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Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 - provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" S. 2543, "the Prescription Drug Pricing Reduction Act" H.R. 3235, "Access to Genetic Counseling Act" H.R. 925, Health and Economic Recovery Omnibus Emergency Solutions Act (HEROS Act 2.0) H.R. 133, "Consolidated Appropriations Act, 2021" - provisions related to increasing the number of Medicare-funded residency positions, to Medicare, Medicaid, and COVID response Legislative proposals aimed at combating coronavirus impacting Medicare and Medicaid programs

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Proposed changes to Medicare hospital reimbursement policy Medicare hospital prospective payment system Site-neutral payment policies H.R. 1384/S. 1129, Medicare for All and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act S.2543, the Prescription Drug Pricing Reduction Act H.R. 925, Health and Economic Recovery Omnibus Emergency Solutions Act (HEROS Act 2.0) H.R. 133, "Consolidated Appropriations Act, 2021" - provisions related to Medicare and Medicaid Legislative proposals aimed at combating coronavirus impacting Medicare and Medicaid programs

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

Proposed changes to Medicare hospital reimbursement policy Star Rating System methodology and suspension of the display of overall star ratings on Hospital Compare while the agency continues its important work of enhancing the validity and meaningfulness of star ratings H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions Site-neutral payment policies Oppose H.R. 1384/S. 1129, Medicare for All - provisions related to establishment of a national health insurance program Oppose H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans Oppose H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans Oppose H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan Oppose H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option Oppose S 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare Oppose H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes H.R. 3, "Elijah E. Cummings Lower Drug Costs Now Act" H.R. 748, "Coronavirus Aid, Relief, and Economic Security Act" (CARES Act) - provisions related to Medicare Senate Health, Economic Assistance, Liability Protections and Schools (HEALS) Act H.R. 925, Health and Economic Recovery Omnibus Emergency Solutions Act (HEROS Act 2.0) Legislative proposals aimed at combating coronavirus impacting Medicare and Medicaid programs H.R. 133, "Consolidated Appropriations Act, 2021" - provisions related to Medicare and hospitals

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" H.R. 3235, "Access to Genetic Counseling Act"

Client expense: $398,118 · Firm income: Not reported

H.R. 107, Burgess: Rebate cap, regarding all bio-pharmaceutical related provisions. H.R. 275, Medicare Prescription Drug Negotiation Act, regarding all bio-pharmaceutical related provisions. H.R. 366, Insulin Access for All Act, regarding all bio-pharmaceutical related provisions. H.R. 1034, D. Collins/S. 640, Kennedy: Phair Pricing Act - Share the savings, regarding all bio-pharmaceutical related provisions. H.R. 1035, Prescription Drug Price Transparency Act, regarding all bio-pharmaceutical related provisions. H.R. 1332, Fair Care Act, regarding all bio-pharmaceutical related provisions. H.R. 1346, Medicare Buy-In and Health Care Stabilization Act, regarding all bio-pharmaceutical related provisions. H.R. 1384, Medicare for All Act, regarding all bio-pharmaceutical related provisions. H.R. 1781, Payment Commission Data Act of 2019, regarding all bio-pharmaceutical related provisions. H.R. 1788, Limits the penalty for Part B late enrollment to 15 percent and twice the period of no enrollment, regarding all bio-pharmaceutical related provisions. H.R. 2087, Reporting drug pricing information to Medicare, regarding all bio-pharmaceutical related provisions. H.R. 2113, Prescription STAR Act, regarding all bio-pharmaceutical related provisions. H.R.3, Lower Drug Costs Now Act of 2019, regarding all bio-pharmaceutical related provisions S. 62, Empowering Medicare Seniors to Negotiate Drug Prices, regarding all bio-pharmaceutical related provisions. S. 99, Medicare Drug Price Negotiation Act, regarding all bio-pharmaceutical related provisions. S. 205, Right Rebate Act, regarding all bio-pharmaceutical related provisions. S. 377/H.R. 1046, Medicare Negotiation and Competitive Licensing Act, regarding all bio-pharmaceutical related provisions. S. 470, Medicare at 50 Act, regarding all bio-pharmaceutical related provisions. S. 474, Stopping the Pharmaceutical Industry from Keeping drugs Expensive (SPIKE) Act of 2019 , regarding all bio-pharmaceutical related provisions. S. 475, RxCAP Act, regarding all bio-pharmaceutical related provisions. S. 476, Creating Transparency to Have Drug Rebates Unlocked (C-THRU Act) of 2019, regarding all bio-pharmaceutical related provisions. S. 551, REFUND Act of 2019, regarding all bio-pharmaceutical related provisions. S. 691, Expands Part D OOP assistance for low-income seniors and individuals with disabilities, regarding all bio-pharmaceutical related provisions. S. 801/H.R. 1781, Allows MedPAC and MACPAC to have access to information on drug rebates, regarding all bio-pharmaceutical related provisions. S. 981, Medicare-X Choice Act of 2019, regarding all bio-pharmaceutical related provisions. Pending rule to change the Rebate Safe Harbor, regarding all bio-pharmaceutical related provisions. H.R. 1839, Medicaid Services Investment and Accountability Act, regarding all bio-pharmaceutical related provisions H.R. 2452, Medicare for America Act, regarding all bio-pharmaceutical related provisions H.R. 3107, Improving Seniors Timely Access to Care Act, regarding all bio-pharmaceutical related provisions H.R. 3327, Drug Price Transparency for Medicare Patients Act, regarding all bio-pharmaceutical related provisions S. 1261/H.R. 2463, Choose Medicare Act, regarding all bio-pharmaceutical related provisions S. 1497, Health Care Price Check Act, regarding all bio-pharmaceutical related provisions S. 2081, a bill to require drug manufacturers to provide rebates for drugs furnished under Medicare Part B for which the growth in average sales price has exceeded inflation, regarding all bio-pharmaceutical related provisions. S. 2543, Prescription Drug Pricing Reduction Act of 2019, regarding all bio-pharmaceutical provisions. H.R. 19/S.3129 , Lower Costs, More Cures Act of 2019, regarding all bio-pharmaceutical related provisions H.R. 6218/S. 3457, Preserving Patient Access to Home Infusion Act, regarding all bio-pharmaceutical related provisions No Bill, Reimbursement for and patient access to Chimeric Antigen Receptor (CAR) T-cell therapies. Most Favored Nation (MFN) Model - (CMS-5528-IFC)

Proposed changes to Medicare hospital reimbursement policy Medicare hospital prospective payment system Site-neutral payment policies H.R. 1384/S. 1129, Medicare for All and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act S.2543, the Prescription Drug Pricing Reduction Act H.R. 748, "Coronavirus Aid, Relief, and Economic Security Act" (CARES Act) - provisions related to Medicare Senate Health, Economic Assistance, Liability Protections and Schools (HEALS) Act H.R. 925, Health and Economic Recovery Omnibus Emergency Solutions Act (HEROS Act 2.0) Legislative proposals aimed at combating coronavirus impacting Medicare and Medicaid programs

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

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 - provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" S. 2543, "the Prescription Drug Pricing Reduction Act" H.R. 3235, "Access to Genetic Counseling Act" H.R. 748, "Coronavirus Aid, Relief, and Economic Security Act" (CARES Act) - provisions related to Medicare Senate Health, Economic Assistance, Liability Protections and Schools (HEALS) Act H.R. 925, Health and Economic Recovery Omnibus Emergency Solutions Act (HEROS Act 2.0) Legislative proposals aimed at combating coronavirus impacting Medicare and Medicaid programs

Proposed changes to Medicare hospital reimbursement policy Star Rating System methodology and suspension of the display of overall star ratings on Hospital Compare while the agency continues its important work of enhancing the validity and meaningfulness of star ratings H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions Site-neutral payment policies Oppose H.R. 1384/S. 1129, Medicare for All - provisions related to establishment of a national health insurance program Oppose H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans Oppose H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans Oppose H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan Oppose H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option Oppose S 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare Oppose H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes H.R. 3, "Elijah E. Cummings Lower Drug Costs Now Act" H.R. 748, "Coronavirus Aid, Relief, and Economic Security Act" (CARES Act) - provisions related to Medicare Senate Health, Economic Assistance, Liability Protections and Schools (HEALS) Act H.R. 925, Health and Economic Recovery Omnibus Emergency Solutions Act (HEROS Act 2.0) Legislative proposals aimed at combating coronavirus impacting Medicare and Medicaid programs

Discussions on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussions about the work of Aligning for Health to address social determinants of health; Support HR 1041 / S 586,Critical Access Hospital Relief Act of 2019, a bill to amend title XVIII of the Social Security Act to remove the 96-hour physician certification requirement for inpatient critical access hospital services; Support S 895, Rural Hospital Regulatory Relief Act of 2019, a bill to provide for a permanent extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals; Support S 948,Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes; Discussions in support of the Rural Emergency Medical Center Act (REACH) Act; Support for extension of the Rural Community Hospital Demonstration Program; Support for extension of the Frontier Community Health Integration Project Demonstration program; Discuss changes with House and Senate committees to Section 8122 of the SUPPORT for Patients and Communities Act; Letter of support to Energy and Commerce Committee for the hearing on legislation to strengthen our health care system and ACA market stability; Support HR 1781/ S 801, Payment Commission Data Act of 2019, a bill to amend titles XVIII and XIX of the Social Security Act to provide the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission with access to certain drug payment information, including certain rebate information; Support S 551 Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 or the REFUND Act of 2019, a bill to amend title XVIII of the Social Security Act to require manufacturers of certain single-dose vial drugs payable under part B of the Medicare program to provide rebates with respect to amounts of such drugs discarded, and for other purposes; Support S 824/ HR 1767, Excellence in Mental Health and Addiction Treatment Expansion Act, a bill to increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services; Statement submitted to Senate Finance Committee on the implementation of the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Support HR 2552Protecting Local Access to Care for Everyone Act of 2019 or the PLACE Act of 2019, a bill to direct the Secretary of Health and Human Services to prevent certain payment reductions for clinic visit services furnished at excepted off-campus outpatient departments of a provider under the Medicare program; Support HR 3022, Patient Access Protection Act, a bill to amend title XIX of the Social Security Act to repeal the reductions in Medicaid DSH allotments, and for other purposes; Letter of support to the Ways and Means Committee in support of legislation to improve the quality of an access to services for Medicare beneficiaries, help train the physician workforce and reduce administrative burden on rural hospitals; Support HR 3431, HEARTS and Rural Relief Act, a bill to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2021; Support HR 3417,Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 or the BETTER Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program; Oppose HR 1384, Medicare for All Act of 2019, a bill to establish an improved Medicare for All national health insurance program; Oppose S 1129, Medicare for All Act of 2019, a bill to establish a Medicare-for-all national health insurance program; Letter to House Committee on Ways and Means for the hearing on Pathways to Universal Health Coverage addressing concerns with Medicare for All and believe that the variety of proposals that often are used interchangeably under that name are not the solution; Oppose HR 2452, Medicare for America Act of 2019, a bill to amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans; Letter to House Committee on Budget for the hearing on the Congressional Budget Offices (CBO) Key Design Components and Considerations for Establishing a Single-Payer Health Care System addressing concerns with Medicare for All; Oppose S 1261/ HR 2463, Choose Medicare Act, a bill to provide for the establishment of Medicare part E public health plans, and for other purposes; Oppose S 981/ HR 2000Medicare-X Choice Act of 2019A bill to establish a public health plan; Oppose S 1033/ HR 2085, CHOICE Act, a bill to amend the Public Health Service Act to establish a public health insurance option, and for other purposes; Oppose S 470, Medicare at 50 Act, a bill to amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare; Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes; Submitted Statement to the House Committee on Rules for the Hearing Medicare for All Act of 2019; Comment on provisions of HR 2328,Reauthorizing and Extending Americas Community Health (REACH) Act, support for the Medicaid disproportionate share hospital(DSH) program provisions included in Title III; comments on Title IV, which contains provisions of the No Surprises Act and concern with the legislations approach to determining reimbursement for out-of-network providers; Support HR 3107 Seniors Timely Access to Care Act of 2019, this legislation would establish requirements for the use of prior authorization under Medicare Advantage plans; Meeting with the Senate finance committee to discuss changes to drug bill; Meeting with CMS to discuss changes to prior authorization; Meeting with Department of Labor to discuss issues with ERISA health plans; Met with CMS staff on rural hospital issues; Regulatory burden related to new CMS guidance on documenting Crossover bad debt; Sent a Comment letter to CMS on a final rule on program integrity enhancements to the provider enrollment process for Medicare, Medicaid and Children's Health Insurance Programs; Oppose S. 2860 Patient Access to Higher Quality Health Care Act of 2019, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals, and for other purposes; Support HR 4996, Helping MOMS Act of 2019, a bill amend title XIX of the Social Security Act to provide for a State option under the Medicaid program to provide for and extend continuous coverage for certain individuals, and for other purposes; Addressing hospital concerns about HR 3 Lower Drug Costs Now Act, a bill to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes; Sent comment letter requesting that CMS withdraw the proposed regulation related to Medicaid Program: Medicaid Fiscal Accountability Regulation ( MFAR) financing and supplemental payments. Given that the proposal would severely curtail the availability of health care services to millions of individuals and because many of its provisions are not legally permissible; Discussion with CMS for rural hospitals and critical access hospitals about the Medicare accelerated payment program, which is intended to provide necessary funds to providers, including rural hospitals and critical access hospitals, when there is a disruption in claims submission and/or claims processing; Submitted comments on CMSs proposed rule on Medicare Advantage and Part D prescription drug program for Contract Years 2021 and 2022. The letter focuses on several proposals addressing network adequacy; Letter sent to HHS, CDC, CMS, and SAMHSA requesting specialized guidance and assistance for providers who care for patients with behavioral health disorders; Support resetting the Improving Medicare Post- Acute Care Transformation (IMPACT) Act of 2014 in the next COVID-19 relief package. The IMPACT Acts implementation is behind schedule and does not take into account extensive payment reforms already underway in each post-acute care setting; Letter urging HHS to release substantial additional emergency funds to all hospitals in an expedited manner. This second wave of funding to all hospitals, targeted relief is necessary for hospitals in hot spots, hospitals with a high percentage of payments under Medicare Advantage, hospitals caring for high numbers of Medicaid patients, and rural hospitals; Support HR 6693 Critical Access Hospital Expansion Act of 2020, a bill to amend title XVIII of the Social Security Act to allow States to certify certain hospitals as necessary providers for purposes of designating such hospitals as critical access hospitals under the Medicare program; Support HR 6753/ S 3615 Rural Community Hospital Demonstration Extension Act of 2020, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the rural community hospital demonstration program; Letter urging CMS to use its authority to extend to LTCHs the existing 20% hospital add-on payment for Medicare beneficiaries diagnosed with COVID-19; Letter to CMS urging the agency to temporarily extend certain waivers and make others permanent beyond the COVID-19 public health emergency to allow hospitals to provide better and more cost effective care to their patients and communities; Sent comment letter to CMS about our concerns with the timeline proposed for implementation as well as the potential for penalties for noncompliance within this timeline on the Medicare Program: Electronic Prescribing of Controlled Substances; Sent comment letter on the FY 2021 Inpatient PPS proposed rule addressing CMS proposals related to payer-specific negotiated rate data collection, Medicare DSH payments, CAR T, bad debt, MS-DRG classifications, and quality programs, among other topics. Letter requesting that the CMS delay the implementation of the Appropriate Use Criteria for Advanced Diagnostic Imaging Services program to allow providers the opportunity to implement and test operational changes and acquire the education necessary to achieve compliance with the program; Sent comments to the CMS on the agencys long-term care hospital prospective payment system proposed policy changes and fiscal year 2021 rates; Letter to CMS asking for a delay in the start of repayments associated with the Medicare Accelerated and Advance Payment (AAP) Programs; Letter urging the CMS to continue its suspension of medical review activities throughout the ongoing COVID-19 public health emergency; Letter urging CMS to allow periodic interim payment (PIP) hospitals to carry out their accelerated payment repayment at cost settlement, as was initially communicated by the agency and also request that the agency make alternative repayment approaches available, such as direct payments to the Medicare Administrative Contractor (MAC), for all hospitals; Comment letter on CY 2021 Home Health Prospective Payment System Rate Update proposed rule. While we continue to support the PDGM objective of increasing HH PPS payment accuracy, we remain concerned that CY 2020s large behavioral offset, 4.36%, was implemented on a prospective basis; Letter urging the CMS to withdraw the condition of participation (CoP) that hospitals report daily COVID-19 data and request that CMS immediately release detailed interpretive guidance so hospitals can take the necessary steps to come into compliance; Urged CMS to withdraw its Medicaid fiscal accountability proposed rule from its regulatory agenda because it would "severely curtail the availability of health care services to millions of individuals" and "many of its provisions are not legally permissible."

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" H.R. 3235, "Access to Genetic Counseling Act"

Client expense: $201,000 · Firm income: Not reported

H.R. 107, Burgess: Rebate cap, regarding all bio-pharmaceutical related provisions. H.R. 275, Medicare Prescription Drug Negotiation Act, regarding all bio-pharmaceutical related provisions. H.R. 366, Insulin Access for All Act, regarding all bio-pharmaceutical related provisions. H.R. 1034, D. Collins/S. 640, Kennedy: Phair Pricing Act - Share the savings, regarding all bio-pharmaceutical related provisions. H.R. 1035, Prescription Drug Price Transparency Act, regarding all bio-pharmaceutical related provisions. H.R. 1332, Fair Care Act, regarding all bio-pharmaceutical related provisions. H.R. 1346, Medicare Buy-In and Health Care Stabilization Act, regarding all bio-pharmaceutical related provisions. H.R. 1384, Medicare for All Act, regarding all bio-pharmaceutical related provisions. H.R. 1781, Payment Commission Data Act of 2019, regarding all bio-pharmaceutical related provisions. H.R. 1788, Limits the penalty for Part B late enrollment to 15 percent and twice the period of no enrollment, regarding all bio-pharmaceutical related provisions. H.R. 2087, Reporting drug pricing information to Medicare, regarding all bio-pharmaceutical related provisions. H.R. 2113, Prescription STAR Act, regarding all bio-pharmaceutical related provisions. H.R.3, Lower Drug Costs Now Act of 2019, regarding all bio-pharmaceutical related provisions S. 62, Empowering Medicare Seniors to Negotiate Drug Prices, regarding all bio-pharmaceutical related provisions. S. 99, Medicare Drug Price Negotiation Act, regarding all bio-pharmaceutical related provisions. S. 205, Right Rebate Act, regarding all bio-pharmaceutical related provisions. S. 377/H.R. 1046, Medicare Negotiation and Competitive Licensing Act, regarding all bio-pharmaceutical related provisions. S. 470, Medicare at 50 Act, regarding all bio-pharmaceutical related provisions. S. 474, Stopping the Pharmaceutical Industry from Keeping drugs Expensive (SPIKE) Act of 2019 , regarding all bio-pharmaceutical related provisions. S. 475, RxCAP Act, regarding all bio-pharmaceutical related provisions. S. 476, Creating Transparency to Have Drug Rebates Unlocked (C-THRU Act) of 2019, regarding all bio-pharmaceutical related provisions. S. 551, REFUND Act of 2019, regarding all bio-pharmaceutical related provisions. S. 691, Expands Part D OOP assistance for low-income seniors and individuals with disabilities, regarding all bio-pharmaceutical related provisions. S. 801/H.R. 1781, Allows MedPAC and MACPAC to have access to information on drug rebates, regarding all bio-pharmaceutical related provisions. S. 981, Medicare-X Choice Act of 2019, regarding all bio-pharmaceutical related provisions. Pending rule to change the Rebate Safe Harbor, regarding all bio-pharmaceutical related provisions. H.R. 1839, Medicaid Services Investment and Accountability Act, regarding all bio-pharmaceutical related provisions H.R. 2452, Medicare for America Act, regarding all bio-pharmaceutical related provisions H.R. 3107, Improving Seniors Timely Access to Care Act, regarding all bio-pharmaceutical related provisions H.R. 3327, Drug Price Transparency for Medicare Patients Act, regarding all bio-pharmaceutical related provisions S. 1261/H.R. 2463, Choose Medicare Act, regarding all bio-pharmaceutical related provisions S. 1497, Health Care Price Check Act, regarding all bio-pharmaceutical related provisions S. 2081, a bill to require drug manufacturers to provide rebates for drugs furnished under Medicare Part B for which the growth in average sales price has exceeded inflation, regarding all bio-pharmaceutical related provisions. S. 2543, Prescription Drug Pricing Reduction Act of 2019, regarding all bio-pharmaceutical provisions. H.R. 19/S.3129 , Lower Costs, More Cures Act of 2019, regarding all bio-pharmaceutical related provisions H.R. 6218/S. 3457, Preserving Patient Access to Home Infusion Act, regarding all bio-pharmaceutical related provisions No Bill, Reimbursement for and patient access to Chimeric Antigen Receptor (CAR) T-cell therapies.

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 - provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" S. 2543, "the Prescription Drug Pricing Reduction Act" H.R. 3235, "Access to Genetic Counseling Act" H.R. 6201, "Families First Coronavirus Response Act" - provisions related to Medicaid and Medicare H.R. 748, "Coronavirus Aid, Relief, and Economic Security Act" (CARES Act) - provisions related to Medicare H.R. 6800, "HEROES Act" Legislative proposals aimed at combating coronavirus impacting Medicare and Medicaid programs

Proposed changes to Medicare hospital reimbursement policy Medicare hospital prospective payment system Site-neutral payment policies H.R. 1384/S. 1129, Medicare for All and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act S.2543, the Prescription Drug Pricing Reduction Act H.R. 6201, "Families First Coronavirus Response Act" - provisions related to Medicaid and Medicare H.R. 748, "Coronavirus Aid, Relief, and Economic Security Act" (CARES Act) - provisions related to Medicare H.R. 6800, "HEROES Act" Legislative proposals aimed at combating coronavirus impacting Medicare and Medicaid programs

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

Proposed changes to Medicare hospital reimbursement policy Star Rating System methodology and suspension of the display of overall star ratings on Hospital Compare while the agency continues its important work of enhancing the validity and meaningfulness of star ratings H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions Site-neutral payment policies Oppose H.R. 1384/S. 1129, Medicare for All - provisions related to establishment of a national health insurance program Oppose H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans Oppose H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans Oppose H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan Oppose H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option Oppose S 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare Oppose H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes H.R. 3, "Elijah E. Cummings Lower Drug Costs Now Act" H.R. 6201, "Families First Coronavirus Response Act" - provisions related to Medicaid and Medicare H.R. 748, "Coronavirus Aid, Relief, and Economic Security Act" (CARES Act) - provisions related to Medicare H.R. 6800, "HEROES Act" Legislative proposals aimed at combating coronavirus impacting Medicare and Medicaid programs

Discussions on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussions about the work of Aligning for Health to address social determinants of health; Support HR 1041 / S 586,Critical Access Hospital Relief Act of 2019, a bill to amend title XVIII of the Social Security Act to remove the 96-hour physician certification requirement for inpatient critical access hospital services; Support S 895, Rural Hospital Regulatory Relief Act of 2019, a bill to provide for a permanent extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals; Support S 948,Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes; Discussions in support of the Rural Emergency Medical Center Act (REACH) Act; Support for extension of the Rural Community Hospital Demonstration Program; Support for extension of the Frontier Community Health Integration Project Demonstration program; Discuss changes with House and Senate committees to Section 8122 of the SUPPORT for Patients and Communities Act; Letter of support to Energy and Commerce Committee for the hearing on legislation to strengthen our health care system and ACA market stability; Support HR 1781/ S 801, Payment Commission Data Act of 2019, a bill to amend titles XVIII and XIX of the Social Security Act to provide the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission with access to certain drug payment information, including certain rebate information; Support S 551 Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 or the REFUND Act of 2019, a bill to amend title XVIII of the Social Security Act to require manufacturers of certain single-dose vial drugs payable under part B of the Medicare program to provide rebates with respect to amounts of such drugs discarded, and for other purposes; Support S 824/ HR 1767, Excellence in Mental Health and Addiction Treatment Expansion Act, a bill to increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services; Statement submitted to Senate Finance Committee on the implementation of the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Support HR 2552Protecting Local Access to Care for Everyone Act of 2019 or the PLACE Act of 2019, a bill to direct the Secretary of Health and Human Services to prevent certain payment reductions for clinic visit services furnished at excepted off-campus outpatient departments of a provider under the Medicare program; Support HR 3022, Patient Access Protection Act, a bill to amend title XIX of the Social Security Act to repeal the reductions in Medicaid DSH allotments, and for other purposes; Letter of support to the Ways and Means Committee in support of legislation to improve the quality of an access to services for Medicare beneficiaries, help train the physician workforce and reduce administrative burden on rural hospitals; Support HR 3431, HEARTS and Rural Relief Act, a bill to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2021; Support HR 3417,Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 or the BETTER Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program; Oppose HR 1384, Medicare for All Act of 2019, a bill to establish an improved Medicare for All national health insurance program; Oppose S 1129, Medicare for All Act of 2019, a bill to establish a Medicare-for-all national health insurance program; Letter to House Committee on Ways and Means for the hearing on Pathways to Universal Health Coverage addressing concerns with Medicare for All and believe that the variety of proposals that often are used interchangeably under that name are not the solution; Oppose HR 2452, Medicare for America Act of 2019, a bill to amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans; Letter to House Committee on Budget for the hearing on the Congressional Budget Offices (CBO) Key Design Components and Considerations for Establishing a Single-Payer Health Care System addressing concerns with Medicare for All; Oppose S 1261/ HR 2463, Choose Medicare Act, a bill to provide for the establishment of Medicare part E public health plans, and for other purposes; Oppose S 981/ HR 2000Medicare-X Choice Act of 2019A bill to establish a public health plan; Oppose S 1033/ HR 2085, CHOICE Act, a bill to amend the Public Health Service Act to establish a public health insurance option, and for other purposes; Oppose S 470, Medicare at 50 Act, a bill to amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare; Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes; Submitted Statement to the House Committee on Rules for the Hearing Medicare for All Act of 2019; Comment on provisions of HR 2328,Reauthorizing and Extending Americas Community Health (REACH) Act, support for the Medicaid disproportionate share hospital(DSH) program provisions included in Title III; comments on Title IV, which contains provisions of the No Surprises Act and concern with the legislations approach to determining reimbursement for out-of-network providers; Support HR 3107 Seniors Timely Access to Care Act of 2019, this legislation would establish requirements for the use of prior authorization under Medicare Advantage plans; Meeting with the Senate finance committee to discuss changes to drug bill; Meeting with CMS to discuss changes to prior authorization; Meeting with Department of Labor to discuss issues with ERISA health plans; Met with CMS staff on rural hospital issues; Regulatory burden related to new CMS guidance on documenting Crossover bad debt; Sent a Comment letter to CMS on a final rule on program integrity enhancements to the provider enrollment process for Medicare, Medicaid and Children's Health Insurance Programs; Oppose S. 2860 Patient Access to Higher Quality Health Care Act of 2019, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals, and for other purposes; Support HR 4996, Helping MOMS Act of 2019, a bill amend title XIX of the Social Security Act to provide for a State option under the Medicaid program to provide for and extend continuous coverage for certain individuals, and for other purposes; Addressing hospital concerns about HR 3 Lower Drug Costs Now Act, a bill to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes; Sent comment letter requesting that CMS withdraw the proposed regulation related to Medicaid Program: Medicaid Fiscal Accountability Regulation ( MFAR) financing and supplemental payments. Given that the proposal would severely curtail the availability of health care services to millions of individuals and because many of its provisions are not legally permissible; Discussion with CMS for rural hospitals and critical access hospitals about the Medicare accelerated payment program, which is intended to provide necessary funds to providers, including rural hospitals and critical access hospitals, when there is a disruption in claims submission and/or claims processing; Submitted comments on CMSs proposed rule on Medicare Advantage and Part D prescription drug program for Contract Years 2021 and 2022. The letter focuses on several proposals addressing network adequacy; Letter sent to HHS, CDC, CMS, and SAMHSA requesting specialized guidance and assistance for providers who care for patients with behavioral health disorders; Support resetting the Improving Medicare Post- Acute Care Transformation (IMPACT) Act of 2014 in the next COVID-19 relief package. The IMPACT Acts implementation is behind schedule and does not take into account extensive payment reforms already underway in each post-acute care setting; Letter urging HHS to release substantial additional emergency funds to all hospitals in an expedited manner. This second wave of funding to all hospitals, targeted relief is necessary for hospitals in hot spots, hospitals with a high percentage of payments under Medicare Advantage, hospitals caring for high numbers of Medicaid patients, and rural hospitals; Support HR 6693 Critical Access Hospital Expansion Act of 2020, a bill to amend title XVIII of the Social Security Act to allow States to certify certain hospitals as necessary providers for purposes of designating such hospitals as critical access hospitals under the Medicare program; Support HR 6753/ S 3615 Rural Community Hospital Demonstration Extension Act of 2020, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the rural community hospital demonstration program; Letter urging CMS to use its authority to extend to LTCHs the existing 20% hospital add-on payment for Medicare beneficiaries diagnosed with COVID-19; Letter to CMS urging the agency to temporarily extend certain waivers and make others permanent beyond the COVID-19 public health emergency to allow hospitals to provide better and more cost effective care to their patients and communities.

H.R. 107, Burgess: Rebate cap, regarding all bio-pharmaceutical related provisions. H.R. 275, Medicare Prescription Drug Negotiation Act, regarding all bio-pharmaceutical related provisions. H.R. 366, Insulin Access for All Act, regarding all bio-pharmaceutical related provisions. H.R. 1034, D. Collins/S. 640, Kennedy: Phair Pricing Act - Share the savings, regarding all bio-pharmaceutical related provisions. H.R. 1035, Prescription Drug Price Transparency Act, regarding all bio-pharmaceutical related provisions. H.R. 1332, Fair Care Act, regarding all bio-pharmaceutical related provisions. H.R. 1346, Medicare Buy-In and Health Care Stabilization Act, regarding all bio-pharmaceutical related provisions. H.R. 1384, Medicare for All Act, regarding all bio-pharmaceutical related provisions. H.R. 1781, Payment Commission Data Act of 2019, regarding all bio-pharmaceutical related provisions. H.R. 1788, Limits the penalty for Part B late enrollment to 15 percent and twice the period of no enrollment, regarding all bio-pharmaceutical related provisions. H.R. 2087, Reporting drug pricing information to Medicare, regarding all bio-pharmaceutical related provisions. H.R. 2113, Prescription STAR Act, regarding all bio-pharmaceutical related provisions. H.R.3, Lower Drug Costs Now Act of 2019, regarding all bio-pharmaceutical related provisions S. 62, Empowering Medicare Seniors to Negotiate Drug Prices, regarding all bio-pharmaceutical related provisions. S. 99, Medicare Drug Price Negotiation Act, regarding all bio-pharmaceutical related provisions. S. 205, Right Rebate Act, regarding all bio-pharmaceutical related provisions. S. 377/H.R. 1046, Medicare Negotiation and Competitive Licensing Act, regarding all bio-pharmaceutical related provisions. S. 470, Medicare at 50 Act, regarding all bio-pharmaceutical related provisions. S. 474, Stopping the Pharmaceutical Industry from Keeping drugs Expensive (SPIKE) Act of 2019 , regarding all bio-pharmaceutical related provisions. S. 475, RxCAP Act, regarding all bio-pharmaceutical related provisions. S. 476, Creating Transparency to Have Drug Rebates Unlocked (C-THRU Act) of 2019, regarding all bio-pharmaceutical related provisions. S. 551, REFUND Act of 2019, regarding all bio-pharmaceutical related provisions. S. 691, Expands Part D OOP assistance for low-income seniors and individuals with disabilities, regarding all bio-pharmaceutical related provisions. S. 801/H.R. 1781, Allows MedPAC and MACPAC to have access to information on drug rebates, regarding all bio-pharmaceutical related provisions. S. 981, Medicare-X Choice Act of 2019, regarding all bio-pharmaceutical related provisions. Pending rule to change the Rebate Safe Harbor, regarding all bio-pharmaceutical related provisions. H.R. 1839, Medicaid Services Investment and Accountability Act, regarding all bio-pharmaceutical related provisions H.R. 2452, Medicare for America Act, regarding all bio-pharmaceutical related provisions H.R. 3107, Improving Seniors Timely Access to Care Act, regarding all bio-pharmaceutical related provisions H.R. 3327, Drug Price Transparency for Medicare Patients Act, regarding all bio-pharmaceutical related provisions S. 1261/H.R. 2463, Choose Medicare Act, regarding all bio-pharmaceutical related provisions S. 1497, Health Care Price Check Act, regarding all bio-pharmaceutical related provisions S. 2081, a bill to require drug manufacturers to provide rebates for drugs furnished under Medicare Part B for which the growth in average sales price has exceeded inflation, regarding all bio-pharmaceutical related provisions. S. 2543, Prescription Drug Pricing Reduction Act of 2019, regarding all bio-pharmaceutical provisions. H.R. 19/S.3129 , Lower Costs, More Cures Act of 2019, regarding all bio-pharmaceutical related provisions H.R. 6218/S. 3457, Preserving Patient Access to Home Infusion Act, regarding all bio-pharmaceutical related provisions No Bill, Reimbursement for and patient access to Chimeric Antigen Receptor (CAR) T-cell therapies.

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" H.R. 3235, "Access to Genetic Counseling Act"

Client expense: $201,000 · Firm income: Not reported

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" H.R. 3235, "Access to Genetic Counseling Act"

Client expense: $201,000 · Firm income: Not reported

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" H.R. 3235, "Access to Genetic Counseling Act"

Client expense: $129,472 · Firm income: Not reported

Discussions on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussions about the work of Aligning for Health to address social determinants of health; Support HR 1041 / S 586,Critical Access Hospital Relief Act of 2019, a bill to amend title XVIII of the Social Security Act to remove the 96-hour physician certification requirement for inpatient critical access hospital services; Support S 895, Rural Hospital Regulatory Relief Act of 2019, a bill to provide for a permanent extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals; Support S 948,Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes; Discussions in support of the Rural Emergency Medical Center Act (REACH) Act; Support for extension of the Rural Community Hospital Demonstration Program; Support for extension of the Frontier Community Health Integration Project Demonstration program; Discuss changes with House and Senate committees to Section 8122 of the SUPPORT for Patients and Communities Act; Letter of support to Energy and Commerce Committee for the hearing on legislation to strengthen our health care system and ACA market stability; Support HR 1781/ S 801, Payment Commission Data Act of 2019, a bill to amend titles XVIII and XIX of the Social Security Act to provide the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission with access to certain drug payment information, including certain rebate information; Support S 551 Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 or the REFUND Act of 2019, a bill to amend title XVIII of the Social Security Act to require manufacturers of certain single-dose vial drugs payable under part B of the Medicare program to provide rebates with respect to amounts of such drugs discarded, and for other purposes; Support S 824/ HR 1767, Excellence in Mental Health and Addiction Treatment Expansion Act, a bill to increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services; Statement submitted to Senate Finance Committee on the implementation of the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Support HR 2552Protecting Local Access to Care for Everyone Act of 2019 or the PLACE Act of 2019, a bill to direct the Secretary of Health and Human Services to prevent certain payment reductions for clinic visit services furnished at excepted off-campus outpatient departments of a provider under the Medicare program; Support HR 3022, Patient Access Protection Act, a bill to amend title XIX of the Social Security Act to repeal the reductions in Medicaid DSH allotments, and for other purposes; Letter of support to the Ways and Means Committee in support of legislation to improve the quality of an access to services for Medicare beneficiaries, help train the physician workforce and reduce administrative burden on rural hospitals; Support HR 3431, HEARTS and Rural Relief Act, a bill to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2021; Support HR 3417,Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 or the BETTER Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program; Oppose HR 1384, Medicare for All Act of 2019, a bill to establish an improved Medicare for All national health insurance program; Oppose S 1129, Medicare for All Act of 2019, a bill to establish a Medicare-for-all national health insurance program; Letter to House Committee on Ways and Means for the hearing on Pathways to Universal Health Coverage addressing concerns with Medicare for All and believe that the variety of proposals that often are used interchangeably under that name are not the solution; Oppose HR 2452, Medicare for America Act of 2019, a bill to amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans; Letter to House Committee on Budget for the hearing on the Congressional Budget Offices (CBO) Key Design Components and Considerations for Establishing a Single-Payer Health Care System addressing concerns with Medicare for All; Oppose S 1261/ HR 2463, Choose Medicare Act, a bill to provide for the establishment of Medicare part E public health plans, and for other purposes; Oppose S 981/ HR 2000Medicare-X Choice Act of 2019A bill to establish a public health plan; Oppose S 1033/ HR 2085, CHOICE Act, a bill to amend the Public Health Service Act to establish a public health insurance option, and for other purposes; Oppose S 470, Medicare at 50 Act, a bill to amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare; Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes; Submitted Statement to the House Committee on Rules for the Hearing Medicare for All Act of 2019; Comment on provisions of HR 2328,Reauthorizing and Extending Americas Community Health (REACH) Act, support for the Medicaid disproportionate share hospital(DSH) program provisions included in Title III; comments on Title IV, which contains provisions of the No Surprises Act and concern with the legislations approach to determining reimbursement for out-of-network providers; Support HR 3107 Seniors Timely Access to Care Act of 2019, this legislation would establish requirements for the use of prior authorization under Medicare Advantage plans; Meeting with the Senate finance committee to discuss changes to drug bill; Meeting with CMS to discuss changes to prior authorization; Meeting with Department of Labor to discuss issues with ERISA health plans; Met with CMS staff on rural hospital issues; Regulatory burden related to new CMS guidance on documenting Crossover bad debt; Sent a Comment letter to CMS on a final rule on program integrity enhancements to the provider enrollment process for Medicare, Medicaid and Children's Health Insurance Programs; Oppose S. 2860 Patient Access to Higher Quality Health Care Act of 2019, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals, and for other purposes; Support HR 4996, Helping MOMS Act of 2019, a bill amend title XIX of the Social Security Act to provide for a State option under the Medicaid program to provide for and extend continuous coverage for certain individuals, and for other purposes; Addressing hospital concerns about HR 3 Lower Drug Costs Now Act, a bill to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes; Sent comment letter requesting that CMS withdraw the proposed regulation related to Medicaid Program: Medicaid Fiscal Accountability Regulation ( MFAR) financing and supplemental payments. Given that the proposal would severely curtail the availability of health care services to millions of individuals and because many of its provisions are not legally permissible.

H.R. 107, Burgess: Rebate cap, regarding all bio-pharmaceutical related provisions. H.R. 275, Medicare Prescription Drug Negotiation Act, regarding all bio-pharmaceutical related provisions. H.R. 366, Insulin Access for All Act, regarding all bio-pharmaceutical related provisions. H.R. 1034, D. Collins/S. 640, Kennedy: Phair Pricing Act - Share the savings, regarding all bio-pharmaceutical related provisions. H.R. 1035, Prescription Drug Price Transparency Act, regarding all bio-pharmaceutical related provisions. H.R. 1332, Fair Care Act, regarding all bio-pharmaceutical related provisions. H.R. 1346, Medicare Buy-In and Health Care Stabilization Act, regarding all bio-pharmaceutical related provisions. H.R. 1384, Medicare for All Act, regarding all bio-pharmaceutical related provisions. H.R. 1781, Payment Commission Data Act of 2019, regarding all bio-pharmaceutical related provisions. H.R. 1788, Limits the penalty for Part B late enrollment to 15 percent and twice the period of no enrollment, regarding all bio-pharmaceutical related provisions. H.R. 2087, Reporting drug pricing information to Medicare, regarding all bio-pharmaceutical related provisions. H.R. 2113, Prescription STAR Act, regarding all bio-pharmaceutical related provisions. H.R.3, Lower Drug Costs Now Act of 2019, regarding all bio-pharmaceutical related provisions S. 62, Empowering Medicare Seniors to Negotiate Drug Prices, regarding all bio-pharmaceutical related provisions. S. 99, Medicare Drug Price Negotiation Act, regarding all bio-pharmaceutical related provisions. S. 205, Right Rebate Act, regarding all bio-pharmaceutical related provisions. S. 377/H.R. 1046, Medicare Negotiation and Competitive Licensing Act, regarding all bio-pharmaceutical related provisions. S. 470, Medicare at 50 Act, regarding all bio-pharmaceutical related provisions. S. 474, Stopping the Pharmaceutical Industry from Keeping drugs Expensive (SPIKE) Act of 2019 , regarding all bio-pharmaceutical related provisions. S. 475, RxCAP Act, regarding all bio-pharmaceutical related provisions. S. 476, Creating Transparency to Have Drug Rebates Unlocked (C-THRU Act) of 2019, regarding all bio-pharmaceutical related provisions. S. 551, REFUND Act of 2019, regarding all bio-pharmaceutical related provisions. S. 691, Expands Part D OOP assistance for low-income seniors and individuals with disabilities, regarding all bio-pharmaceutical related provisions. S. 801/H.R. 1781, Allows MedPAC and MACPAC to have access to information on drug rebates, regarding all bio-pharmaceutical related provisions. S. 981, Medicare-X Choice Act of 2019, regarding all bio-pharmaceutical related provisions. Pending rule to change the Rebate Safe Harbor, regarding all bio-pharmaceutical related provisions. H.R. 1839, Medicaid Services Investment and Accountability Act, regarding all bio-pharmaceutical related provisions H.R. 2452, Medicare for America Act, regarding all bio-pharmaceutical related provisions H.R. 3107, Improving Seniors Timely Access to Care Act, regarding all bio-pharmaceutical related provisions H.R. 3327, Drug Price Transparency for Medicare Patients Act, regarding all bio-pharmaceutical related provisions S. 1261/H.R. 2463, Choose Medicare Act, regarding all bio-pharmaceutical related provisions S. 1497, Health Care Price Check Act, regarding all bio-pharmaceutical related provisions S. 2081, a bill to require drug manufacturers to provide rebates for drugs furnished under Medicare Part B for which the growth in average sales price has exceeded inflation, regarding all bio-pharmaceutical related provisions. S. 2543, Prescription Drug Pricing Reduction Act of 2019, regarding all bio-pharmaceutical provisions. H.R. 19/S.3129 , Lower Costs, More Cures Act of 2019, regarding all bio-pharmaceutical related provisions H.R. 6218/S. 3457, Preserving Patient Access to Home Infusion Act, regarding all bio-pharmaceutical related provisions No Bill, Reimbursement for and patient access to Chimeric Antigen Receptor (CAR) T-cell therapies.

Proposed changes to Medicare hospital reimbursement policy Medicare hospital prospective payment system Site-neutral payment policies H.R. 1384/S. 1129, Medicare for All and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act S.2543, the Prescription Drug Pricing Reduction Act H.R. 6201, "Families First Coronavirus Response Act" - provisions related to Medicaid and Medicare H.R. 748, "Coronavirus Aid, Relief, and Economic Security Act" (CARES Act) - provisions related to Medicare Legislative proposals aimed at combating coronavirus impacting Medicare and Medicaid programs

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

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 - provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" S. 2543, "the Prescription Drug Pricing Reduction Act" H.R. 3235, "Access to Genetic Counseling Act" H.R. 6201, "Families First Coronavirus Response Act" - provisions related to Medicaid and Medicare H.R. 748, "Coronavirus Aid, Relief, and Economic Security Act" (CARES Act) - provisions related to Medicare Legislative proposals aimed at combating coronavirus impacting Medicare and Medicaid programs

Proposed changes to Medicare hospital reimbursement policy Star Rating System methodology and suspension of the display of overall star ratings on Hospital Compare while the agency continues its important work of enhancing the validity and meaningfulness of star ratings H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions Site-neutral payment policies Oppose H.R. 1384/S. 1129, Medicare for All - provisions related to establishment of a national health insurance program Oppose H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans Oppose H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans Oppose H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan Oppose H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option Oppose S 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes H.R. 3, "Elijah E. Cummings Lower Drug Costs Now Act" H.R. 6201, "Families First Coronavirus Response Act" - provisions related to Medicaid and Medicare H.R. 748, "Coronavirus Aid, Relief, and Economic Security Act" (CARES Act) - provisions related to Medicare Legislative proposals aimed at combating coronavirus impacting Medicare and Medicaid programs

Proposed changes to Medicare hospital reimbursement policy Medicare hospital prospective payment system Site-neutral payment policies H.R. 1384/S. 1129, Medicare for All and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, Elijah E. Cummings Lower Drug Costs Now Act S.2543, the Prescription Drug Pricing Reduction Act

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

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 - provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" S. 2543, the Prescription Drug Pricing Reduction Act H.R. 3235, "Access to Genetic Counseling Act"

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

Proposed changes to Medicare hospital reimbursement policy Star Rating System methodology and suspension of the display of overall star ratings on Hospital Compare while the agency continues its important work of enhancing the validity and meaningfulness of star ratings H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions Site-neutral payment policies Oppose H.R. 1384/S. 1129, Medicare for All - provisions related to establishment of a national health insurance program Oppose H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans Oppose H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans Oppose H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan Oppose H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option Oppose S 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes H.R. 3, "Elijah E. Cummings Lower Drug Costs Now Act"

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

Discussions on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussions about the work of Aligning for Health to address social determinants of health; Support HR 1041 / S 586,Critical Access Hospital Relief Act of 2019, a bill to amend title XVIII of the Social Security Act to remove the 96-hour physician certification requirement for inpatient critical access hospital services; Support S 895, Rural Hospital Regulatory Relief Act of 2019, a bill to provide for a permanent extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals; Support S 948,Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes; Discussions in support of the Rural Emergency Medical Center Act (REACH) Act; Support for extension of the Rural Community Hospital Demonstration Program; Support for extension of the Frontier Community Health Integration Project Demonstration program; Discuss changes with House and Senate committees to Section 8122 of the SUPPORT for Patients and Communities Act; Letter of support to Energy and Commerce Committee for the hearing on legislation to strengthen our health care system and ACA market stability; Letter urging the Centers for Medicare & Medicaid Services (CMS)to consider alternative payment solutions for Chimeric Antigen Receptor T-cell (CAR T) therapy; Joint letter urging Congress to delay the start of the Medicaid disproportionate share hospital (DSH) cuts, which are scheduled to begin in fiscal year (FY) 2020; Comments to CMS on exploring ways continually to improve the Medicaid managed care program to ensure access to high-quality care for the Medicaid population; Support HR 1781/ S 801, Payment Commission Data Act of 2019, a bill to amend titles XVIII and XIX of the Social Security Act to provide the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission with access to certain drug payment information, including certain rebate information; Support S 551 Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 or the REFUND Act of 2019, a bill to amend title XVIII of the Social Security Act to require manufacturers of certain single-dose vial drugs payable under part B of the Medicare program to provide rebates with respect to amounts of such drugs discarded, and for other purposes; Support S 824/ HR 1767, Excellence in Mental Health and Addiction Treatment Expansion Act, a bill to increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services; Statement submitted to Senate Finance Committee on the implementation of the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Support HR 2552Protecting Local Access to Care for Everyone Act of 2019 or the PLACE Act of 2019, a bill to direct the Secretary of Health and Human Services to prevent certain payment reductions for clinic visit services furnished at excepted off-campus outpatient departments of a provider under the Medicare program; Support HR 3022, Patient Access Protection Act, a bill to amend title XIX of the Social Security Act to repeal the reductions in Medicaid DSH allotments, and for other purposes; Letter of support to the Ways and Means Committee in support of legislation to improve the quality of an access to services for Medicare beneficiaries, help train the physician workforce and reduce administrative burden on rural hospitals; Support HR 3431, HEARTS and Rural Relief Act, a bill to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2021; Support HR 3417,Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 or the BETTER Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program; Oppose HR 1384, Medicare for All Act of 2019, a bill to establish an improved Medicare for All national health insurance program; Oppose S 1129, Medicare for All Act of 2019, a bill to establish a Medicare-for-all national health insurance program; Letter to House Committee on Ways and Means for the hearing on Pathways to Universal Health Coverage addressing concerns with Medicare for All and believe that the variety of proposals that often are used interchangeably under that name are not the solution; Oppose HR 2452, Medicare for America Act of 2019, a bill to amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans; Letter to House Committee on Budget for the hearing on the Congressional Budget Offices (CBO) Key Design Components and Considerations for Establishing a Single-Payer Health Care System addressing concerns with Medicare for All; Oppose S 1261/ HR 2463, Choose Medicare Act, a bill to provide for the establishment of Medicare part E public health plans, and for other purposes; Oppose S 981/ HR 2000Medicare-X Choice Act of 2019A bill to establish a public health plan; Oppose S 1033/ HR 2085, CHOICE Act, a bill to amend the Public Health Service Act to establish a public health insurance option, and for other purposes; Oppose S 470, Medicare at 50 Act, a bill to amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare; Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes; Submitted Statement to the House Committee on Rules for the Hearing Medicare for All Act of 2019; Comment on provisions of HR 2328,Reauthorizing and Extending Americas Community Health (REACH) Act, support for the Medicaid disproportionate share hospital(DSH) program provisions included in Title III; comments on Title IV, which contains provisions of the No Surprises Act and concern with the legislations approach to determining reimbursement for out-of-network providers; Support HR 3107 Seniors Timely Access to Care Act of 2019, this legislation would establish requirements for the use of prior authorization under Medicare Advantage plans; Meeting with the Senate finance committee to discuss changes to drug bill; Meeting with CMS to discuss changes to prior authorization; Meeting with Department of Labor to discuss issues with ERISA health plans; Met with CMS staff on rural hospital issues; Regulatory burden related to new CMS guidance on documenting Crossover bad debt; Sent a Comment letter to CMS on a final rule on program integrity enhancements to the provider enrollment process for Medicare, Medicaid and Children's Health Insurance Programs; Oppose S. 2860 Patient Access to Higher Quality Health Care Act of 2019, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals, and for other purposes; Support HR 4996, Helping MOMS Act of 2019, a bill amend title XIX of the Social Security Act to provide for a State option under the Medicaid program to provide for and extend continuous coverage for certain individuals, and for other purposes; Addressing hospital concerns about HR 3 Lower Drug Costs Now Act, a bill to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes.

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" H.R. 3235, "Access to Genetic Counseling Act"

Client expense: $325,590 · Firm income: Not reported

H.R. 107, Burgess: Rebate cap, regarding all bio-pharmaceutical related provisions. H.R. 275, Medicare Prescription Drug Negotiation Act, regarding all bio-pharmaceutical related provisions. H.R. 366, Insulin Access for All Act, regarding all bio-pharmaceutical related provisions. H.R. 1034, D. Collins/S. 640, Kennedy: Phair Pricing Act - Share the savings, regarding all bio-pharmaceutical related provisions. H.R. 1035, Prescription Drug Price Transparency Act, regarding all bio-pharmaceutical related provisions. H.R. 1332, Fair Care Act, regarding all bio-pharmaceutical related provisions. H.R. 1346, Medicare Buy-In and Health Care Stabilization Act, regarding all bio-pharmaceutical related provisions. H.R. 1384, Medicare for All Act, regarding all bio-pharmaceutical related provisions. H.R. 1781, Payment Commission Data Act of 2019, regarding all bio-pharmaceutical related provisions. H.R. 1788, Limits the penalty for Part B late enrollment to 15 percent and twice the period of no enrollment, regarding all bio-pharmaceutical related provisions. H.R. 2087, Reporting drug pricing information to Medicare, regarding all bio-pharmaceutical related provisions. H.R. 2113, Prescription STAR Act, regarding all bio-pharmaceutical related provisions. H.R.3, Lower Drug Costs Now Act of 2019, regarding all bio-pharmaceutical related provisions S. 62, Empowering Medicare Seniors to Negotiate Drug Prices, regarding all bio-pharmaceutical related provisions. S. 99, Medicare Drug Price Negotiation Act, regarding all bio-pharmaceutical related provisions. S. 205, Right Rebate Act, regarding all bio-pharmaceutical related provisions. S. 377/H.R. 1046, Medicare Negotiation and Competitive Licensing Act, regarding all bio-pharmaceutical related provisions. S. 470, Medicare at 50 Act, regarding all bio-pharmaceutical related provisions. S. 474, Stopping the Pharmaceutical Industry from Keeping drugs Expensive (SPIKE) Act of 2019 , regarding all bio-pharmaceutical related provisions. S. 475, RxCAP Act, regarding all bio-pharmaceutical related provisions. S. 476, Creating Transparency to Have Drug Rebates Unlocked (C-THRU Act) of 2019, regarding all bio-pharmaceutical related provisions. S. 551, REFUND Act of 2019, regarding all bio-pharmaceutical related provisions. S. 691, Expands Part D OOP assistance for low-income seniors and individuals with disabilities, regarding all bio-pharmaceutical related provisions. S. 801/H.R. 1781, Allows MedPAC and MACPAC to have access to information on drug rebates, regarding all bio-pharmaceutical related provisions. S. 981, Medicare-X Choice Act of 2019, regarding all bio-pharmaceutical related provisions. Pending rule to change the Rebate Safe Harbor, regarding all bio-pharmaceutical related provisions. H.R. 1839, Medicaid Services Investment and Accountability Act, regarding all bio-pharmaceutical related provisions H.R. 2452, Medicare for America Act, regarding all bio-pharmaceutical related provisions H.R. 3107, Improving Seniors Timely Access to Care Act, regarding all bio-pharmaceutical related provisions H.R. 3327, Drug Price Transparency for Medicare Patients Act, regarding all bio-pharmaceutical related provisions S. 1261/H.R. 2463, Choose Medicare Act, regarding all bio-pharmaceutical related provisions S. 1497, Health Care Price Check Act, regarding all bio-pharmaceutical related provisions S. 2081, a bill to require drug manufacturers to provide rebates for drugs furnished under Medicare Part B for which the growth in average sales price has exceeded inflation, regarding all bio-pharmaceutical related provisions. S. 2543, Prescription Drug Pricing Reduction Act of 2019, regarding all bio-pharmaceutical provisions. H.R. 19/S.3129 , Lower Costs, More Cures Act of 2019, regarding all bio-pharmaceutical related provisions

Proposed changes to Medicare hospital reimbursement policy Medicare hospital prospective payment system Site-neutral payment policies H.R. 1384/S. 1129, Medicare for All and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act"

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

Legislative proposals affecting Medicare and Medicaid hospital reimbursement policies Health Information Technology Medicare Graduate Medical Education payments H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions H.R. 3414, "Opioid Workforce Act" - provisions related to expanding Medicare funding for opioid or pain management residency programs Site-neutral payment policies H.R. 1384/S. 1129, Medicare for all and other public option alternative proposals H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option S. 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R. 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare and to provide for health insurance market stabilization H.R. 3, "Lower Drug Costs Now Act" H.R. 3235, "Access to Genetic Counseling Act"

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

Proposed changes to Medicare hospital reimbursement policy Star Rating System methodology and suspension of the display of overall star ratings on Hospital Compare while the agency continues its important work of enhancing the validity and meaningfulness of star ratings H.R. 1763/S. 348, "Resident Physician Shortage Reduction Act" - provisions related to increasing the number of Medicare-funded residency positions Site-neutral payment policies Oppose H.R. 1384/S. 1129, Medicare for All - provisions related to establishment of a national health insurance program Oppose H.R. 2452, Medicare for America Act of 2010 provisions related to establishment of a Medicare for America health program to provide for comprehensive health coverage for all Americans Oppose H.R. 2463/S. 1261, Choose Medicare Act - provisions related to the establishment of Medicare part E public health plans Oppose H.R. 2000/S. 981, Medicare-X Choice Act of 2019 - provisions related to the establishment of a public health plan Oppose H.R. 2085/S. 1033, CHOICE Act - provisions amending the Public Health Service Act to establish a public health insurance option Oppose S 470, Medicare at 50 Act - provisions related to amending title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019 - provisions related to providing for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes H.R. 3, "Lower Drug Costs Now Act"

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

___ H.R. 3: Lower Drug Costs Now Act of 2019 - Provisions related to prescription drug pricing, foreign reference pricing, Part D, manufacturer rebates, and other provisions ___ H.R. 107: To amend title XIX of the Social Security Act to sunset the limit on the maximum rebate amount for single source drugs and innovator multiple source drugs - Provisions related to Medicaid drug rebates ___ H.R. 275: Medicare Prescription Drug Price Negotiation Act of 2019 - Provisions related to Part D and drug pricing negotiation ___ H.R. 448: Medicare Drug Price Negotiation Act - Provisions related to Part D and drug pricing negotiation ___ H.R. 937: Right Rebate Act of 2019 - Provisions related to Medicaid drug rebates and drug classification ___ H.R. 1034: Phair Pricing Act of 2019 - Provisions related to Part D and manufacturer rebates ___ H.R. 1035: Prescription Drug Price Transparency Act - Provisions related to drug pricing transparency and pharmacy benefit managers ___ H.R. 1046: Medicare Negotiation and Competitive Licensing Act of 2019 - Provisions related to Part D, drug pricing negotiation and compulsory licensing ___ H.R. 1346: Medicare Buy-In and Health Care Stabilization Act of 2019 - Provisions related to Part D and drug pricing negotiation ___ H.R. 1384: Medicare for All Act of 2019 - Provisions related to Part D, drug pricing negotiation and march-in rights ___ H.R. 1839: Medicaid Services Investment and Accountability Act - Provisions related to Medicaid drug rebates and drug classification ___ H.R. 2000: Medicare-X Choice Act of 2019 - Provisions related to Part D and drug pricing negotiation ___ H.R. 2452: Medicare for America Act of 2019 - Provisions related to Part D and drug pricing negotiation ___ H.R. 2463: Choose Medicare Act - Provisions related to Part D and drug pricing negotiation ___ H.R. 2757: Creating Lower cost Alternative for Your prescription drugs Act - Provisions related to Part D and patient cost-sharing ___ H.R. 3029: Improving Low-Income Access to Prescription Drugs Act of 2019 - Provisions related to Part D prescription drug plans ___ H.R. 3523: End Price Gouging for Medications Act - Provisions related to prescription drug pricing and foreign reference pricing ___ H.R. 3910: Equality in Medicare and Medicaid Treatment Act of 2019 - Provisions related to CMMI models ___ S. 62: Empowering Medicare Seniors to Negotiate Drug Prices Act of 2019 - Provisions related to Part D and drug pricing negotiation ___ S. 99: Medicare Drug Price Negotiation Act - Provisions related to Part D and drug pricing negotiation ___ S. 205: Right Rebate Act of 2019 - Provisions related to Medicaid drug rebates and drug classification ___ S. 377: Medicare Negotiation and Competitive Licensing Act of 2019 - Provisions related to Part D, drug pricing negotiation and compulsory licensing ___ S. 475: Reducing Existing Costs Associated with Pharmaceuticals for Seniors (RxCap) Act of 2019 - Provisions related to Part D and patient cost-sharing ___ S. 470: Medicare at 50 Act - Provisions related to Part D and drug pricing negotiation ___ S. 476: Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2019 - Provisions related to transparency of prescription drug pricing and pharmacy benefit managers ___ S. 640: Phair Pricing Act of 2019 - Provisions related to Part D and manufacturer rebates ___ S. 691: Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 - Provisions related to Part D and patient out-of-pocket costs ___ S. 801: Payment Commission Data Act - Provisions related to prescription drug pricing transparency and reporting ___ S. 981: Medicare-X Choice Act of 2019 - Provisions related to Part D and drug pricing negotiation ___ S. 1129: Medicare for All Act of 2019 - Provisions related to Part D and drug pricing negotiation ___ S. 1261: Choose Medicare Act - Provisions related to Part D and drug pricing negotiation ___ S. 1497: Health Care Price Check Act of 2019 - Provisions related to Medicare pricing transparency ___ S. 1785: Fair AMP Act - Provisions related to Medicaid drug rebates ___ S. 1801: Affordable Medications Act - Provisions relate to Part D drug pricing negotiation, importation, IP issues and pricing transparency ___ S. 1895: Lowering Health Care Costs Act - Provisions related to prescription drug pricing, transparency and patent issues ___ S. 1897: A bill to establish a process for updating the labeling of certain drugs with outdated labeling - Provisions related to prescription drug labeling ___ S. 1987: End Price Gouging for Medications Act - Provisions related to prescription drug pricing and foreign reference pricing ___ S. 1999: Improving Low-Income Access to Prescription Drugs Act of 2019 - Provisions related to Part D prescription drug plans ___ S. 2051: Strengthening Average Sales Price Reporting Act - Provisions related to Medicare pricing transparency and rebates ___ S. 2081: Stop Drug Companies from Overcharging Seniors in Medicare Part B Act of 2019 - Provisions related to prescription drug pricing and manufacturer rebates ___ S. 2247: Phair Pricing Act of 2019 - Provisions related to Part D and manufacturer rebates ___ S. 2252: Empowering States to Address Drug Costs Act - Provisions related to prescription drug pricing transparency ___ S. 2543: Prescription Drug Pricing Reduction Act of 2019 - Provisions related to prescription drug pricing, transparency, manufacturer rebates and other provisions ___ Medicare Access and Childrens Health Insurance Program (CHIP) reauthorization policy issues ___ Department of Health and Human Services (HHS) drug policy issues and regulatory policy issues ___ Part D policy issues including non-interference and rebates policy issues ___ Part B reform including MedPAC recommendations and other policy issues and local coverage decisions ___ Drug cost and pricing policy issues ___ Transparency policy issues ___ Alternative payment models policy issues ___ Value-based purchasing arrangements policy issues ___ Anti-Kickback Statute policy issues ___ Center for Medicare and Medicaid Innovation (CMMI) policy issues ___ Medicaid rebates and waiver policy issues ___ Prescription drug abuse policy issues ___ ANPRM; Medicare Program; International Pricing Index Model for Medicare Part B Drugs (CMS-5528-ANPRM) ___ Proposed Rule; Medicare and Medicaid Programs; Regulation To Require Drug Pricing Transparency (CMS-4187-P) ___ Proposed Rule; Contract Year (CY) 2020 Medicare Advantage and Part D Drug Pricing (CMS-4180-P) ___ Request for Information: Medicare and State Health Care Programs: Fraud and Abuse; Request for Information Regarding the Anti-Kickback Statute and Beneficiary Inducements CMP; 83 Fed. Reg. 43607 (Aug. 27, 2018) ___ Removal of Safe Harbor Protection for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection (RIN 0936-AA08) Monograph Reform and HSA/FSAs

Discussions on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussions about the work of Aligning for Health to address social determinants of health; Support HR 1041 / S 586,Critical Access Hospital Relief Act of 2019, a bill to amend title XVIII of the Social Security Act to remove the 96-hour physician certification requirement for inpatient critical access hospital services; Support S 895, Rural Hospital Regulatory Relief Act of 2019, a bill to provide for a permanent extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals; Support S 948,Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes; Discussions in support of the Rural Emergency Medical Center Act (REACH) Act; Support for extension of the Rural Community Hospital Demonstration Program; Support for extension of the Frontier Community Health Integration Project Demonstration program; Discuss changes with House and Senate committees to Section 8122 of the SUPPORT for Patients and Communities Act; Letter of support to Energy and Commerce Committee for the hearing on legislation to strengthen our health care system and ACA market stability; Letter urging the Centers for Medicare & Medicaid Services (CMS)to consider alternative payment solutions for Chimeric Antigen Receptor T-cell (CAR T) therapy; Joint letter urging Congress to delay the start of the Medicaid disproportionate share hospital (DSH) cuts, which are scheduled to begin in fiscal year (FY) 2020; Comments to CMS on exploring ways continually to improve the Medicaid managed care program to ensure access to high-quality care for the Medicaid population; Support HR 1781/ S 801, Payment Commission Data Act of 2019, a bill to amend titles XVIII and XIX of the Social Security Act to provide the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission with access to certain drug payment information, including certain rebate information; Support S 551 Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 or the REFUND Act of 2019, a bill to amend title XVIII of the Social Security Act to require manufacturers of certain single-dose vial drugs payable under part B of the Medicare program to provide rebates with respect to amounts of such drugs discarded, and for other purposes; Support S 824/ HR 1767, Excellence in Mental Health and Addiction Treatment Expansion Act, a bill to increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services; Statement submitted to Senate Finance Committee on the implementation of the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Support HR 2552Protecting Local Access to Care for Everyone Act of 2019 or the PLACE Act of 2019, a bill to direct the Secretary of Health and Human Services to prevent certain payment reductions for clinic visit services furnished at excepted off-campus outpatient departments of a provider under the Medicare program; Support HR 3022, Patient Access Protection Act, a bill to amend title XIX of the Social Security Act to repeal the reductions in Medicaid DSH allotments, and for other purposes; Letter of support to the Ways and Means Committee in support of legislation to improve the quality of an access to services for Medicare beneficiaries, help train the physician workforce and reduce administrative burden on rural hospitals; Support HR 3431, HEARTS and Rural Relief Act, a bill to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2021; Support HR 3417,Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 or the BETTER Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program; Oppose HR 1384, Medicare for All Act of 2019, a bill to establish an improved Medicare for All national health insurance program; Oppose S 1129, Medicare for All Act of 2019, a bill to establish a Medicare-for-all national health insurance program; Letter to House Committee on Ways and Means for the hearing on Pathways to Universal Health Coverage addressing concerns with Medicare for All and believe that the variety of proposals that often are used interchangeably under that name are not the solution; Oppose HR 2452, Medicare for America Act of 2019, a bill to amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans; Letter to House Committee on Budget for the hearing on the Congressional Budget Offices (CBO) Key Design Components and Considerations for Establishing a Single-Payer Health Care System addressing concerns with Medicare for All; Oppose S 1261/ HR 2463, Choose Medicare Act, a bill to provide for the establishment of Medicare part E public health plans, and for other purposes; Oppose S 981/ HR 2000Medicare-X Choice Act of 2019A bill to establish a public health plan; Oppose S 1033/ HR 2085, CHOICE Act, a bill to amend the Public Health Service Act to establish a public health insurance option, and for other purposes; Oppose S 470, Medicare at 50 Act, a bill to amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare; Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes; Submitted Statement to the House Committee on Rules for the Hearing Medicare for All Act of 2019; Comment on provisions of HR 2328,Reauthorizing and Extending Americas Community Health (REACH) Act, support for the Medicaid disproportionate share hospital(DSH) program provisions included in Title III; comments on Title IV, which contains provisions of the No Surprises Act and concern with the legislations approach to determining reimbursement for out-of-network providers; Support HR 3107 Seniors Timely Access to Care Act of 2019, this legislation would establish requirements for the use of prior authorization under Medicare Advantage plans; Meeting with the Senate finance committee to discuss changes to drug bill; Meeting with CMS to discuss changes to prior authorization; Meeting with Department of Labor to discuss issues with ERISA health plans.

H.R. 3: Lower Drug Costs Now Act of 2019 - Provisions related to prescription drug pricing, foreign reference pricing, Part D, manufacturer rebates, and other provisions H.R. 107: To amend title XIX of the Social Security Act to sunset the limit on the maximum rebate amount for single source drugs and innovator multiple source drugs - Provisions related to Medicaid drug rebates H.R. 275: Medicare Prescription Drug Price Negotiation Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 366: Insulin Access for All Act of 2019 - Provisions related to insulin cost-sharing H.R. 448: Medicare Drug Price Negotiation Act - Provisions related to Part D and drug pricing negotiation H.R. 937: Right Rebate Act of 2019 - Provisions related to Medicaid drug rebates and drug classification H.R. 1034: Phair Pricing Act of 2019 - Provisions related to Part D and manufacturer rebates H.R. 1035: Prescription Drug Price Transparency Act - Provisions related to drug pricing transparency and pharmacy benefit managers H.R. 1046: Medicare Negotiation and Competitive Licensing Act of 2019 - Provisions related to Part D, drug pricing negotiation and compulsory licensing H.R. 1346: Medicare Buy-In and Health Care Stabilization Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 1384: Medicare for All Act of 2019 - Provisions related to Part D, drug pricing negotiation and march-in rights H.R. 1839: Medicaid Services Investment and Accountability Act - Provisions related to Medicaid drug rebates and drug classification H.R. 2000: Medicare-X Choice Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 2452: Medicare for America Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 2463: Choose Medicare Act - Provisions related to Part D and drug pricing negotiation H.R. 2757: Creating Lower cost Alternative for Your prescription drugs Act - Provisions related to Part D and patient cost-sharing H.R. 3029: Improving Low-Income Access to Prescription Drugs Act of 2019 - Provisions related to Part D prescription drug plans H.R. 3523: End Price Gouging for Medications Act - Provisions related to prescription drug pricing and foreign reference pricing H.R. 3910: Equality in Medicare and Medicaid Treatment Act of 2019 - Provisions related to CMMI models S. 62: Empowering Medicare Seniors to Negotiate Drug Prices Act of 2019 - Provisions related to Part D and drug pricing negotiation S. 99: Medicare Drug Price Negotiation Act - Provisions related to Part D and drug pricing negotiation S. 205: Right Rebate Act of 2019 - Provisions related to Medicaid drug rebates and drug classification S. 377: Medicare Negotiation and Competitive Licensing Act of 2019 - Provisions related to Part D, drug pricing negotiation and compulsory licensing S. 475: Reducing Existing Costs Associated with Pharmaceuticals for Seniors (RxCap) Act of 2019 - Provisions related to Part D and patient cost-sharing S. 470: Medicare at 50 Act - Provisions related to Part D and drug pricing negotiation S. 476: Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2019 - Provisions related to transparency of prescription drug pricing and pharmacy benefit managers S. 551: Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 - Provisions related to prescription drug vial sizes and rebates S. 640: Phair Pricing Act of 2019 - Provisions related to Part D and manufacturer rebates S. 691: Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 - Provisions related to Part D and patient out-of-pocket costs S. 801: Payment Commission Data Act - Provisions related to prescription drug pricing transparency and reporting S. 981: Medicare-X Choice Act of 2019 - Provisions related to Part D and drug pricing negotiation S. 1129: Medicare for All Act of 2019 - Provisions related to Part D and drug pricing negotiation S. 1261: Choose Medicare Act - Provisions related to Part D and drug pricing negotiation S. 1497: Health Care Price Check Act of 2019 - Provisions related to Medicare pricing transparency S. 1785: Fair AMP Act - Provisions related to Medicaid drug rebates S. 1801: Affordable Medications Act - Provisions related to Part D drug pricing negotiation, importation, IP issues and pricing transparency S. 1895: Lowering Health Care Costs Act - Provisions related to prescription drug pricing, transparency and patent issues S. 1897: A bill to establish a process for updating the labeling of certain drugs with outdated labeling - Provisions related to prescription drug labeling S. 1987: End Price Gouging for Medications Act - Provisions related to prescription drug pricing and foreign reference pricing S. 1999: Improving Low-Income Access to Prescription Drugs Act of 2019 - Provisions related to Part D prescription drug plans S. 2051: Strengthening Average Sales Price Reporting Act - Provisions related to Medicare pricing transparency and rebates S. 2081: Stop Drug Companies from Overcharging Seniors in Medicare Part B Act of 2019 - Provisions related to prescription drug pricing and manufacturer rebates S. 2247: Phair Pricing Act of 2019 - Provisions related to Part D and manufacturer rebates S. 2252: Empowering States to Address Drug Costs Act - Provisions related to prescription drug pricing transparency S. 2543: Prescription Drug Pricing Reduction Act of 2019 - Provisions related to prescription drug pricing, transparency, manufacturer rebates and other provisions Medicare Access and Childrens Health Insurance Program (CHIP) reauthorization policy issues Department of Health and Human Services (HHS) drug policy issues and regulatory policy issues Part D policy issues including non-interference and rebates policy issues Part B reform including MedPAC recommendations and other policy issues and local coverage decisions Drug cost and pricing policy issues Transparency policy issues Alternative payment models policy issues Policy issues related to patient medication information Value-based purchasing arrangements policy issues Anti-Kickback Statute policy issues Center for Medicare and Medicaid Innovation (CMMI) policy issues Medicaid rebates and waiver policy issues Prescription drug abuse policy issues ANPRM; Medicare Program; International Pricing Index Model for Medicare Part B Drugs (CMS-5528-ANPRM) Proposed Rule; Medicare and Medicaid Programs; Regulation To Require Drug Pricing Transparency (CMS-4187-P) Proposed Rule; Contract Year (CY) 2020 Medicare Advantage and Part D Drug Pricing (CMS-4180-P) Request for Information: Medicare and State Health Care Programs: Fraud and Abuse; Request for Information Regarding the Anti-Kickback Statute and Beneficiary Inducements CMP; 83 Fed. Reg. 43607 (Aug. 27, 2018) Removal of Safe Harbor Protection for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection (RIN 0936-AA08)

H.R. 3 Lower Drug Costs Now Act of 2019 -allowing Medicare to negotiate prescription drug prices, limiting the ability of drug companies to spike their prices overnight, ensuring that actions to address egregious prices apply to coverage beyond Medicare S. 2543 Prescription Drug Pricing Reduction Act of 2019 - comprehensive legislation to lower prescription drug prices in the Medicare and Medicaid programs, to improve transparency related to pharmaceutical prices and transactions, to lower patients' out-of-pocket costs, and to ensure accountability to taxpayers H.R. 3853 Personal Needs Allowance Modernization Act of 2019 - increase under the Medicaid program the minimum monthly personal needs allowance for institutionalized individuals and couples H.R.4386 Stop the Wait Act - eliminate the Medicare and disability insurance benefits waiting periods for disabled individuals. H.R.1393 Medicare Dental, Vision, and Hearing Benefit Act of 2019 - provide for coverage of dental, vision, and hearing care under the Medicare program. H.R.576 Seniors Have Eyes, Ears, and Teeth Act - expands Medicare coverage to include eyeglasses, hearing aids, and dental care. S.22/H.R.2951 Medicare Dental Benefit Act of 2019 - coverage of dental services under Medicare Part B H.R.1342 EMPOWER Care Act - reauthorize the Money Follows the Person Demonstration Program H.R. 1343 - Protecting Married Seniors Act - provisions regarding Medicaid eligibility that protect against spousal impoverishment for recipients of home and community-based services. S.99 / H.R.448 - The Medicare Drug Price Negotiation Act - negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D H.R.1046 / S.377 Medicare Negotiation and Competitive Licensing Act of 2019 - requiring Secretary of Health and Human Services to negotiate prices of prescription drugs furnished under part D of the Medicare program S.470 Medicare at 50 Act - option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R.1329 Medicaid Reentry Act - allows Medicaid payment for medical services furnished to an incarcerated individual during the 30-day period preceding the individual's release H.R.1354 Territories Health Equity Act - make improvements to the treatment of the United States territories under the Medicare and Medicaid programs H.R.1384, S.1129 Medicare for All Act - establishes a national health insurance program Medicare Prescription Drug Savings and Choice Act - public option for drug coverage within Medicare Part D HEAL for Immigrant Women and Families Act of 2019 - Removes the five year waiting period for immigrants to become eligible for Medicaid and CHIP H.R.2463, S.1261 Choose Medicare Act - establishment of Medicare part E public health plans S.1423Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2019 - provide for coverage of dental, vision, and hearing care under the Medicare and Medicaid programs

H.R. 107, Burgess: Rebate cap, regarding all bio-pharmaceutical related provisions. H.R. 275, Medicare Prescription Drug Negotiation Act, regarding all bio-pharmaceutical related provisions. H.R. 366, Insulin Access for All Act, regarding all bio-pharmaceutical related provisions. H.R. 1034, D. Collins/S. 640, Kennedy: Phair Pricing Act - Share the savings, regarding all bio-pharmaceutical related provisions. H.R. 1035, Prescription Drug Price Transparency Act, regarding all bio-pharmaceutical related provisions. H.R. 1332, Fair Care Act, regarding all bio-pharmaceutical related provisions. H.R. 1346, Medicare Buy-In and Health Care Stabilization Act, regarding all bio-pharmaceutical related provisions. H.R. 1384, Medicare for All Act, regarding all bio-pharmaceutical related provisions. H.R. 1781, Payment Commission Data Act of 2019, regarding all bio-pharmaceutical related provisions. H.R. 1788, Limits the penalty for Part B late enrollment to 15 percent and twice the period of no enrollment, regarding all bio-pharmaceutical related provisions. H.R. 2087, Reporting drug pricing information to Medicare, regarding all bio-pharmaceutical related provisions. H.R. 2113, Prescription STAR Act, regarding all bio-pharmaceutical related provisions. H.R.3, Lower Drug Costs Now Act of 2019, regarding all bio-pharmaceutical related provisions S. 62, Empowering Medicare Seniors to Negotiate Drug Prices, regarding all bio-pharmaceutical related provisions. S. 99, Medicare Drug Price Negotiation Act, regarding all bio-pharmaceutical related provisions. S. 205, Right Rebate Act, regarding all bio-pharmaceutical related provisions. S. 377/H.R. 1046, Medicare Negotiation and Competitive Licensing Act, regarding all bio-pharmaceutical related provisions. S. 470, Medicare at 50 Act, regarding all bio-pharmaceutical related provisions. S. 474, Stopping the Pharmaceutical Industry from Keeping drugs Expensive (SPIKE) Act of 2019 , regarding all bio-pharmaceutical related provisions. S. 475, RxCAP Act, regarding all bio-pharmaceutical related provisions. S. 476, Creating Transparency to Have Drug Rebates Unlocked (C-THRU Act) of 2019, regarding all bio-pharmaceutical related provisions. S. 551, REFUND Act of 2019, regarding all bio-pharmaceutical related provisions. S. 691, Expands Part D OOP assistance for low-income seniors and individuals with disabilities, regarding all bio-pharmaceutical related provisions. S. 801/H.R. 1781, Allows MedPAC and MACPAC to have access to information on drug rebates, regarding all bio-pharmaceutical related provisions. S. 981, Medicare-X Choice Act of 2019, regarding all bio-pharmaceutical related provisions. Pending rule to change the Rebate Safe Harbor, regarding all bio-pharmaceutical related provisions. H.R. 1839, Medicaid Services Investment and Accountability Act, regarding all bio-pharmaceutical related provisions H.R. 2452, Medicare for America Act, regarding all bio-pharmaceutical related provisions H.R. 3107, Improving Seniors Timely Access to Care Act, regarding all bio-pharmaceutical related provisions H.R. 3327, Drug Price Transparency for Medicare Patients Act, regarding all bio-pharmaceutical related provisions S. 1261/H.R. 2463, Choose Medicare Act, regarding all bio-pharmaceutical related provisions S. 1497, Health Care Price Check Act, regarding all bio-pharmaceutical related provisions S. 2081, a bill to require drug manufacturers to provide rebates for drugs furnished under Medicare Part B for which the growth in average sales price has exceeded inflation, regarding all bio-pharmaceutical related provisions. S. 2543, Prescription Drug Pricing Reduction Act of 2019, regarding all bio-pharmaceutical provisions.

H.R. 107: To amend title XIX of the Social Security Act to sunset the limit on the maximum rebate amount for single source drugs and innovator multiple source drugs - Provisions related to Medicaid drug rebates H.R. 275: Medicare Prescription Drug Price Negotiation Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 366: Insulin Access for All Act of 2019 - Provisions related to insulin cost-sharing H.R. 448: Medicare Drug Price Negotiation Act - Provisions related to Part D and drug pricing negotiation H.R. 937: Right Rebate Act of 2019 - Provisions related to Medicaid drug rebates and drug classification H.R. 1034: Phair Pricing Act of 2019 - Provisions related to Part D and manufacturer rebates H.R. 1035: Prescription Drug Price Transparency Act - Provisions related to drug pricing transparency and pharmacy benefit managers H.R. 1046: Medicare Negotiation and Competitive Licensing Act of 2019 - Provisions related to Part D, drug pricing negotiation and compulsory licensing H.R. 1346: Medicare Buy-In and Health Care Stabilization Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 1384: Medicare for All Act of 2019 - Provisions related to Part D, drug pricing negotiation and march-in rights H.R. 1781: Payment Commission Data Act - Provisions related to prescription drug pricing transparency and reporting H.R. 1788: Medicare Part B Fairness Act - Provisions related to Part B enrollment H.R. 1839: Medicaid Services Investment and Accountability Act - Provisions related to Medicaid drug rebates and drug classification H.R. 2000: Medicare-X Choice Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 2452: Medicare for America Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 2463: Choose Medicare Act - Provisions related to Part D and drug pricing negotiation H.R. 2757: Creating Lower cost Alternative for Your prescription drugs Act - Provisions related to Part D and patient cost-sharing H.R. 3029: Improving Low-Income Access to Prescription Drugs Act of 2019 - Provisions related to Part D prescription drug plans H.R. 3107: Improving Seniors' Timely Access to Care Act of 2019 - Provisions related to Medicare Advantage insurance plans H.R. 3276: Fair AMP Act - Provisions related to Medicaid drug rebates S. 62: Empowering Medicare Seniors to Negotiate Drug Prices Act of 2019 - Provisions related to Part D and drug pricing negotiation S. 99: Medicare Drug Price Negotiation Act - Provisions related to Part D and drug pricing negotiation S. 205: Right Rebate Act of 2019 - Provisions related to Medicaid drug rebates and drug classification S. 377: Medicare Negotiation and Competitive Licensing Act of 2019 - Provisions related to Part D, drug pricing negotiation and compulsory licensing S. 475: Reducing Existing Costs Associated with Pharmaceuticals for Seniors (RxCap) Act of 2019 - Provisions related to Part D and patient cost-sharing S. 470: Medicare at 50 Act - Provisions related to Part D and drug pricing negotiation S. 476: Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2019 - Provisions related to transparency of prescription drug pricing and pharmacy benefit managers S. 551: Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 - Provisions related to prescription drug vial sizes and rebates S. 640: Phair Pricing Act of 2019 - Provisions related to Part D and manufacturer rebates S. 691: Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 - Provisions related to Part D and patient out-of-pocket costs S. 801: Payment Commission Data Act - Provisions related to prescription drug pricing transparency and reporting S. 1129: Medicare for All Act of 2019 - Provisions related to Part D and drug pricing negotiation S. 1261: Choose Medicare Act - Provisions related to Part D and drug pricing negotiation S. 1785: Fair AMP Act - Provisions related to Medicaid drug rebates S. 1801: Affordable Medications Act - Provisions relate to Part D drug pricing negotiation, importation, IP issues and pricing transparency S. 1895: Lower Health Care Costs Act - Provisions related to prescription drug pricing, transparency and patent issues S. 1897: A bill to establish a process for updating the labeling of certain drugs with outdated labeling - Provisions related to prescription drug labeling S. 1926: PrEP Access and Coverage Act - PrEP insurance coverage requirement and grant program for uninsured S. __: Patient Affordability Value and Efficiency Act - Value-based arrangements Medicare Access and Childrens Health Insurance Program (CHIP) reauthorization policy issues Department of Health and Human Services (HHS) drug policy issues and regulatory policy issues Part D policy issues including non-interference and rebates policy issues Part B reform including MedPAC recommendations and other policy issues and local coverage decisions Drug cost and pricing policy issues Transparency policy issues Alternative payment models policy issues Value-based purchasing arrangements policy issues Anti-Kickback Statute policy issues Center for Medicare and Medicaid Innovation (CMMI) policy issues Medicaid rebates and waiver policy issues Prescription drug abuse policy issues ANPRM; Medicare Program; International Pricing Index Model for Medicare Part B Drugs (CMS-5528-ANPRM) Proposed Rule; Medicare and Medicaid Programs; Regulation To Require Drug Pricing Transparency (CMS-4187-P) Proposed Rule; Contract Year (CY) 2020 Medicare Advantage and Part D Drug Pricing (CMS-4180-P) Request for Information: Medicare and State Health Care Programs: Fraud and Abuse; Request for Information Regarding the Anti-Kickback Statute and Beneficiary Inducements CMP; 83 Fed. Reg. 43607 (Aug. 27, 2018) Removal of Safe Harbor Protection for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection (RIN 0936-AA08)

H.R. 107: To amend title XIX of the Social Security Act to sunset the limit on the maximum rebate amount for single source drugs and innovator multiple source drugs - Provisions related to Medicaid drug rebates H.R. 275: Medicare Prescription Drug Price Negotiation Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 366: Insulin Access for All Act of 2019 - Provisions related to insulin cost-sharing H.R. 448: Medicare Drug Price Negotiation Act - Provisions related to Part D and drug pricing negotiation H.R. 937: Right Rebate Act of 2019 - Provisions related to Medicaid drug rebates and drug classification H.R. 1034: Phair Pricing Act of 2019 - Provisions related to Part D and manufacturer rebates H.R. 1035: Prescription Drug Price Transparency Act - Provisions related to drug pricing transparency and pharmacy benefit managers H.R. 1046: Medicare Negotiation and Competitive Licensing Act of 2019 - Provisions related to Part D, drug pricing negotiation and compulsory licensing H.R. 1346: Medicare Buy-In and Health Care Stabilization Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 1384: Medicare for All Act of 2019 - Provisions related to Part D, drug pricing negotiation and march-in rights H.R. 1781: Payment Commission Data Act - Provisions related to prescription drug pricing transparency and reporting H.R. 1788: Medicare Part B Fairness Act - Provisions related to Part B enrollment H.R. 1839: Medicaid Services Investment and Accountability Act - Provisions related to Medicaid drug rebates and drug classification H.R. 2000: Medicare-X Choice Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 2452: Medicare for America Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 2463: Choose Medicare Act - Provisions related to Part D and drug pricing negotiation H.R. 2757: Creating Lower cost Alternative for Your prescription drugs Act - Provisions related to Part D and patient cost-sharing H.R. 3029: Improving Low-Income Access to Prescription Drugs Act of 2019 - Provisions related to Part D prescription drug plans H.R. 3107: Improving Seniors' Timely Access to Care Act of 2019 - Provisions related to Medicare Advantage insurance plans H.R. 3276: Fair AMP Act - Provisions related to Medicaid drug rebates S. 62: Empowering Medicare Seniors to Negotiate Drug Prices Act of 2019 - Provisions related to Part D and drug pricing negotiation S. 99: Medicare Drug Price Negotiation Act - Provisions related to Part D and drug pricing negotiation S. 205: Right Rebate Act of 2019 - Provisions related to Medicaid drug rebates and drug classification S. 377: Medicare Negotiation and Competitive Licensing Act of 2019 - Provisions related to Part D, drug pricing negotiation and compulsory licensing S. 475: Reducing Existing Costs Associated with Pharmaceuticals for Seniors (RxCap) Act of 2019 - Provisions related to Part D and patient cost-sharing S. 470: Medicare at 50 Act - Provisions related to Part D and drug pricing negotiation S. 476: Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2019 - Provisions related to transparency of prescription drug pricing and pharmacy benefit managers S. 551: Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 - Provisions related to prescription drug vial sizes and rebates S. 640: Phair Pricing Act of 2019 - Provisions related to Part D and manufacturer rebates S. 691: Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 - Provisions related to Part D and patient out-of-pocket costs S. 801: Payment Commission Data Act - Provisions related to prescription drug pricing transparency and reporting S. 1129: Medicare for All Act of 2019 - Provisions related to Part D and drug pricing negotiation S. 1261: Choose Medicare Act - Provisions related to Part D and drug pricing negotiation S. 1785: Fair AMP Act - Provisions related to Medicaid drug rebates S. 1801: Affordable Medications Act - Provisions relate to Part D drug pricing negotiation, importation, IP issues and pricing transparency S. 1895: Lower Health Care Costs Act - Provisions related to prescription drug pricing, transparency and patent issues S. 1897: A bill to establish a process for updating the labeling of certain drugs with outdated labeling - Provisions related to prescription drug labeling S. 1926: PrEP Access and Coverage Act - PrEP insurance coverage requirement and grant program for uninsured S. __: Patient Affordability Value and Efficiency Act - Value-based arrangements Medicare Access and Childrens Health Insurance Program (CHIP) reauthorization policy issues Department of Health and Human Services (HHS) drug policy issues and regulatory policy issues Part D policy issues including non-interference and rebates policy issues Part B reform including MedPAC recommendations and other policy issues and local coverage decisions Drug cost and pricing policy issues Transparency policy issues Alternative payment models policy issues Value-based purchasing arrangements policy issues Anti-Kickback Statute policy issues Center for Medicare and Medicaid Innovation (CMMI) policy issues Medicaid rebates and waiver policy issues Prescription drug abuse policy issues ANPRM; Medicare Program; International Pricing Index Model for Medicare Part B Drugs (CMS-5528-ANPRM) Proposed Rule; Medicare and Medicaid Programs; Regulation To Require Drug Pricing Transparency (CMS-4187-P) Proposed Rule; Contract Year (CY) 2020 Medicare Advantage and Part D Drug Pricing (CMS-4180-P) Request for Information: Medicare and State Health Care Programs: Fraud and Abuse; Request for Information Regarding the Anti-Kickback Statute and Beneficiary Inducements CMP; 83 Fed. Reg. 43607 (Aug. 27, 2018) Removal of Safe Harbor Protection for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection (RIN 0936-AA08)

Discussions on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussions about the work of Aligning for Health to address social determinants of health; Support HR 1041 / S 586,Critical Access Hospital Relief Act of 2019, a bill to amend title XVIII of the Social Security Act to remove the 96-hour physician certification requirement for inpatient critical access hospital services; Support S 895, Rural Hospital Regulatory Relief Act of 2019, a bill to provide for a permanent extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals; Support S 948,Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes; Discussions in support of the Rural Emergency Medical Center Act (REACH) Act; Support for extension of the Rural Community Hospital Demonstration Program; Support for extension of the Frontier Community Health Integration Project Demonstration program; Discuss changes with House and Senate committees to Section 8122 of the SUPPORT for Patients and Communities Act; Letter of support to Energy and Commerce Committee for the hearing on legislation to strengthen our health care system and ACA market stability; Letter urging the Centers for Medicare & Medicaid Services (CMS)to consider alternative payment solutions for Chimeric Antigen Receptor T-cell (CAR T) therapy; Joint letter urging Congress to delay the start of the Medicaid disproportionate share hospital (DSH) cuts, which are scheduled to begin in fiscal year (FY) 2020; Comments to CMS on exploring ways continually to improve the Medicaid managed care program to ensure access to high-quality care for the Medicaid population; Support HR 1781/ S 801, Payment Commission Data Act of 2019, a bill to amend titles XVIII and XIX of the Social Security Act to provide the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission with access to certain drug payment information, including certain rebate information; Support S 551 Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 or the REFUND Act of 2019, a bill to amend title XVIII of the Social Security Act to require manufacturers of certain single-dose vial drugs payable under part B of the Medicare program to provide rebates with respect to amounts of such drugs discarded, and for other purposes; Support S 824/ HR 1767, Excellence in Mental Health and Addiction Treatment Expansion Act, a bill to increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services; Statement submitted to Senate Finance Committee on the implementation of the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Support HR 2552Protecting Local Access to Care for Everyone Act of 2019 or the PLACE Act of 2019, a bill to direct the Secretary of Health and Human Services to prevent certain payment reductions for clinic visit services furnished at excepted off-campus outpatient departments of a provider under the Medicare program; Support HR 3022, Patient Access Protection Act, a bill to amend title XIX of the Social Security Act to repeal the reductions in Medicaid DSH allotments, and for other purposes; Letter of support to the Ways and Means Committee in support of legislation to improve the quality of an access to services for Medicare beneficiaries, help train the physician workforce and reduce administrative burden on rural hospitals; Support HR 3431, HEARTS and Rural Relief Act, a bill to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2021; Support HR 3417,Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 or the BETTER Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program; Oppose HR 1384, Medicare for All Act of 2019, a bill to establish an improved Medicare for All national health insurance program; Oppose S 1129, Medicare for All Act of 2019, a bill to establish a Medicare-for-all national health insurance program; Letter to House Committee on Ways and Means for the hearing on Pathways to Universal Health Coverage addressing concerns with Medicare for All and believe that the variety of proposals that often are used interchangeably under that name are not the solution; Oppose HR 2452, Medicare for America Act of 2019, a bill to amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans; Letter to House Committee on Budget for the hearing on the Congressional Budget Offices (CBO) Key Design Components and Considerations for Establishing a Single-Payer Health Care System addressing concerns with Medicare for All; Oppose S 1261/ HR 2463, Choose Medicare Act, a bill to provide for the establishment of Medicare part E public health plans, and for other purposes; Oppose S 981/ HR 2000Medicare-X Choice Act of 2019A bill to establish a public health plan; Oppose S 1033/ HR 2085, CHOICE Act, a bill to amend the Public Health Service Act to establish a public health insurance option, and for other purposes; Oppose S 470, Medicare at 50 Act, a bill to amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare; Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes; Submitted Statement to the House Committee on Rules for the Hearing Medicare for All Act of 2019.

To amend title XI of the Social Security Act to require manufacturers of certain drugs, devices, biologicals, and medical supplies to report on product samples provided to certain health care providers, and for other purposes. (H.R. 2064) Community Health Investment, Modernization, and Excellence Act (H.R. 1983) State Health Care Premium Reduction Act (H.R. 1425) Choose Medicare Act (S. 1261) Access to Birth Control Act (S. 1086) Protecting Americans with Preexisting Conditions Act (H.R. 896) Strengthening Health Care and Lowering Prescription Drug Costs Act (H.R. 897) Supporting reproductive health care in the United States (H. Con. Res. 40/S. Con. Res. 18) Family Coverage Act (S. 1935) Affordability is Access (H.R. 3296/S. 1847) Lower Health Care Costs Act (S. 1895) Birth Control Access Innovation Act (Not yet introduced) Jeanette Acosta Invest in Women's Health Act (H.R. 3129/S. 1735) Maternal Care Act (H.R. 2902) Maternal Care Access and Reducing Emergencies Act (S. 1602) Healthy Mommies Act (H.R. 2602) MOMMA's Act (H.R. 1897/S. 916) Rural MOMS Act (Not yet introduced)

Client expense: $164,223 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 107: To amend title XIX of the Social Security Act to sunset the limit on the maximum rebate amount for single source drugs and innovator multiple source drugs - Provisions related to Medicaid drug rebates H.R. 275: Medicare Prescription Drug Price Negotiation Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 366: Insulin Access for All Act of 2019 - Provisions related to insulin cost-sharing H.R. 448: Medicare Drug Price Negotiation Act - Provisions related to Part D and drug pricing negotiation H.R. 937: Right Rebate Act of 2019 - Provisions related to Medicaid drug rebates and drug classification H.R. 1034: Phair Pricing Act of 2019 - Provisions related to Part D and manufacturer rebates H.R. 1035: Prescription Drug Price Transparency Act - Provisions related to drug pricing transparency and pharmacy benefit managers H.R. 1046: Medicare Negotiation and Competitive Licensing Act of 2019 - Provisions related to Part D, drug pricing negotiation and compulsory licensing H.R. 1346: Medicare Buy-In and Health Care Stabilization Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 1384: Medicare for All Act of 2019 - Provisions related to Part D, drug pricing negotiation and march-in rights H.R. 1781: Payment Commission Data Act - Provisions related to prescription drug pricing transparency and reporting H.R. 1788: Medicare Part B Fairness Act - Provisions related to Part B enrollment H.R. 1839: Medicaid Services Investment and Accountability Act - Provisions related to Medicaid drug rebates and drug classification H.R. 2000: Medicare-X Choice Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 2452: Medicare for America Act of 2019 - Provisions related to Part D and drug pricing negotiation H.R. 2463: Choose Medicare Act - Provisions related to Part D and drug pricing negotiation H.R. 2757: Creating Lower cost Alternative for Your prescription drugs Act - Provisions related to Part D and patient cost-sharing H.R. 3029: Improving Low-Income Access to Prescription Drugs Act of 2019 - Provisions related to Part D prescription drug plans H.R. 3107: Improving Seniors' Timely Access to Care Act of 2019 - Provisions related to Medicare Advantage insurance plans H.R. 3276: Fair AMP Act - Provisions related to Medicaid drug rebates S. 62: Empowering Medicare Seniors to Negotiate Drug Prices Act of 2019 - Provisions related to Part D and drug pricing negotiation S. 99: Medicare Drug Price Negotiation Act - Provisions related to Part D and drug pricing negotiation S. 205: Right Rebate Act of 2019 - Provisions related to Medicaid drug rebates and drug classification S. 377: Medicare Negotiation and Competitive Licensing Act of 2019 - Provisions related to Part D, drug pricing negotiation and compulsory licensing S. 475: Reducing Existing Costs Associated with Pharmaceuticals for Seniors (RxCap) Act of 2019 - Provisions related to Part D and patient cost-sharing S. 470: Medicare at 50 Act - Provisions related to Part D and drug pricing negotiation S. 476: Creating Transparency to Have Drug Rebates Unlocked (C-THRU) Act of 2019 - Provisions related to transparency of prescription drug pricing and pharmacy benefit managers S. 551: Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 - Provisions related to prescription drug vial sizes and rebates S. 640: Phair Pricing Act of 2019 - Provisions related to Part D and manufacturer rebates S. 691: Medicare Extra Rx Higher Eligibility Limits in Part D Act of 2019 - Provisions related to Part D and patient out-of-pocket costs S. 801: Payment Commission Data Act - Provisions related to prescription drug pricing transparency and reporting S. 1129: Medicare for All Act of 2019 - Provisions related to Part D and drug pricing negotiation S. 1261: Choose Medicare Act - Provisions related to Part D and drug pricing negotiation S. 1785: Fair AMP Act - Provisions related to Medicaid drug rebates S. 1801: Affordable Medications Act - Provisions relate to Part D drug pricing negotiation, importation, IP issues and pricing transparency S. 1895: Lower Health Care Costs Act - Provisions related to prescription drug pricing, transparency and patent issues S. 1897: A bill to establish a process for updating the labeling of certain drugs with outdated labeling - Provisions related to prescription drug labeling S. 1926: PrEP Access and Coverage Act - PrEP insurance coverage requirement and grant program for uninsured S. __: Patient Affordability Value and Efficiency Act - Value-based arrangements Medicare Access and Childrens Health Insurance Program (CHIP) reauthorization policy issues Department of Health and Human Services (HHS) drug policy issues and regulatory policy issues Part D policy issues including non-interference and rebates policy issues Part B reform including MedPAC recommendations and other policy issues and local coverage decisions Drug cost and pricing policy issues Transparency policy issues Alternative payment models policy issues Value-based purchasing arrangements policy issues Anti-Kickback Statute policy issues Center for Medicare and Medicaid Innovation (CMMI) policy issues Medicaid rebates and waiver policy issues Prescription drug abuse policy issues ANPRM; Medicare Program; International Pricing Index Model for Medicare Part B Drugs (CMS-5528-ANPRM) Proposed Rule; Medicare and Medicaid Programs; Regulation To Require Drug Pricing Transparency (CMS-4187-P) Proposed Rule; Contract Year (CY) 2020 Medicare Advantage and Part D Drug Pricing (CMS-4180-P) Request for Information: Medicare and State Health Care Programs: Fraud and Abuse; Request for Information Regarding the Anti-Kickback Statute and Beneficiary Inducements CMP; 83 Fed. Reg. 43607 (Aug. 27, 2018) Removal of Safe Harbor Protection for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection (RIN 0936-AA08)

H.R. 107, Burgess: Rebate cap, regarding all bio-pharmaceutical related provisions. H.R. 275, Medicare Prescription Drug Negotiation Act, regarding all bio-pharmaceutical related provisions. H.R. 366, Insulin Access for All Act, regarding all bio-pharmaceutical related provisions. H.R. 1034, D. Collins/S. 640, Kennedy: Phair Pricing Act - Share the savings, regarding all bio-pharmaceutical related provisions. H.R. 1035, Prescription Drug Price Transparency Act, regarding all bio-pharmaceutical related provisions. H.R. 1332, Fair Care Act, regarding all bio-pharmaceutical related provisions. H.R. 1346, Medicare Buy-In and Health Care Stabilization Act, regarding all bio-pharmaceutical related provisions. H.R. 1384, Medicare for All Act, regarding all bio-pharmaceutical related provisions. H.R. 1781, Payment Commission Data Act of 2019, regarding all bio-pharmaceutical related provisions. H.R. 1788, Limits the penalty for Part B late enrollment to 15 percent and twice the period of no enrollment, regarding all bio-pharmaceutical related provisions. H.R. 2087, Reporting drug pricing information to Medicare, regarding all bio-pharmaceutical related provisions. H.R. 2113, Prescription STAR Act, regarding all bio-pharmaceutical related provisions. S. 62, Empowering Medicare Seniors to Negotiate Drug Prices, regarding all bio-pharmaceutical related provisions. S. 99, Medicare Drug Price Negotiation Act, regarding all bio-pharmaceutical related provisions. S. 205, Right Rebate Act, regarding all bio-pharmaceutical related provisions. S. 377/H.R. 1046, Medicare Negotiation and Competitive Licensing Act, regarding all bio-pharmaceutical related provisions. S. 470, Medicare at 50 Act, regarding all bio-pharmaceutical related provisions. S. 474, Stopping the Pharmaceutical Industry from Keeping drugs Expensive (SPIKE) Act of 2019 , regarding all bio-pharmaceutical related provisions. S. 475, RxCAP Act, regarding all bio-pharmaceutical related provisions. S. 476, Creating Transparency to Have Drug Rebates Unlocked (C-THRU Act) of 2019, regarding all bio-pharmaceutical related provisions. S. 551, REFUND Act of 2019, regarding all bio-pharmaceutical related provisions. S. 691, Expands Part D OOP assistance for low-income seniors and individuals with disabilities, regarding all bio-pharmaceutical related provisions. S. 801/H.R. 1781, Allows MedPAC and MACPAC to have access to information on drug rebates, regarding all bio-pharmaceutical related provisions. S. 981, Medicare-X Choice Act of 2019, regarding all bio-pharmaceutical related provisions. Pending rule to change the Rebate Safe Harbor, regarding all bio-pharmaceutical related provisions. H.R. 1839, Medicaid Services Investment and Accountability Act, regarding all bio-pharmaceutical related provisions H.R. 2452, Medicare for America Act, regarding all bio-pharmaceutical related provisions H.R. 3107, Improving Seniors Timely Access to Care Act, regarding all bio-pharmaceutical related provisions H.R. 3327, Drug Price Transparency for Medicare Patients Act, regarding all bio-pharmaceutical related provisions S. 1261/H.R. 2463, Choose Medicare Act, regarding all bio-pharmaceutical related provisions S. 1497, Health Care Price Check Act, regarding all bio-pharmaceutical related provisions S. 2081, a bill to require drug manufacturers to provide rebates for drugs furnished under Medicare Part B for which the growth in average sales price has exceeded inflation, regarding all bio-pharmaceutical related provisions

H.R.2757 Creating Lower Cost Alternative for Your (CLAY) Prescription Drug Act - would eliminate cost-sharing for generic drugs for low-income Medicare beneficiaries H.R.1393 Medicare Dental, Vision, and Hearing Benefit Act of 2019 - provide for coverage of dental, vision, and hearing care under the Medicare program. H.R.576 Seniors Have Eyes, Ears, and Teeth Act - expands Medicare coverage to include eyeglasses, hearing aids, and dental care. S.22 Medicare Dental Benefit Act of 2019 - coverage of dental services under Medicare Part B H.R.1342 EMPOWER Care Act - reauthorize the Money Follows the Person Demonstration Program H.R. 1343 - Protecting Married Seniors Act - provisions regarding Medicaid eligibility that protect against spousal impoverishment for recipients of home and community-based services. S.99 / H.R.448 - The Medicare Drug Price Negotiation Act - negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D H.R.1046 / S.377 Medicare Negotiation and Competitive Licensing Act of 2019 - requiring Secretary of Health and Human Services to negotiate prices of prescription drugs furnished under part D of the Medicare program S.470 Medicare at 50 Act - option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare H.R.1329 Medicaid Reentry Act - allows Medicaid payment for medical services furnished to an incarcerated individual during the 30-day period preceding the individual's release H.R.1354 Territories Health Equity Act - make improvements to the treatment of the United States territories under the Medicare and Medicaid programs H.R.3215, S.1754 The Disaster Relief Medicaid Act - provide Medicaid assistance to individuals and families affected by a disaster or emergency H.R.1384, S.1129 Medicare for All Act - establishes a national health insurance program H.R.2477, S.1280 Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act - establish a system to notify individuals approaching Medicare eligibility, to simplify and modernize the eligibility enrollment process Medicare Prescription Drug Savings and Choice Act - public option for drug coverage within Medicare Part D H.R.2463, S.1261 Choose Medicare Act - establishment of Medicare part E public health plans S.1423 Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2019 - provide for coverage of dental, vision, and hearing care under the Medicare and Medicaid programs