Rural Physician Workforce Production Act of 2018

Medicare-Graduate Medical Education; HRSA THCGME Program; Advancing Medical Resident Training in Community Hospitals Act of 2017, H.R. 4552/S. 1291; Restoring Rural Residencies Act, S. 455; Resident Physician Shortage Act of 2017, H.R. 2267/S. 1301; Opioid Workforce Act of 2018, H.R. 5818/S. 2843; Rural Physician Workforce Production Act of 2018, S. 3014; Advancing Medical Resident Training in Community Hospitals Act of 2018, H.R. 6056; Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, H.R. 6; Advancing Medical Resident Training in Community Hospitals Act, H.R. 284; Creating Access to Residency Education (CARE) Act of 2018, H.R. 7233

Client expense: $60,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare-Graduate Medical Education; HRSA THCGME Program; Advancing Medical Resident Training in Community Hospitals Act of 2017, H.R. 4552/S. 1291; Restoring Rural Residencies Act, S. 455; Resident Physician Shortage Act of 2017, H.R. 2267/S. 1301; Substance Use Disorder Workforce Loan Repayment Act of 2018, H.R. 5102/S. 2524; Opioid Workforce Act of 2018, H.R. 5818/S. 2843; Building a Health Care Workforce for the Future Act, H.R. 2574/S. 3095; Rural Physician Workforce Production Act of 2018, S. 3014; Advancing Medical Resident Training in Community Hospitals Act of 2018, H.R. 6056; Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, H.R. 6; Advancing Medical Resident Training in Community Hospitals Act, H.R. 284

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

H.R. 2267/ S. 1301, Resident Shortage Physician Reduction Act of 2017 Issue: Support additional funding of graduate medical education H.R. 5818/S.2843, Opioid Workforce Act of 2018 Issue: Support additional funding for graduate medical education for addiction medicine, addiction psychiatry, and pain management residency programs S. 3014 Rural Physician Workforce Production Act of 2018 Issue: Oppose legislation redesigning Medicare GME payment formulas Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose Medicare hospital cuts Issue: Support Medicare Graduate Medical Education (GME) per resident amount technical corrections and administrative relief. Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose overly burdensome discussion draft Medicaid GME transparency legislation. Issue: Educate Congress on role of academic medicine as it relates to price transparency initiatives S. 455, Restoring Rural Residencies Act of 2017 Issue: Support technical correction to increase access to physician services in rural communities by allowing teaching hospitals to count resident time spent in critical access hospitals for purposes of Medicare GME payments. Issue: Development and implementation of new Medicaid Disproportionate Share Hospital (DSH) formula required under the ACA. Issue: Support extension of Medicaid Disproportionate Share Hospital (DSH) cuts delay Issue: Support allowing providers in new delivery models (e.g., ACOs, bundled payments, etc.) to access medical records with information on substance use disorders Issue: Support aligning 42 CFR Part 2 regulations with the Health Insurance Portability and Accountability Act (HIPAA) for the purposes of treatment, payment, and healthcare operations. Issue: Modify CMS Hospital Compare Star Ratings to allow stakeholders time to work together to address concerns with methodology. Support inclusion of sociodemographic status as part of quality programs Issue: ACA Section 1115 and 1332 Medicaid Waivers Issue: ACA Medicaid expansion. Maintain commitment to match State spending on medical care for Medicaid beneficiaries without limits, caps, or block grants. Maintain and enforce network adequacy requirements and mandate sufficient payments to providers. Issue: Support a third agreement period for certain Accountable Care Organizations in Medicare Shared Savings Program Issue: Support a delay in CMS issuing a final national coverage decision until the agency has an opportunity to receive and consider alternatives to limiting coverage to FDA-approved diagnostic tests developed using Next Generation Sequencing technology. H.R. 7217, Improving Medicaid Programs and Opportunities for Eligible Beneficiaries (IMPROVE) Act, Title I H.R. 3325/S. 428, ACE Kids Act Issue: Support legislation to improve health care for children with complex medical conditions on Medicaid Issue: Oppose Physician Fee Schedule rule proposal to collapse Medicare E/M coding

Policies impacting Medicare coverage and reimbursement for clinical laboratory services. Implementation of the Affordable Care Act (P.L.111-148). Medicare and Medicaid funding for graduate medical education. FDA regulation of Laboratory-Developed Tests (LDTs). Medicaid safety-net issues. S.3120, HEAL Act of 2018. H.R.6, SUPPORT for Patients and Communities Act. S.3014, Rural Physician Workforce Production Act of 2018. H.R.2267/S.1301, Resident Physician Shortage Reduction Act of 2017.

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

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

Issues related to health care coverage, graduate medical education, and 340B. H.R.5385/S.2597, Children's Hospital GME Support Reauthorization Act of 2018. S.3014, Rural Physician Workforce Production Act of 2018. H.R.5818/S.2843, Opioid Workforce Act of 2018.

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

Government targets: Agriculture, Dept of (USDA), HOUSE OF REPRESENTATIVES, SENATE

S. 3014 - Rural Physician Workforce Production Act of 2018: GME Reform to support rural residency training; Seek co-sponsors on legislation to amend title XVII of the Social Security Act to support rural residency training funding. HR 6 - Support for patients and communities Act: Supported HR 6, the comprehensive opioids bill. HR 2553: Know the Lowest Price Act: Supported legislation to prohibit pharmacy contact gag rules. No Bill No.- Congressional Primary Care Caucus: Urge members to join the Caucus and support Primary Care to achieve the triple aim in healthcare; Increase membership in the bipartisan caucus to increase awareness of primary care value. No Bill No. - Advanced Primary Care Alternative Payment Model: Seek co-signors on letter to HHS on APC-APM payment model. No Bill No. - Administrative Burden: Advocate for end to E/M documentation guidelines, AUC, etc. in WM Red Tape Initiative; Advocate for AAFP's administration burden principles. No Bill No. - Administrative simplification: Promote reduced administrative burden on family physicians of prior authorization, EMR. No Bill No. - Social Determinants of Health: Advancing Health Equity by addressing SDOH. No Bill No. - Advisory Committee on Training in Primary Care Medicine and Dentistry: Health professions training grants for family medicine. No Bill No. - Rural Health: Eliminate disparities to access to quality care for rural populations. No Bill No. - AHRQ National Guidelines Clearinghouse: Closure of the NGC. No Bill No. - CPC+ reports: Timing, usefulness of reports. No Bill No. - MSSP/ACO proposed rule: Changes to accountable care organizations. No Bill No. - Medicare fraud and abuse:CMS fraud and abuse programs. No Bill No. - Physician focused payment model process: How the PTAC process is working. No Bill No. - Medicare Part C/D changes: Telehealth benefits. No Bill No. - Medicare 2019 payments: E/M payment changes in 2019 and beyond.

S. 3014 - Rural Physician Workforce Production Act: Graduate Medical Education reform, rural physician workforce; Seek House sponsors; GME Reform to support rural residency training; Seek co-sponsors on legislation to amend title XVII of the Social Security Act to support rural residency training funding. No Bill No.- Congressional Primary Care Caucus: Increase membership in the bipartisan primary care caucus; Urge members to join the Primary Care Caucus to achieve the triple aim in healthcare. No Bill No.- National Health Service Corps: Medical Student Debt Relief and Rural and Underserved area access to Family Physicians. No Bill No. - Advisory Committee on Training in Primary Care Medicine and Dentistry: Health professions training grants for family medicine. No Bill No. - Teaching Health Center Graduate Medical Education Program Reauthorization: Meeting with staff to discuss THCGME reauthorization.

Client expense: $1,334,107 · Firm income: Not reported

S. 3014 Rural Physician Workforce Production Act of 2018: Seek co-sponsors to amend title XVIII of the Social Security Act to support rural residency training funding. HR 2 - Farm Bill: Advocating for SNAP funding, nutrition assistance, and other relevant priorities. HR 6 - Support for patients and communities Act: Supported HR 6, the comprehensive opioids bill. HR 1318/ S. 1112: Preventing Maternal Deaths Act: Seek co-sponsors on legislation to amend title XVII of the Social Security Act to support rural residency training funding. HR 2553: Know the Lowest Price Act: Supported legislation to prohibit pharmacy contact gag rules. HR 5858 - Primary Care Patient Protection Act: Seek co-sponsors for legislation to require coverage without a deductible of certain primary care services by high deductible health plans. H.R. 6310; H.R. 6317 - Direct Primary Care: Supported testimony to the promoting legislation to allow Americans with HSAs to use their accounts to pay for DPC arrangements. No Bill No.- Congressional Primary Care Caucus: Urge members to join the Primary Care Caucus to achieve the triple aim in healthcare; Increase membership in the bipartisan caucus to increase awareness of primary care value. No Bill No. - Administrative simplification: Promote reduced administrative burden on family physicians of prior authorization, EMR. No Bill No.- National Health Service Corps: Medical Student Debt Relief and Rural and Underserved area access to Family Physicians. No Bill No. - Patient Centered Outcomes Research Institute: Patient Centered, primary care research, AHRQ funding. No Bill No. - Social Determinants of Health: Advancing Health Equity by addressing SDOH. No Bill No. - Advisory Committee on Training in Primary Care Medicine and Dentistry: Health professions training grants for family medicine. No Bill No. - Rural Health: Eliminate disparities to access to quality care for rural populations. No Bill No. - AHRQ National Guidelines Clearinghouse: Closure of the NGC. No Bill No. - CPC+ reports: Timing, usefulness of reports. No Bill No. - MSSP/ACO proposed rule: Changes to accountable care organizations. No Bill No. - RFI on the EHR reporting period: Usefulness of EHR. No Bill No. - Medicare fraud and abuse:CMS fraud and abuse programs. No Bill No. - Physician focused payment model process: How the PTAC process is working. No Bill No. - Social risk factors in Medicare Programs: How SoDH should be reported. No Bill No. - Drug pricing transparency: Support for drug transparency. No Bill No. - State waivers granted through HHS: How state waivers should support primary care. No Bill No. - Medicare Part C/D changes: Telehealth benefits. No Bill No. - Medicare 2019 payments: E/M payment changes in 2019 and beyond. No Bill No. - Administrative Burden: Shared the AAFP's principles. No Bill No. - Teaching Health Center Graduate Medical Education Program Reauthorization: Meeting with staff to discuss THCGME reauthorization. No Bill No. - Advanced Primary Care Alternative Payment Model: seek co-signors on letter to HHS on APC-APM model. No Bill No. - Administrative Burden: Advocate for end to E/M documentation guidelines, AUC, etc. in WM Red Tape Initiative.

Graduate Medical Education Affordable Care Act Teaching Health Centers Reauthorization Primary Care Exception Under Teaching Physician Regulation Rural Graduate Medical Education S.455 Restoring Rural Residencies Act of 2016 Regulations & sub-regulatory issue re: Teaching Physician Regulation S.1291, H.R.4552 Advancing Resident Training in Community Hospitals Act of 2017 The Rural Physician Workforce Production Act of 2018, S.3014

Client expense: $59,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), President of the U.S., SENATE, Veterans Affairs, Dept of (VA)

Adequacy of health care workforce associated with expansion of health care coverage; Reauthorization of the Childrens Health Insurance Program (CHIP); issues related to health care coverage; H.R. 2257, Guard and Reservists Education Improvement Act; H.R.3, Spending Cuts to Expired and Unnecessary Programs Act; Graduate Medical Education Issues; H.R. 5385/S. 2597, Children's Hospital GME Support Reauthorization Act of 2018; S. 3014, Rural Physician Workforce Production Act of 2018; H.R. 5818/S. 2843, Opioid Workforce Act of 2018; S. 3014, Rural Physician Workforce Production Act of 2018; Nicotine regulation issues; S. 2446, Safe Staffing for Nurse and Patient Safety Act; POLST issues; H.R. 6458 NOTA Amendments Bill of 2019; Issues related to allocation of Livers.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 455, Restoring Rural Residencies Act; S.3014, Rural Physicians Workforce Protection Act of 2018; implementation of the Mission Act - a pilot program under the Department of Veterans Affairs for rural family physician training programs; appropriations for the Agency for Healthcare Research and Quality and title 7 primary care funding under the Public Health Service Act; reauthorization for title 7 primary care funding

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1318 - Maternal Accountability Act/Preventing Maternal Deaths: Promoted preventing maternal mortality. HR 5961, HR 6147, HR 6470, HR 6157, S 3158, S 2976 - Oppose tobacco riders in Ag bill & cut to CDC's Office on Smoking and Health: Public Health/Tobacco control. HR 6157 - Increased funding for HHS, AHRQ, HRSA, CMS, CDC, SAMSHA in FY 19: AAFP FY 2019 federal spending priorities for primary care training, research & access. H.R. 6310; H.R. 6317 - Direct Primary Care: Advocate for co-sponsorship of bill to allow Americans with HSAs to use their accounts to pay for DPC arrangements. S. 3014 - Rural Physician Workforce Production Act of 2018: Graduate Medical Education reform, rural physician workforce; Seek House sponsors; GME Reform to support rural residency training; Seek co-sponsors on legislation to amend title XVII of the Social Security Act to support rural residency training funding. HR 5858 - Primary Care Patient Protection Act: Seek co-sponsors for legislation to require coverage without a deductible of certain primary care services by high deductible health plans. No Bill No.- Congressional Primary Care Caucus: Urge members to join the Primary Care Caucus to achieve the triple aim in healthcare; Increase membership in the bipartisan caucus to increase awareness of primary care value. No Bill No. - Direct Primary Care: work with members and staff on language of DPC legislation that passed the House. No Bill No. - Administrative Burden: Advocate for end to E/M documentation guidelines, AUC, etc. in WM Red Tape Initiative; Advocate for AAFP's administration burden principles. No Bill No. - Administrative simplification: Promote reduced administrative burden on family physicians of prior authorization, EMR. No Bill No.- National Health Service Corps: Medical Student Debt Relief and Rural and Underserved area access to Family Physicians. No Bill No. - Advisory Committee on Training in Primary Care Medicine and Dentistry: Health professions training grants for family medicine. No Bill No. - Opioid Epidemic: Support evidence-based approaches to curb opioid abuse. No Bill No. - AHRQ National Guidelines Clearinghouse: Closure of the NGC. No Bill No. - Blueprint to Lower Drug Prices: Reducing out of pocket costs. No Bill No. - Title X regulations: interference in the practice of medicine and access to evidence-based care. No Bill No. - Asbestos new use: Any form of asbestos exposure is a threat to health. No Bill No. - Physician self referral law: Transforming practices and collaborating with others to provide team-based, patient-centered care. Physician practice and flexibility. No Bill No. - Physician fee schedule: 2019 Medicare payment rates and the quality payment program. No Bill No. - Physician focused payment model process: How the PTAC process is working. No Bill No. - 2019 outpatient prospective payment system: Site of Service Neutrality. No Bill No. - Advanced Primary Care Alternative Payment Model: Seek co-signors on letter to HHS on APC-APM payment model. No Bill No. - Farm Bill/Nutrition: Advocating against the Farm Bill's SNAP cuts, as included withing the AAFP's Farm Bill Letter.

S. 3014 - Rural Physician Workforce Production Act: Graduate Medical Education reform, rural physician workforce; Seek House sponsors; GME Reform to support rural residency training; Seek co-sponsors on legislation to amend title XVII of the Social Security Act to support rural residency training funding. No Bill No.- Congressional Primary Care Caucus: Urge members to join the Primary Care Caucus to achieve the triple aim in healthcare; Increase membership in the bipartisan caucus to increase awareness of primary care value. No Bill No.- National Health Service Corps: Medical Student Debt Relief and Rural and Underserved area access to Family Physicians. No Bill No. - Advisory Committee on Training in Primary Care Medicine and Dentistry: Health professions training grants for family medicine.

Client expense: $865,582 · Firm income: Not reported

S. 2553 - Know the Lowest Price Act: Advocating for the Know the Lowest Price Act: A bill to eliminate gag rules as part of Medicare Advantage and Part D contracts. S. 3014 - Rural Physician Workforce Production Act of 2018: GME Reform to support rural residency training; Seek co-sponsors on legislation to amend title XVII of the Social Security Act to suppoert rural residency training funding. HR 6157 - Increased funding for HHS, AHRQ, HRSA, CMS, CDC, SAMSHA in FY 19: AAFP FY 2019 federal spending priorities for primary care training, research & access. No Bill No. - Administrative Burden: Advocate for end to E/M documentation guidelines, AUC, etc. in WM Red Tape Initiative; Advocate for AAFP's administration burden principles. No Bill No.- Congressional Primary Care Caucus: Urge members to join the Caucus and support Primary Care to achieve the triple aim in healthcare; Increase membership in the bipartisan caucus to increase awareness of primary care value. No Bill No. - Administrative simplification: Promote reduced administrative burden on family physicians of prior authorization, EMR. No Bill No.- National Health Service Corps: Medical Student Debt Relief and Rural and Underserved area access to Family Physicians. No Bill No. - Advisory Committee on Training in Primary Care Medicine and Dentistry: Health professions training grants for family medicine. No Bill No. - Opioid Epidemic: Evidence based approaches to curb opioid abuse No Bill No. - AHRQ National Guidelines Clearinghouse: Closure of the NGC. No Bill No. - Blueprint to Lower Drug Prices: Reducing out of pocket costs. No Bill No. - Title X regulations: interference in the practice of medicine and access to evidence-based care. No Bill No. - Physician self referral law: Transforming practices and collaborating with others to provide team-based, patient-centered care. Physician practice and flexibility. No Bill No. - Physician fee schedule: 2019 Medicare payment rates and the quality payment program. No Bill No. - 2019 outpatient prospective payment system: Site of Service Neutrality. No Bill No. - Advanced Primary Care Alternative Payment Model: Seek co-signors on letter to HHS on APC-APM payment model.

H.R. 2267/ S. 1301, Resident Shortage Physician Reduction Act of 2017 Issue: Support additional funding of graduate medical education H.R. 5818/S.2843, Opioid Workforce Act of 2018 Issue: Support additional funding for graduate medical education for addiction medicine, addiction psychiatry, and pain management residency programs S. 3014 Rural Physician Workforce Production Act of 2018 Issue: Oppose legislation redesigning Medicare GME payment formulas Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose Medicare hospital cuts Issue: Support Medicare Graduate Medical Education (GME) per resident amount technical corrections and administrative relief. Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose overly burdensome discussion draft Medicaid GME transparency legislation as part of opioid legislative package Issue: Submit letter and educate Congress on role of academic medicine as it relates to price transparency initiatives S. 455, Restoring Rural Residencies Act of 2017 Issue: Support technical correction to increase access to physician services in rural communities by allowing teaching hospitals to count resident time spent in critical access hospitals for purposes of Medicare GME payments. Issue: Development and implementation of new Medicare Disproportionate Share Hospital (DSH) formula required under the ACA. Issue: Support allowing providers in new delivery models (e.g., ACOs, bundled payments, etc.) to access medical records with information on substance use disorders Issue: Modify CMS Hospital Compare Star Ratings to allow stakeholders time to work together to address concerns with methodology. Support inclusion of sociodemographic status as part of quality programs Issue: ACA Section 1115 and 1332 Medicaid Waivers Issue: ACA Medicaid expansion. Maintain commitment to match State spending on medical care for Medicaid beneficiaries without limits, caps, or block grants. Maintain and enforce network adequacy requirements and mandate sufficient payments to providers. Issue: Support a third agreement period for certain Accountable Care Organizations in Medicare Shared Savings Program Issue: Support a delay in CMS issuing a final national coverage decision until the agency has an opportunity to receive and consider alternatives to limiting coverage to FDA-approved diagnostic tests developed using Next Generation Sequencing technology. H.R. 3325/S. 428, ACE Kids Act Issue: Support legislation to improve health care for children with complex medical conditions on Medicaid Issue: Oppose Physician Fee Schedule rule proposal to collapse Medicare E/M coding

Medicare-Graduate Medical Education; HRSA THCGME Program; Advancing Medical Resident Training in Community Hospitals Act of 2017, H.R. 4552/S. 1291; Restoring Rural Residencies Act, S. 455; Resident Physician Shortage Act of 2017, H.R. 2267/S. 1301; Substance Use Disorder Workforce Loan Repayment Act of 2018, H.R. 5102/S. 2524; Opioid Workforce Act of 2018, H.R. 5818/S. 2843; Building a Health Care Workforce for the Future Act, H.R. 2574/S. 3095; Rural Physician Workforce Production Act of 2018, S. 3014; Advancing Medical Resident Training in Community Hospitals Act of 2018, H.R. 6056; Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, H.R. 6; Advancing Medical Resident Training in Community Hospitals Act, H.R. 284

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

Policies impacting Medicare coverage and reimbursement for clinical laboratory services. Implementation of the Affordable Care Act (P.L.111-148). Medicare and Medicaid funding for graduate medical education. FDA regulation of Laboratory-Developed Tests (LDTs). Medicaid safety-net issues. H.R.5818/S.2843, Opioid Workforce Act of 2018. S.2680, Opioid Crisis Response Act of 2018. S.3120, HEAL Act of 2018. H.R.6, SUPPORT for Patients and Communities Act. S.3014, Rural Physician Workforce Production Act of 2018. H.R.2267/S.1301, Resident Physician Shortage Reduction Act of 2017.

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

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

Issues related to health care coverage, graduate medical education, and 340B. H.R.5385/S.2597, Children's Hospital GME Support Reauthorization Act of 2018. S.3014, Rural Physician Workforce Production Act of 2018. H.R.5818/S.2843, Opioid Workforce Act of 2018.

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

Government targets: Agriculture, Dept of (USDA), HOUSE OF REPRESENTATIVES, SENATE

Adequacy of health care workforce associated with expansion of health care coverage; Reauthorization of the Childrens Health Insurance Program (CHIP); issues related to health care coverage; H.R. 2257, Guard and Reservists Education Improvement Act; H.R.3, Spending Cuts to Expired and Unnecessary Programs Act; Graduate Medical Education Issues; H.R. 5385/S. 2597, Children's Hospital GME Support Reauthorization Act of 2018; S. 3014, Rural Physician Workforce Production Act of 2018; H.R. 5818/S. 2843, Opioid Workforce Act of 2018; S. 3014, Rural Physician Workforce Production Act of 2018; Nicotine regulation issues; S. 2446, Safe Staffing for Nurse and Patient Safety Act; POLST issues; H.R. 6458 NOTA Amendments Bill of 2019.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Graduate Medical Education Affordable Care Act American Health Care Act HR 1628 Teaching Health Centers Reauthorization Primary Care Exception Under Teaching Physician Regulation Rural Graduate Medical Education S.455 Restoring Rural Residencies Act of 2016 Regulations & sub-regulatory issue re: Teaching Physician Regulation S.1291, H.R.4552 Advancing Resident Training in Community Hospitals Act of 2017 The Rural Physician Workforce Production Act of 2018, S.3014

Client expense: $56,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), President of the U.S., SENATE, Veterans Affairs, Dept of (VA)

Policies related to graduate medical education and payment for primary care; general education around primary care issues; policies related to opioid abuse; H.R. 365/S.1358 Primary Care Enhancement Act; H.R. 5858 Primary Act Patient Protection Act of 2018; H.R. 6, the SUPPORT for Patients and Communities Act; H.R. 5138 Bipartisan HSA Improvement Act; S.3014 Rural Physician Workforce Production Act.

Client expense: Not reported · Firm income: $60,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 455, Restoring Rural Residencies Act; S.3014, Rural Physicians Workforce Protection Act of 2018; implementation of the Mission Act - a pilot program under the Department of Veterans Affairs for rural family physician training programs; appropriations for the Agency for Healthcare Research and Quality and title 7 primary care funding under the Public Health Service Act; reauthorization for title 7 primary care funding

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2267/ S. 1301, Resident Shortage Physician Reduction Act of 2017 Issue: Support additional funding of graduate medical education H.R. 5818/S.2843, Opioid Workforce Act of 2018 Issue: Support additional funding for graduate medical education for addiction medicine, addiction psychiatry, and pain management residency programs S. 3014 Rural Physician Workforce Production Act of 2018 Issue: Oppose legislation redesigning Medicare GME payment formulas Issues: Support lifting cap on number of residents Medicare will count when determining teaching hospitals' Medicare Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments Issue: Oppose reduction of Medicare GME/IME payments Issue: Oppose reduction in Medicare hospital outpatient department reimbursement. Issue: Oppose Medicare hospital cuts Issue: Support Medicare Graduate Medical Education (GME) per resident amount technical corrections and administrative relief. Issue: Oppose redesign of Medicare Indirect Medical Education financing and redistribution. Issue: Oppose overly burdensome discussion draft Medicaid GME transparency legislation as part of opioid legislative package Issue: Submit letter and educate Congress on role of academic medicine as it relates to price transparency initiatives S. 455, Restoring Rural Residencies Act of 2017 Issue: Support technical correction to increase access to physician services in rural communities by allowing teaching hospitals to count resident time spent in critical access hospitals for purposes of Medicare GME payments. P.L. 115-123, Bipartisan Budget Act of 2018, Division E P.L. 115-120, Extension of Continuing Appropriations Act, 2018, Division C H.R. 3921, Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable (HEALTHY KIDS) Act of 2017 Issue: Support the reauthorization of and extension of funding for the Childrens Health Insurance Program (CHIP). Issue: Development and implementation of new Medicare Disproportionate Share Hospital (DSH) formula required under the ACA. Issue: Support allowing providers in new delivery models (e.g., ACOs, bundled payments, etc.) to access medical records with information on substance use disorders Issue: Modify CMS Hospital Compare Star Ratings to allow stakeholders time to work together to address concerns with methodology. Support inclusion of sociodemographic status as part of quality programs Issue: ACA Section 1115 and 1332 Medicaid Waivers Issue: ACA Medicaid expansion. Maintain commitment to match State spending on medical care for Medicaid beneficiaries without limits, caps, or block grants. Maintain and enforce network adequacy requirements and mandate sufficient payments to providers. H.R. 6, SUPPORT for Patients and Communities Act Issue: Support policy eliminating Medicaid IMD exclusion and revising 42 Code of Federal Regulations (CFR) Part 2 to amend the Public Health Service Act to align federal privacy standards for substance use disorder (SUD) patient records more closely with standards under the Health Insurance Portability and Accountability Act (HIPAA). Issue: Support policies to address the opioid epidemic including improving coverage and payment for non-opioid therapies, enhancing usability of PDMPs, addressing physician shortages, promoting medication assisted treatment, eliminating Medicare limits on in-patient psychiatric hospital treatment, eliminating Medicaid IMD exclusion, aligning privacy regulations and investing in research and education, and reauthorizing the Patient Centered Outcomes Research Institute. Issue: Support a third agreement period for certain Accountable Care Organizations in Medicare Shared Savings Program Issue: Support a delay in CMS issuing a final national coverage decision until the agency has an opportunity to receive and consider alternatives to limiting coverage to FDA-approved diagnostic tests developed using Next Generation Sequencing technology. Issue: Support nominees for the Medicare Payment Advisory Committee (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC)

S. 3014 - Rural Physician Workforce Production Act: Graduate Medical Education reform, rural physician workforce; Seek co-sponsors on rural GME bill; seek House sponsors; Advocated for the Rural Physician Workforce Production Act; Seek Co-sponsors on legislation to amend the title XVIII of the Social Security Act to support rural residency training funding. S 3158 - HRSA funding-FY 2019 HHS Appropriations: Funding for access to primary care, health professional training grants, Title X family planning. S. 3158 - Increased overall spending FY19 HHS Appropriations: AAFP FY 2019 federal spending priorities for primary care training, research & access. No Bill No. - National Health Services Corps.: Sustainable funding for NHSC to provide access and debt relief. No Bill No. - Public Service Loan Forgiveness Program: Medical Student Debt relief. No Bill No. - Concern with Public Service Loan Forgiveness Program: Physician training and PSLF programs. No Bill No.- Congressional Primary Care Caucus: Urge members to join the Primary Care Caucus to achieve the triple aim in healthcare.

Client expense: $795,726 · Firm income: Not reported

S. 2704 - Medicare Beneficiary Opioid Addiction Treatment: Responding to senate inquiry in support of Opioid treatment. S. 3014 - Rural Physician Workforce Production Act: Graduate Medical Education reform, rural physician workforce; seek co-sponsors on rural GME bill; seek House sponsors; seek co-sponsors on legislation to amend the title XVII of the Social Security Act to support rural residency training funding. S. 3158 - Increased overall spending FY19 HHS Appropriations: AAFP FY 2019 federal spending priorities for primary care training, research & access. S. 3158 -CMS funding-FY 2019 HHS Appropriations S 3158 & House draft: Support effective, efficient management of Medicare, Medicaid, CHIP & Marketplaces. No Bill No. - Opioid Epidemic: Evidence based approaches to curb opioid abuse; Commented on E&C Bills. Advocated for the ACE Research Act and CONNECTIONS Act. No Bill No. - Overcoming Gaps in the Treatment of Mental Illness Research: Improved mental health services. No Bill No. - Advanced Primary Care Alternative Payment Model: New Medicare alternative payment model. Mo Bill No. - CMS on documentation burden listening session: How to ensure access to Medicaid Services. No Bill No. - CMS on access to Medicaid Services: How to ensure access to Medicaid Services. No Bill No. - CMS on RFI Direct Provider contracting models: How CMS should focus on the APC-APM but also implement the AAFP's DPC model; Seek co-signors on letter to HHS on APC-APM payment model. No Bill No.- Congressional Primary Care Caucus: Urge members to join the Caucus and support Primary Care to achieve the triple aim in healthcare. No Bill No. - Administrative Burden: Advocate for end to E/M documentation guidelines, AUC, etc. in WM Red Tape Relief initiative. No Bill No. - Insurance Market Stabilization: Outreach on ACA policies and possible market stabilization. No Bill No. - Drug Pricing: Provided feedback on the CREATES Act and PACED Act. Drafted a drug pricing letter. No Bill No. - MACRA/Advanced Primary Care APM: Raised awareness of the AAFP's primary care payment model.

S. 1112/HR 1318 - Maternal Accountability Act/Preventing Maternal Deaths: Promoted preventing maternal mortality. S. 2691 - Opioid Crisis Accountability Act - Responding to Senate inquiry on restricting the marketing and distribution of opioids. S. 2704 - Medicare Beneficiary Opioid Addiction Treatment: Responding to senate inquiry in support of Opioid treatment. S 2852, S. 2852 & House Draft: ASPR & Pandemic & All Hazards Preparedness Act reauthorization: Public Health preparedness. S. 3014 - Rural Physician Workforce Production Act: Graduate Medical Education reform, rural physician workforce; seek co-sponsors on rural GME bill; seek House sponsors; Seek Co-sponsors on legislation to amend the title XVIII of the Social Security Act to support rural residency training funding. S 3158 - HRSA funding-FY 2019 HHS Appropriations: Funding for access to primary care, health professional training grants, Title X family planning. S. 3158 - CDC funding-FY 2019 HHS Appropriations: Chronic Disease Prevention & Health Promotion, Immunization. S. 3158 - Increased overall spending FY19 HHS Appropriations: AAFP FY 2019 federal spending priorities for primary care training, research & access. S. 3158 - Rural Health programs funding-FY 2019 HHS Appropriations: Eliminate disparities of access to quality care for all populations. S. 3158 - Gun Violence Prevention CDC funding-FY 2019 HHS Appropriation:Gun violence is a public health emergency. S 3158 - AHRQ funding-FY 2019 HHS Appropriations:Primary Care Research, US Preventive Services Task Force. S. 3158 - SAMHSA funding-FY 2019 HHS Appropriations: Provide adequate resources for substance abuse treatment. S. 3158 - CMS funding-FY 2019 HHS Appropriations S 3158 & House draft: Support effective, efficient management of Medicare, Medicaid, CHIP & Marketplaces. HR 2 - Agriculture Improvement Act: Issued concerns about the SNAP cuts and health care policies. HR 5858 - Primary Care Patient Protection Act: Seek co-sponsors for legislation to require coverage without a deductible of certain primary care services by high deductible health plans. H.R. 6310; H.R. 6317 - Direct Primary Care: Advocate for co-sponsorship of bill to allow Americans with HSAs to use their accounts to pay for DPC arrangements. No Bill No. - Opioid Epidemic: Support evidence based approaches to curb opioid abuse; Commented on E&C Bills. Advocated for the ACE Research Act and CONNECTIONS Act. No Bill No. - Overcoming Gaps in the Treatment of Mental Illness Research: Improved mental health services. No Bill No. - Shoulder Injury Related to Vaccine Administration: Responding to Senate inquiry on vaccine injury prevention. No Bill No. - Paid sick leave to benefit American workers: Public Health. No Bill No. - Oppose tobacco riders in Ag bill & cut to CDCs Office on Smoking and Health: Public Health/Tobacco Control. No Bill No. - National Health Services Corps.: Sustainable funding for NHSC to provide access and debt relief. No Bill No. - Administrative Burden: Administrative simplification to stem physician burnout; Advocate for end to E/M documentation guidelines, AUC, etc. in WM Red Tape Initiative. No Bill No. - Advanced Primary Care Alternative Payment Model: New Medicare alternative payment model; Seek co-signors on letter to HHS on APC-APM payment model. No Bill No. - HHS on the HPV draft paper: How to improve HPV vaccination rates. No Bill No.- Congressional Primary Care Caucus: Urge members to join the Primary Care Caucus to achieve the triple aim in healthcare. No Bill No. - Direct Primary Care:advocate for co-sponsorship of bill to allow Americans with HSAs to use DPCs. No Bill No. - Insurance Market Stabilization: Outreach on ACA policies and possible market stabilization. No Bill No. - Drug Pricing: Provided feedback ont he CREATES Act and PACED Act. Drafted a drug pricing letter.

Issues related to health care coverage. Children's Health Insurance Program (CHIP) issues; H.R.3, Spending Cuts to Expired and Unnecessary Programs Act. Graduate Medical Education issues. S.1301/H.R.2267, Resident Physician Shortage Reduction Act of 2017. H.R.4143, Dialysis PATIENTS Demonstration Act of 2017. H.R.5385/S.2597, Children's Hospital GME Support Reauthorization Act of 2018. S.3014, Rural Physician Workforce Production Act of 2018. H.R.5818/S.2843, Opioid Workforce Act of 2018.

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

Government targets: Agriculture, Dept of (USDA), HOUSE OF REPRESENTATIVES, SENATE

Graduate Medical Education Affordable Care Act American Health Care Act HR 1628 Teaching Health Centers Reauthorization Primary Care Exception Under Teaching Physician Regulation Rural Graduate Medical Education S.455 Restoring Rural Residencies Act of 2016 Regulations & sub-regulatory issue re: Teaching Physician Regulation S.1291, H.R.4552 Advancing Resident Training in Community Hospitals Act of 2017 The Rural Physician Workforce Production Act of 2018 (draft), Now S.3014

Client expense: $56,176 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), President of the U.S., SENATE, Veterans Affairs, Dept of (VA)

Adequacy of health care workforce associated with expansion of health care coverage; Affordable Care Act (P.L. 111-148) repeal and Market Stabilization Proposed Rule, H.R. 1628 American Health Care Act of 2017/Better Care Reconciliation Act of 2017; Reauthorization of the Childrens Health Insurance Program (CHIP); issues related to health care coverage; H.R. 2257, Guard and Reservists Education Improvement Act; H.R.2267/S. 1301, Resident Physician Shortage Reduction Act of 2017; H.R. 4143, Dialysis PATIENTS Demonstration Act of 2017; H.R. 2797, Patient Choice and Quality Care Act of 2017; H.R.3, Spending Cuts to Expired and Unnecessary Programs Act; Graduate Medical Education Issues; H.R. 5385/S. 2597, Children's Hospital GME Support Reauthorization Act of 2018; S. 3014, Rural Physician Workforce Production Act of 2018; H.R. 5818/S. 2843, Opioid Workforce Act of 2018; S. 3014, Rural Physician Workforce Production Act of 2018; Nicotine regulation issues; S. 2446, Safe Staffing for Nurse and Patient Safety Act; POLST issues.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discussed graduate medical education and the Rural Workforce Production Act (S 3014) Expressed support for the 340B program and opposed payment reductions to hospitals associated with 340B Discussed CMS certification of micro-hospitals Expressed support for opioid abuse prevention legislation - HR 6, HR 6082, HR 5797 Discussed regulation of marijuana research Discussed womens health research

Client expense: $91,420 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, Natl Institute of Standards & Technology (NIST), Natl Science Foundation (NSF), SENATE, Veterans Affairs, Dept of (VA)

S. 455, Restoring Rural Residencies Act; S.3014, Rural Physicians Workforce Protection Act of 2018; changes to policy under the Department of Veterans Affairs for rural family physician training programs; appropriations for the Agency for Healthcare Research and Quality and title 7 primary care funding under the Public Health Service Act

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE