibit the possession or transfer of certain firearm accessories, and for other purposes. H.R.3986 - Stopping the Iron Pipeline Act of 2017- To provide for the establishment of a national standard for incorporating a passive identification ability into all firearms sold in the United States. H.R.3999 - To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes.- To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes. H.R.4064 - To impose restrictions on the sale of binary explosives, and for other purposes.- To impose restrictions on the sale of binary explosives, and for other purposes. S.2095 - Assault Weapons Ban of 2017- To regulate assault weapons, to ensure that the right to keep and bear arms is not unlimited, and for other purposes. H.R.4344 - End Purchase of Firearms by Dangerous Individuals Act of 2017- To incentivize State reporting systems that allow mental health professionals to submit information on certain individuals deemed dangerous for purposes of prohibiting firearm possession by such individuals, and for other purposes. S.2150 - Imitation Firearms Safety Act of 2017- To improve requirements for entering into commerce of imitation firearms, and for other purposes. H.R.4721 - Armor-Piercing Bullets Act of 2017- To enact into law a framework for deciding whether certain projectiles are primarily intended for sporting purposes for purposes of determining whether the projectiles are armor piercing ammunition. H.R.4765 - Prevent Crime and Terrorism Act of 2018- To amend the Arms Export Control Act to prohibit the removal of certain items under category I, II, or III of the United States Munitions List for purposes of transferring the item to or controlling the item under any portion of the Commerce Control List of dual-use items in the Export Administration Regulations. H.R.5077 - Assault Weapons Ban of 2018- To regulate assault weapons, to ensure that the right to keep and bear arms is not unlimited, and for other purposes. H.R.5087 - Assault Weapons Ban of 2018- To regulate the importation, manufacture, possession, sale or transfer of assault weapons, and for other purposes. H.R.5103 - Gun Violence Prevention and Safe Communities Act of 2018- To amend the Internal Revenue Code of 1986 to increase the excise tax and special occupational tax in respect of firearms and to increase the transfer tax on any other weapon, and for other purposes. H.R.5106 - Investor Choice Against Gun Proliferation Act- To amend the Securities Exchange Act of 1934 to require issuers to disclose in an annual report any substantial financial relationship with any manufacturer or dealer of firearms or ammunition. H.R.5271 - Tiahrt Restrictions Repeal Act- To repeal certain impediments to the administration of the firearms laws. S.2627 - A bill to appropriately restrict sales of ammunition - To appropriately restrict sales of ammunition. H.R.5383 - Ammunition Background Check Act of 2018- To prevent the purchase of ammunition by prohibited purchasers. H.R.5410 - SAFER Now Act - To improve public safety through sensible reforms to firearms regulations.

H.R.1137 - Collectible Firearms Protection Act - To amend the Arms Export Control Act to provide that certain firearms listed as curios or relics may be imported into the United States by a licensed importer without obtaining authorization from the Department of State or the Department of Defense, and for other purposes. H.R.2033 - Undetectable Firearms Modernization Act - To modernize the Undetectable Firearms Act of 1988. H.R.2380 - Handgun Trigger Safety Act of 2017 - To provide for the development and use of technology for personalized handguns, to require that all handguns manufactured or sold in, or imported into, the United States incorporate such technology, and for other purposes. S.1541 - A bill to modify the definition of an antique firearm. H.R.3947 - Automatic Gunfire Prevention Act- To prohibit the possession or transfer of certain firearm accessories, and for other purposes. H.R.3962 - Stop Online Ammunition Sales Act of 2017- To require face-to-face purchases of ammunition, to require licensing of ammunition dealers, and to require reporting regarding bulk purchases of ammunition. S.1915 - Handgun Trigger Safety Act of 2017- To provide for the development and use of technology for personalized handguns, to require that all handguns manufactured or sold in, or imported into, the United States incorporate such technology, and for other purposes. S.1916 - Automatic Gunfire Prevention Act- To prohibit the possession or transfer of certain firearm accessories, and for other purposes. H.R.3986 - Stopping the Iron Pipeline Act of 2017- To provide for the establishment of a national standard for incorporating a passive identification ability into all firearms sold in the United States. H.R.3999 - To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes.- To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes. H.R.4064 - To impose restrictions on the sale of binary explosives, and for other purposes.- To impose restrictions on the sale of binary explosives, and for other purposes. S.2095 - Assault Weapons Ban of 2017- To regulate assault weapons, to ensure that the right to keep and bear arms is not unlimited, and for other purposes. H.R.4344 - End Purchase of Firearms by Dangerous Individuals Act of 2017- To incentivize State reporting systems that allow mental health professionals to submit information on certain individuals deemed dangerous for purposes of prohibiting firearm possession by such individuals, and for other purposes. S.2150 - Imitation Firearms Safety Act of 2017- To improve requirements for entering into commerce of imitation firearms, and for other purposes. H.R.4721 - Armor-Piercing Bullets Act of 2017- To enact into law a framework for deciding whether certain projectiles are primarily intended for sporting purposes for purposes of determining whether the projectiles are armor piercing ammunition. Legislation related to instant background checks for firearms purchases, firearms attachments and mental health issues.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program; voiced strong opposition to the American Health Care Act/Better Care Reconciliation Act/Graham-Cassidy proposal because these bills would cap the federal contribution to Medicaid or block grant the program, end support for Medicaid expansion, allow state waivers to eliminate essential evidence-based benefits, cut funding for opioid use treatment, restrict access to womens health services, and replace the Affordable Care Acts income-based premium and cost-saving subsidies with regressive age-based ones that will raise premiums and deductibles for most Americans, especially, for older, poorer and sicker patients. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments in 2019; proposing specific alternatives to CMS Advancing Care Information program that is to replace the current Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Clinical Practice Improvement categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians; that CMS use its authority to adjust resource use down from 10 percent in the first performance period by setting resource use at zero and increasing the quality performance category by 10 percent to make up for the difference; that CMS ensures the utmost transparency in how the Agency attributes cost, based on the use of the patient relationship categories and codes, along with the codes for care episodes and patient conditions; that CMS allow all Accountable Care Organizations (ACOs) to be eligible to participate in Track 1+ and to not restrict participation based on ACO size or composition (ex. only physician-led ACOs or small ACOs); that CMS allow current ACOs to move into Track 1+ at the start of any performance year and not be required to wait until the beginning of their next three-year agreement period; that Track 1+ utilize the same benchmarking methodology used for the other MSSP tracks; that CMS implement a minimum threshold of 5,000 beneficiaries for Track 1+, which is consistent with the other MSSP tracks but is lower than the 10,000 (or 7,500 for rural ACOs) beneficiary threshold used in the Next Generation ACO model. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Urged lawmakers to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; Allocate GME funds transparently and specifically to activities that further the educational mission of teaching and training residents and fellows with input from practicing clinicians and in collaboration with their professional organizations. FY2018 Appropriations: Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps. Also, advocated for the reauthorization of critical workforce programs that expired on Sept. 30, 2017 including, Community Health Centers, the Teaching Health Center Graduate Medical Education program, the National Health Services Corps, and expired on Dec. 8th, the Title VII Health Professions programs; Advocated for raising the budget caps equally on defense and non-defense discretionary spending; Restore $40 million in unobligated funds for the National Quality Forum plus $7.5 million in funding for the next two fiscal years. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their cost-sharing reduction subsidies (CSRs) and that those CSRs should be continued indefinitely as part of a larger bipartisan effort to stabilize the individual insurance market. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Reducing Administrative Burdens on Physicians: Urged Congress to reduce administrative tasks that negatively impact physicians and patients, including: 1) Encourage the administration to convene a multi-agency task force to identify tasks that could be streamlined or eliminated, based on a new comprehensive framework to assess the intent and impact of administrative tasks on care as proposed in ACPs policy paper, Putting Patients First by Reducing Administrative Tasks in Health Care. Establish a process to require that CMS and other relevant federal agencies reexamine and replace the existing E/M documentation guidelines with input from practicing clinicians and their professional organizations, 3) Call on federal advisory bodies, such as the Medicare Payment Advisory Commission (MedPAC), to research the effect of administrative tasks on patient and family care experience and outcomes, 4) Facilitate congressional hearings among government, clinician stakeholders, EHR vendors and suppliers to foster collaboration between parties to recognize their role and responsibility in reducing health IT administrative burdens. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Urged lawmakers to include language in the final House opioids legislative package to ensure healthcare providers who are engaged in population health initiatives have access to the medical records they need, including information on substance use disorders, to effectively and safely treat their patients; Urged lawmakers to reach agreement on a final conference report to the Comprehensive Addiction and Recovery Act (CARA) that would include: Development of a federal interagency task force to review, modify, and update, as appropriate, best practices for pain management and prescribing pain medication; Grants to states to expand awareness and education of physicians, patients, health care providers regarding the risks associated with the misuse of opioids; A comprehensive Prescription Drug Monitoring Program (PDMP) to track the dispensing of controlled substances; Increased availability of opioid overdose reversal drugs; Alternatives to incarceration to individuals who misuse opioid drugs and other substances to manage their pain. The College was also encourage by Administrations Opioid Commission report, released in November, that emphasizes the need to expand access to substance use disorder treatment, for which there is a massive demand in many parts of the country. Chronic Care Management: Urged lawmakers to eliminate the beneficiary co-pay for chronic care management (CCM) services, require reimbursement and coverage of additional codes for more complex CCM services, direct HHS to authorize payment for CCM codes to allow physicians to spend up to 40 minutes with a patient and an additional code that would allow for 60 minutes of treatment for a patient with multiple chronic illnesses; Advocated for passage of The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, S. 870, which would expand the use of tele-health for individuals with stroke, provide flexibility for Medicare beneficiaries to be part of an Accountable Care Organization, extend the Independence at Home model of care. Childrens Health: Advocated for a 5-year extension of the Childrens Health Insurance Program (CHIP), which expired on Sept. 30, 2017, on the basis of it serving as the key health insurance safety net program for children of low-income families. Insurance Market Stabilization: Advocated with Congress on the need to stabilize the health insurance market, including the need to fund cost-sharing reduction (CSRs) payments for the long-term; Urged enactment of legislation, built around robust federal funding for reinsurance that is adequate to ensure stability, encourage competition and lower costs for consumers while maintaining the core consumer protections in current federal statute. Reinsurance provisions of this legislation should be structured in a manner to bring relief to consumers in every state. To assure its sustainability, any legislative solution must be bipartisan. Immigration: Voiced support to Congress on the need to pass the Development, Relief, and Education for Alien Minors (DREAM) Act of 2017, H.R. 3440. This legislation would establish a three-step pathway to U.S. citizenship through college, work, or the armed services for individuals who were born in another country and brought illegally to the U.S. at a young age (DREAMers). Clinical Labs: Commented to the Centers for Medicare and Medicaid Services (CMS) on issues pertaining to the Protecting Access to Medicare Act of 2014 (PAMA), specifically citing concerns about the potential impacts of PAMA on patient access to critical rapid clinical testing services offered to patients while they are receiving medical care in their physicians office; expressed further concerns about impending cuts on Jan. 1, 2018 for physician office-based testing services. Medicare Physician Fee Schedule: Commented to CMS on the CY2018 proposed and final rules on the Physician Fee Schedule, including: any revisions made to the E/M documentation guidelines should not result in a revaluation of the entire E/M code set; all relevant stakeholders, including medical specialty organizations, should work with both the Current Procedural Terminology (CPT) Editorial Panel and CMS to create frameworks outlining general principles of care that are beneficial and appropriate for medical specialties in describing the varying approaches to patient care for the current levels of E/M codes; CMS should simplify the documentation requirements necessary to bill CCM services in order to ease the burden of documenting each separate minute of care management over the course of the month; CMS should modify the existing PAMA regulations through issuance of an interim final rule that provides for CMS to conduct targeted market segment surveys (reference laboratories, physician office-base laboratories, independent laboratories, and hospital outreach laboratories) to validate and adjust the final amount calculated based on the data collection to ensure Congressional intent-payment rates that accurately reflect private market payments across all market segments-is achieved; CMS should provide relief from penalties associated with the Medicare EHR Incentive Program (Meaningful Use) for the 2016 performance period for ECs who tried but were unsuccessful at reporting MU. Medicare Access and CHIP Reauthorization Act (MACRA): Called on CMS to: work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM) pathways, including the development and implementation of the performance measures to be used within these programs; to reduce administrative tasks and burdens on physicians; collaborate with specialty societies, frontline clinicians, patients, and electronic health record (EHR) vendors in the development, testing, and implementation of measures with a focus on integrating the measurement of and reporting on performance with quality improvement and care delivery and decreasing clinician burden. Urged Congress to: continue the existing flexibility in the MACRA statute that CMS is currently using for an additional three years so that the agency may move forward as the necessary program elements are put in place; clarify that Medicare Part B drugs and other items and services outside the physician fee schedule are not included in the application of MIPS payment adjustments and determination of MIPS eligibility; rationalize what is considered a small practice; and explicitly authorize the Physician-focused Payment Model Technical Advisory Committee (PTAC) to provide technical assistance to developers of Advanced Payment Models. State Medicaid Waivers: The College commented to CMS on the Arizona Health Care Cost Containment System (AHCCCS) 1115 Waiver amendment request opposing the request for a 5-year maximum lifetime limit on coverage for certain enrollees. Placing an arbitrary limit on enrollment could disrupt continuity of care and undermine the patient-physician relationship. Patients with chronic conditions may need ongoing care management from their physician and health care team. Abruptly ending a patients medical assistance after 5 years could sever a patients link to their care team and threaten progress. The College also commented to CMS on the KanCare 2.0 State Extension Application opposing the 36-month limit on KanCare 2.0 coverage. This proposal would greatly harm patients with complex chronic care needs, including patients with diabetes, obesity, cardiovascular disease, and asthma, who require ongoing care management. The College also commented to CMS on the New Mexico Centennial Care 2017 Extension Application expressing concerns that the states proposal to implement premiums and cost sharing for the Other Adult Group expansion population with household income that exceeds 100% FPL will undermine access to care. The proposal would impose monthly premiums of $10 in 2019 and provide the state the option of raising the premium to $20 a month in subsequent years. The College believes that Medicaid premiums and cost-sharing should be structured in a way that does not discourage enrollment or cause enrollees to disenroll or delay or forgo care due to cost, especially those with chronic disease. Firearms: The College urged Congress to: Reject any consideration of the Concealed Carry Reciprocity Act (H.R. 38) as passed by the House in December, 2017; Pass S. 2095, the Assault Weapons Ban of 2017, which would place bans on the sale of high-velocity, rapid-fire assault rifles (rifles specifically designed to inflict lethal harm to as many victims as possible, in as little time as possible), large capacity ammunition magazines and bump stocks; Pass S. 2135, the Fix NICS Act, which would strengthen the criminal background check system to help ensure that criminals and domestic abusers are prevented from obtaining firearms; Enact strong penalties for persons who unlawfully purchase firearms for other persons who are in a prohibited category-known as straw purchasers; Repeal the Dickey amendment, which limits the ability of the Centers for Disease Control and Prevention, the National Institutes of Health, and the National Institute of Justice, to study the effect of violence and unintentional firearms-related injury on public health and safety, and to eliminate any language in appropriations bills for these agencies that would preclude them from conducting such studies.

Preserving Access to Primary Care Services: Address the shortage of primary care physicians; provide scholarships and loan forgiveness in exchange for primary care service commitments to practice in critical shortage areas; provide grants for medical school mentorship programs and primary care training in community health centers; increase Title VII funding for primary care health programs; increase funding for the National Health Service Corps, provide regulatory relief for primary care physicians; H.R. 7192/S. 1174, the Preserving Patient Access to Primary Care Act (as first introduced in the 111th Congress). Support the Affordable Care Act (P.L. 111-148, P.L. 111-152) by: Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Training more primary care physicians through the National Health Service Corps, Title VII health professions funding, and redistributing unused graduate medical education positions to primary care specialties facing shortages; Beginning in 2014, ensuring that nearly all Americans have access to coverage either through subsidized private health insurance offered by state health exchanges or through Medicaid, if they don't already have access to coverage through an employer, Medicare, or another public program; voiced strong opposition to the American Health Care Act/Better Care Reconciliation Act/Graham-Cassidy proposal because these bills would cap the federal contribution to Medicaid or block grant the program, end support for Medicaid expansion, allow state waivers to eliminate essential evidence-based benefits, cut funding for opioid use treatment, restrict access to womens health services, and replace the Affordable Care Acts income-based premium and cost-saving subsidies with regressive age-based ones that will raise premiums and deductibles for most Americans, especially, for older, poorer and sicker patients. Medicare Physician Payment Reform: Advocated in support of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA), which was enacted in April 2015 and repealed Medicares Sustainable Growth Rate (SGR) formula and moved us to a new value-based payment and delivery system under Medicare; Advocated with CMS on numerous aspects of the MACRA proposed and final rules, including: proposing a distinctive alternative scoring methodology, developed by ACP, which combines, simplifies, aligns and reduces the complexity of the four reporting categories that will qualify physicians for FFS payment adjustments in 2019; proposing specific alternatives to CMS Advancing Care Information program that is to replace the current Meaningful Use program; proposing additional improvements to simplify the reporting requirements for the Quality, Advancing Care Information and Clinical Practice Improvement categories; urging CMS to immediately create virtual reporting options and to create safe harbors for smaller practices until such options are available; proposing more options and flexibility, instead of a one-size fits all approach, for practices to be certified as Patient-Centered Medical Homes or Patient-Centered Medical Home specialty practices, qualifying them for the highest possible score for the Clinical Practice Improvement Activity reporting category; Proposing four different options for Medical Home practices to qualify as advanced Alternative Payment Models, instead of the single option proposed by CMS, including options to allow PCMHs to qualify without taking financial risk: Advocated with CMS on Patient Relationship Categories and Codes, as required by MACRA, specifically: that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) pathways; that the implementation of these categories and codes is carried out in a manner that fully considers and minimizes the impact of reporting burden on the participating clinicians and that has appropriate flexibility to allow for learning and improvement in the approach by both the Agency and the clinicians; that CMS use its authority to adjust resource use down from 10 percent in the first performance period by setting resource use at zero and increasing the quality performance category by 10 percent to make up for the difference; that CMS ensures the utmost transparency in how the Agency attributes cost, based on the use of the patient relationship categories and codes, along with the codes for care episodes and patient conditions; that CMS allow all Accountable Care Organizations (ACOs) to be eligible to participate in Track 1+ and to not restrict participation based on ACO size or composition (ex. only physician-led ACOs or small ACOs); that CMS allow current ACOs to move into Track 1+ at the start of any performance year and not be required to wait until the beginning of their next three-year agreement period; that Track 1+ utilize the same benchmarking methodology used for the other MSSP tracks; that CMS implement a minimum threshold of 5,000 beneficiaries for Track 1+, which is consistent with the other MSSP tracks but is lower than the 10,000 (or 7,500 for rural ACOs) beneficiary threshold used in the Next Generation ACO model. Medical Education: Provide incentives to medical schools, community health centers, or hospitals, to increase the numbers of physicians choosing primary care; authorize HHS to selectively eliminate Graduate Medical Education (GME) caps for residency programs in primary care, advocated for S. 1627, which would increase the number of Medicare-supported training positions for medical residents by 15 percent (approximately 15,000 slots) over five years, requiring at least 50 percent of the new positions to be allocated to specialties facing a current shortage; Urged lawmakers to combine DGME and IME into a single, more functional payment program, and broaden the GME financing structure to include all payers; Allocate GME funds transparently and specifically to activities that further the educational mission of teaching and training residents and fellows with input from practicing clinicians and in collaboration with their professional organizations FY2018 Appropriations: Supported funding to "improve health care quality, enhance consumer choice, advance patient safety, improve efficiency, reduce medical errors, and broaden access to essential services; Advocated for funding for AHRQ and Patient Centered Outcome Research Trust Fund, the Health Resources and Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement; National Health Service Corps. Also, advocated for the reauthorization of critical workforce programs that expired on Sept. 30, 2017 including, Community Health Centers, the Teaching Health Center Graduate Medical Education program, the National Health Services Corps, and expired on Dec. 8th, the Title VII Health Professions programs; Advocated for raising the budget caps equally on defense and non-defense discretionary spending; Restore $40 million in unobligated funds for the National Quality Forum plus $7.5 million in funding for the next two fiscal years. Public Health Programs and Funding: Increase funding to accomplish the core missions and activities of the major federal public health agencies, including: biomedical and behavioral research, disease prevention and health promotion, access to safety net health care services, health professions education, mental health and substance abuse, health services research, food and drug safety. Improving Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Ensure that all Americans will have access to affordable coverage. Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Regarding the Essential Health Benefits Bulletin, issued by the Department of Health and Human Services (HHS) on December 16, 2011, the College advocated for striking a balance between comprehensiveness and affordability while giving States some freedom to determine a package that best serve the needs of residents. The College believes that strong oversight is needed when determining the initial benchmark plan (and whether it reflects the coverage requirements of the Affordable Care Act) and how the package will be updated, particularly if insurers are given the ability to substitute benefits within and across categories. State and the federal government must work in concert with physicians, health care providers and payers to determine and promote use of clinically effective and cost-effective services that result in improved patient health while bending the cost curve. Under the Affordable Care Act, advocated to ensure that people residing in states with health insurance marketplaces operated by the federal government do not lose their cost-sharing reduction subsidies (CSRs) and that those CSRs should be continued indefinitely as part of a larger bipartisan effort to stabilize the individual insurance market. Pilot test Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the establishing of a new CMS Innovation Center to pilot-test new payment models, such as the medical home; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Reducing Administrative Burdens on Physicians: Urged Congress to reduce administrative tasks that negatively impact physicians and patients, including: 1) Encourage the administration to convene a multi-agency task force to identify tasks that could be streamlined or eliminated, based on a new comprehensive framework to assess the intent and impact of administrative tasks on care as proposed in ACPs policy paper, Putting Patients First by Reducing Administrative Tasks in Health Care. Establish a process to require that CMS and other relevant federal agencies reexamine and replace the existing E/M documentation guidelines with input from practicing clinicians and their professional organizations, 3) Call on federal advisory bodies, such as the Medicare Payment Advisory Commission (MedPAC), to research the effect of administrative tasks on patient and family care experience and outcomes, 4) Facilitate congressional hearings among government, clinician stakeholders, EHR vendors and suppliers to foster collaboration between parties to recognize their role and responsibility in reducing health IT administrative burdens. Opioid Abuse: ACP supports efforts in trying to improve access to care and treatment for those suffering from mental health and substance abuse disorders. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP supports a comprehensive national policy on prescription drug abuse containing education, monitoring, proper disposal, and enforcement elements. As contained in S. 2256, Co-Prescribing Saves Lives Act of 2015, ACP is supportive of expanding access to naloxone within the community. ACP also supports the policy proposal known as partial-fill. This would allow a patient to elect to receive a portion of a prescription, and return for either a portion of, or the remainder of the prescription, if the pain persists, up to a 30-day maximum. Urged lawmakers to include language in the final House opioids legislative package to ensure healthcare providers who are engaged in population health initiatives have access to the medical records they need, including information on substance use disorders, to effectively and safely treat their patients; Urged lawmakers to reach agreement on a final conference report to the Comprehensive Addiction and Recovery Act (CARA) that would include: Development of a federal interagency task force to review, modify, and update, as appropriate, best practices for pain management and prescribing pain medication; Grants to states to expand awareness and education of physicians, patients, health care providers regarding the risks associated with the misuse of opioids; A comprehensive Prescription Drug Monitoring Program (PDMP) to track the dispensing of controlled substances; Increased availability of opioid overdose reversal drugs; Alternatives to incarceration to individuals who misuse opioid drugs and other substances to manage their pain. The College was also encourage by Administrations Opioid Commission report, released in November, that emphasizes the need to expand access to substance use disorder treatment, for which there is a massive demand in many parts of the country. Chronic Care Management: Urged lawmakers to eliminate the beneficiary co-pay for chronic care management (CCM) services, require reimbursement and coverage of additional codes for more complex CCM services, direct HHS to authorize payment for CCM codes to allow physicians to spend up to 40 minutes with a patient and an additional code that would allow for 60 minutes of treatment for a patient with multiple chronic illnesses; Advocated for passage of The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act, S. 870, which would expand the use of tele-health for individuals with stroke, provide flexibility for Medicare beneficiaries to be part of an Accountable Care Organization, extend the Independence at Home model of care. Childrens Health: Advocated for a 5-year extension of the Childrens Health Insurance Program (CHIP), which expired on Sept. 30, 2017, on the basis of it serving as the key health insurance safety net program for children of low-income families. Insurance Market Stabilization: Advocated with Congress on the need to stabilize the health insurance market, including the need to fund cost-sharing reduction (CSRs) payments for the long-term; Urged enactment of legislation, built around robust federal funding for reinsurance that is adequate to ensure stability, encourage competition and lower costs for consumers while maintaining the core consumer protections in current federal statute. Reinsurance provisions of this legislation should be structured in a manner to bring relief to consumers in every state. To assure its sustainability, any legislative solution must be bipartisan. Immigration: Voiced support to Congress on the need to pass the Development, Relief, and Education for Alien Minors (DREAM) Act of 2017, H.R. 3440. This legislation would establish a three-step pathway to U.S. citizenship through college, work, or the armed services for individuals who were born in another country and brought illegally to the U.S. at a young age (DREAMers). Clinical Labs: Commented to the Centers for Medicare and Medicaid Services (CMS) on issues pertaining to the Protecting Access to Medicare Act of 2014 (PAMA), specifically citing concerns about the potential impacts of PAMA on patient access to critical rapid clinical testing services offered to patients while they are receiving medical care in their physicians office; expressed further concerns about impending cuts on Jan. 1, 2018 for physician office-based testing services. Medicare Physician Fee Schedule: Commented to CMS on the CY2018 proposed and final rules on the Physician Fee Schedule, including: any revisions made to the E/M documentation guidelines should not result in a revaluation of the entire E/M code set; all relevant stakeholders, including medical specialty organizations, should work with both the Current Procedural Terminology (CPT) Editorial Panel and CMS to create frameworks outlining general principles of care that are beneficial and appropriate for medical specialties in describing the varying approaches to patient care for the current levels of E/M codes; CMS should simplify the documentation requirements necessary to bill CCM services in order to ease the burden of documenting each separate minute of care management over the course of the month; CMS should modify the existing PAMA regulations through issuance of an interim final rule that provides for CMS to conduct targeted market segment surveys (reference laboratories, physician office-base laboratories, independent laboratories, and hospital outreach laboratories) to validate and adjust the final amount calculated based on the data collection to ensure Congressional intent-payment rates that accurately reflect private market payments across all market segments-is achieved; CMS should provide relief from penalties associated with the Medicare EHR Incentive Program (Meaningful Use) for the 2016 performance period for ECs who tried but were unsuccessful at reporting MU. Medicare Access and CHIP Reauthorization Act (MACRA): Called on CMS to: work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the agencys thinking in the development of both the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APM) pathways, including the development and implementation of the performance measures to be used within these programs; to reduce administrative tasks and burdens on physicians; collaborate with specialty societies, frontline clinicians, patients, and electronic health record (EHR) vendors in the development, testing, and implementation of measures with a focus on integrating the measurement of and reporting on performance with quality improvement and care delivery and decreasing clinician burden. Urged Congress to: continue the existing flexibility in the MACRA statute that CMS is currently using for an additional three years so that the agency may move forward as the necessary program elements are put in place; clarify that Medicare Part B drugs and other items and services outside the physician fee schedule are not included in the application of MIPS payment adjustments and determination of MIPS eligibility; rationalize what is considered a small practice; and explicitly authorize the Physician-focused Payment Model Technical Advisory Committee (PTAC) to provide technical assistance to developers of Advanced Payment Models. State Medicaid Waivers: The College commented to CMS on the Arizona Health Care Cost Containment System (AHCCCS) 1115 Waiver amendment request opposing the request for a 5-year maximum lifetime limit on coverage for certain enrollees. Placing an arbitrary limit on enrollment could disrupt continuity of care and undermine the patient-physician relationship. Patients with chronic conditions may need ongoing care management from their physician and health care team. Abruptly ending a patients medical assistance after 5 years could sever a patients link to their care team and threaten progress. The College also commented to CMS on the KanCare 2.0 State Extension Application opposing the 36-month limit on KanCare 2.0 coverage. This proposal would greatly harm patients with complex chronic care needs, including patients with diabetes, obesity, cardiovascular disease, and asthma, who require ongoing care management. The College also commented to CMS on the New Mexico Centennial Care 2017 Extension Application expressing concerns that the states proposal to implement premiums and cost sharing for the Other Adult Group expansion population with household income that exceeds 100% FPL will undermine access to care. The proposal would impose monthly premiums of $10 in 2019 and provide the state the option of raising the premium to $20 a month in subsequent years. The College believes that Medicaid premiums and cost-sharing should be structured in a way that does not discourage enrollment or cause enrollees to disenroll or delay or forgo care due to cost, especially those with chronic disease. Firearms: The College urged Congress to: Reject any consideration of the Concealed Carry Reciprocity Act (H.R. 38) as passed by the House in December, 2017; Pass S. 2095, the Assault Weapons Ban of 2017, which would place bans on the sale of high-velocity, rapid-fire assault rifles (rifles specifically designed to inflict lethal harm to as many victims as possible, in as little time as possible), large capacity ammunition magazines and bump stocks; Pass S. 2135, the Fix NICS Act, which would strengthen the criminal background check system to help ensure that criminals and domestic abusers are prevented from obtaining firearms; Enact strong penalties for persons who unlawfully purchase firearms for other persons who are in a prohibited category-known as straw purchasers; Repeal the Dickey amendment, which limits the ability of the Centers for Disease Control and Prevention, the National Institutes of Health, and the National Institute of Justice, to study the effect of violence and unintentional firearms-related injury on public health and safety, and to eliminate any language in appropriations bills for these agencies that would preclude them from conducting such studies.

S. 2009 - Background Check Expansion Act S. 1916 - Automatic Gunfire Prevention Act HR 4240 - Public Safety and Second Amendment rights Protection Act of 2017 S. 1992/HR 3361 - SECURE Firearm Storage Act HR 3947 - Automatic Gunfire Prevention Act HR 3984 - Equal Access to Justice for Victims of Gun Violence Act S 1939 - Equal Access to Justice for Victims of Gun Violence Act S. 834/HR 1832 - CDC gun research bills HR 1478 - Gun Violence Research Act HR 3207 - Zero Tolerance for Domestic Abuse Act S. 1539 - Protecting Domestic Violence and Stalking Victims Act of 2017 S. 1923 - Background Check Completion Act of 2017 S. 1945 & H. 4052 Keep Americans Safe Act S. 2095 Assault weapons Ban of 2017 HR 5087 Assault weapons Ban of 2018 S. 2521 Federal Extreme Risk Protection Order Act of 2018 HR 4471/S2492 NICS Denial Notification Act S 2546 Make America Safe & Secure Act

Client expense: $29,212 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.1137 - Collectible Firearms Protection Act - To amend the Arms Export Control Act to provide that certain firearms listed as curios or relics may be imported into the United States by a licensed importer without obtaining authorization from the Department of State or the Department of Defense, and for other purposes. H.R.2033 - Undetectable Firearms Modernization Act - To modernize the Undetectable Firearms Act of 1988. H.R.2380 - Handgun Trigger Safety Act of 2017 - To provide for the development and use of technology for personalized handguns, to require that all handguns manufactured or sold in, or imported into, the United States incorporate such technology, and for other purposes. S.1541 - A bill to modify the definition of an antique firearm. H.R.3947 - Automatic Gunfire Prevention Act- To prohibit the possession or transfer of certain firearm accessories, and for other purposes. H.R.3962 - Stop Online Ammunition Sales Act of 2017- To require face-to-face purchases of ammunition, to require licensing of ammunition dealers, and to require reporting regarding bulk purchases of ammunition. S.1915 - Handgun Trigger Safety Act of 2017- To provide for the development and use of technology for personalized handguns, to require that all handguns manufactured or sold in, or imported into, the United States incorporate such technology, and for other purposes. S.1916 - Automatic Gunfire Prevention Act- To prohibit the possession or transfer of certain firearm accessories, and for other purposes. H.R.3986 - Stopping the Iron Pipeline Act of 2017- To provide for the establishment of a national standard for incorporating a passive identification ability into all firearms sold in the United States. H.R.3999 - To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes.- To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes. H.R.4064 - To impose restrictions on the sale of binary explosives, and for other purposes.- To impose restrictions on the sale of binary explosives, and for other purposes. S.2095 - Assault Weapons Ban of 2017- To regulate assault weapons, to ensure that the right to keep and bear arms is not unlimited, and for other purposes. H.R.4344 - End Purchase of Firearms by Dangerous Individuals Act of 2017- To incentivize State reporting systems that allow mental health professionals to submit information on certain individuals deemed dangerous for purposes of prohibiting firearm possession by such individuals, and for other purposes. S.2150 - Imitation Firearms Safety Act of 2017- To improve requirements for entering into commerce of imitation firearms, and for other purposes. H.R.4721 - Armor-Piercing Bullets Act of 2017- To enact into law a framework for deciding whether certain projectiles are primarily intended for sporting purposes for purposes of determining whether the projectiles are armor piercing ammunition.

H.R.1137 - Collectible Firearms Protection Act - To amend the Arms Export Control Act to provide that certain firearms listed as curios or relics may be imported into the United States by a licensed importer without obtaining authorization from the Department of State or the Department of Defense, and for other purposes. H.R.2033 - Undetectable Firearms Modernization Act - To modernize the Undetectable Firearms Act of 1988. H.R.2380 - Handgun Trigger Safety Act of 2017 - To provide for the development and use of technology for personalized handguns, to require that all handguns manufactured or sold in, or imported into, the United States incorporate such technology, and for other purposes. S.1541 - A bill to modify the definition of an antique firearm. H.R.3947 - Automatic Gunfire Prevention Act- To prohibit the possession or transfer of certain firearm accessories, and for other purposes. H.R.3962 - Stop Online Ammunition Sales Act of 2017- To require face-to-face purchases of ammunition, to require licensing of ammunition dealers, and to require reporting regarding bulk purchases of ammunition. S.1915 - Handgun Trigger Safety Act of 2017- To provide for the development and use of technology for personalized handguns, to require that all handguns manufactured or sold in, or imported into, the United States incorporate such technology, and for other purposes. S.1916 - Automatic Gunfire Prevention Act- To prohibit the possession or transfer of certain firearm accessories, and for other purposes. H.R.3986 - Stopping the Iron Pipeline Act of 2017- To provide for the establishment of a national standard for incorporating a passive identification ability into all firearms sold in the United States. H.R.3999 - To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes.- To amend title 18, United States Code, to prohibit the manufacture, possession, or transfer of any part or combination of parts that is designed and functions to increase the rate of fire of a semiautomatic rifle but does not convert the semiautomatic rifle into a machinegun, and for other purposes. H.R.4064 - To impose restrictions on the sale of binary explosives, and for other purposes.- To impose restrictions on the sale of binary explosives, and for other purposes. S.2095 - Assault Weapons Ban of 2017- To regulate assault weapons, to ensure that the right to keep and bear arms is not unlimited, and for other purposes. H.R.4344 - End Purchase of Firearms by Dangerous Individuals Act of 2017- To incentivize State reporting systems that allow mental health professionals to submit information on certain individuals deemed dangerous for purposes of prohibiting firearm possession by such individuals, and for other purposes. S.2150 - Imitation Firearms Safety Act of 2017- To improve requirements for entering into commerce of imitation firearms, and for other purposes. H.R.4721 - Armor-Piercing Bullets Act of 2017- To enact into law a framework for deciding whether certain projectiles are primarily intended for sporting purposes for purposes of determining whether the projectiles are armor piercing ammunition.