Telehealth Across State Lines Act of 2019

Hospital Group Purchasing - Advocated in support of hospital group purchasing organizations and maintaining the GPO safe harbor. Coronavirus relief Efforts - Supported passage of several bills to provide economic stability, financial relief and regulatory flexibility for hospitals in response to the COVID-19 crisis. H.R. 6074 - Coronavirus Preparedness and Response Supplemental Appropriations Act. H.R. 6201 - Families First Coronavirus Response Act H.R. 748 - Coronavirus Aid, Relief and Economic Stability (CARES) Act Offered recommendations to avoid supply chain disruptions of personal protective equipment and essential medications and supplies for hospitals for treating patients with COVID-19. Supported additional flexibilities to increase access to compounded medications. Urged DEA to expand aggregate production quotas for essential medications. Prescription Drug Pricing - Monitored ongoing negotiations to reduce prescription drug prices. Engaged to clarify provisions in the House (H.R. 3) and Senate (S. 2543) drug pricing bills. 340B Drug Pricing Program - Supported maintaining adequate reimbursement for hospitals purchasing prescription drugs through the 340B Drug Pricing Program. Advocated for preserving the current structure of the program. Surprise Billing - Supported inclusion of provisions to provide for an independent dispute resolution process in legislation to address surprise bills (H.R. 3630; H.R. 2328; S. 1895). Rural Health Care Issues - Offered support for the following legislation that would make improvements to rural health care access: Critical Access Hospital Regulatory Relief (S. 586/H.R. 1041) Rural Hospital Regulatory Relief Act (S. 895/H.R. 3416) Rural Health Clinic Modernization Act (S. 1037/H.R. 2788) Telehealth Across State Lines Act (S. 2408/H.R.4900) CONNECT For Health Act (S. 2741/H.R.4932) Conrad State 30 and Physician Access Reauthorization Act (S. 948/H.R.2895)

Client expense: $210,000 · Firm income: Not reported

Government targets: Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of the Vice President of the United States, SENATE

H.R. 3062/S. 2860 - "Patient Access to Higher Quality Health Care Act of 2019" - Oppose efforts to repeal certain provisions relating to the Medicare exception to the prohibition on certain physician referrals for hospitals. Bad Debt Payments to Hospitals - Oppose any effort to lower bad debt payments to hospitals for Medicare beneficiaries who fail to pay their cost-sharing obligations for treatments provided by the hospital. H.R. 2552 - "Protecting Local Access to Care for Everyone (PLACE) Act" - Support legislation to prevent site neutral cuts. H.R. 1763/ S. 348 - "Resident Physician Shortage Reduction Act of 2019" - Support GME legislation to reduce resident physician shortage. H.R. 3414/S. 2892 - Opioid Workforce Act - Support GME legislation to reduce resident physician shortage. Support access to affordable prescription drugs. H.R. 3107 - "Improving Seniors' Timely Access to Care Act" - Support legislation that streamlines and standardizes prior authorization under the Medicare Advantage program. Sought moratorium on proposed Medicaid Fiscal Accountability Regulation H.R. 748 Coronavirus Aid, Relief, and Economic Security (CARES) Act - Advocated in support of lifting sequester, increasing DRG payments, DSH cut delay, accelerated payment program, and waiving IRF and LTCH Medicare payment requirements in response to COVID-19. H.R. 4899/S. 2406 - Rural America Health Corps Act, H.R. 4900/S. 2408 - Telehealth Across State Lines Act of 2019, H.R. 4898/S. 2411 - Rural Health Innovation Act of 2019 - support expanded access to telehealth and broadband.

Client expense: $640,000 · Firm income: Not reported

PL 116-136 CARES Act (all sections of full text) HR 3502 Protecting People From Surprise Medical Bills Act (all sections of full text)(support) S 1266 Protecting Patients from Surprise Medical Bills Act (all sections of full text)(support) S 1531 Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 (all sections of full text)(support) S 1895 Lower Health Care Costs Act, Title I (all sections of full text)(oppose) Monitored HR 3062 Patient Access to Higher Quality Health Care Act of 2019 Monitored HR 861 The End Surprise Billing Act of 2019 Monitored HR 3630 No Surprises Act Monitored implementation of Sec. 6001 of the Affordable Care Act of 2010 Monitored discussions pertinent to health care group purchasing organizations (GPOs) role in helping to prevent drug shortages Monitored Executive Order #13877 Improving Price Quality Transparency in American Healthcare To Put Patients First Monitored HR 4379 Under-Performing Directories that Affect Treating Emergencies Act Monitored HR 1897 MOMMA's Act ("Mothers and Offspring Mortality and Morbidity Awareness Act") Monitored HR 1551 Quality Care for Moms and Babies Act Monitored HR 2902 Maternal Care Access and Reducing Emergencies Act Monitored HR 2602 Healthy MOMMIES Act Monitored HR 4995 Maternal Health Quality Improvement Act of 2019 Monitored S 2408 Telehealth Across State Lines Act of 2019 Monitored S 2741 Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 Monitored HR 4932 Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019

Client expense: Not reported · Firm income: $130,000

HR 3502 Protecting People from Surprise Medical Bills Act (all sections of full text)(support) S1266 Protecting Patients from Surprise Medical Bills Act (all sections of full text)(support) S1531 Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 (all sections of full text)(support) S1895 Lower Health Care Costs Act, Title I (all sections of full text)(oppose) Monitored HR 3062 Patient Access to Higher Quality Health Care Act of 2019 Monitored HR 861 The End Surprise Billing Act of 2019 Monitored HR 3630 No Surprises Act Monitored implementation of Sec. 6001 of the Affordable Care Act of 2010 Monitored discussions pertinent to health care group purchasing organizations (GPOs) role in helping to prevent drug shortages Monitored Executive Order #13877 Improving Price Quality Transparency in American Healthcare To Put Patients First Monitored HR 4379 Under Performing Directories that Affect Treating Emergencies Act Monitored HR 1897 MOMMA's Act ("Mothers and Offspring Mortality and Morbidity Awareness Act") Monitored HR 1551 Quality Care for Moms and Babies Act Monitored HR 2902 Maternal Care Access and Reducing Emergencies Act Monitored HR 2602 Healthy MOMMIES Act Monitored HR 4995 Maternal Health Quality Improvement Act of 2019 Monitored S 2408 Telehealth Across State Lines Act of 2019 Monitored S 2741 Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 Monitored HR 4932 Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019

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

S. 116, Modernizing Obstetric Medicine Standards Act of 2019 (MOMS Act) (Gillibrand)-maternal health S. 916, Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) (Durbin) -maternal health S. 1012, The Protecting Jessica Grubbs Legacy Act (Capito) - confidential sharing of substance use disorder information S. 1770, Resilience Investment, Support, and Expansion from Trauma Act (RISE from Trauma Act) (Durbin) - trauma care S. 1895, Lower Health Care Costs Act (Alexander-Murray) - surprise medical billing, prescription drug prices, transparency, public health initiatives, exchange of health information, mental health parity, pharmacy benefit manager (PBM) issues, provider directories, disclosure of proprietary information S. 2408, Telehealth Across State Lines Act of 2019 (Blackburn)- telehealth S. 2741, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 (Schatz) - telehealth S. 2885, Stop Marketing and Revealing the Wearables and Trackers Consumer Health Data Act (Cassidy) - consumer health information S. 2897, Patient-Centered Outcomes Research Institute Reauthorization Act (Warner) - PCORI funding S. 2986, Social Determinants Accelerator Act of 2019 (Young) - Social Determinants of Health H.R. 506, Hospital Competition Act (Banks) - hospital consolidation H.R. 525, Strengthening the Health Care Fraud Prevention Task Force Act (Walden) - codification of Healthcare Fraud Prevention Partnership H.R. 861, End Surprise Billing Act (Doggett) - surprise medical bills H.R. 1395, Youth Mental Health Services Act (Roe) - mental health for students H.R. 1409, Transparency in All Health Care Pricing Act (Perlmutter) - transparency in health care pricing H.R. 1897, Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) (Kelly) -maternal health H.R. 2062, Overdose Prevention and Patient Safety Act (Blumenauer) - confidential sharing of substance use disorder information H.R. 2740, HHS Appropriations (DeLauro) - funding for HHS programs and agencies H.R. 3030, Patient-Centered Outcomes Research Extension Act (DeGette) - PCORI reauthorization H.R. 3180, Resilience Investment, Support, and Expansion from Trauma Act (RISE from Trauma Act) (Davis) -trauma care H.R. 3439, Protecting Access to Information for Effective & Necessary Treatment and Services Act (Beyer) - PCORI reauthorization H.R. 4004, Social Determinants Accelerator Act of 2019 (Bustos)- social determinants of health H.R. 4040, Protecting Access to Spinal Surgeries Act (Lewis)- site neutral IPPS payments H.R. 4215, Excellence in Maternal Health Act of 2019 (Bucshon)- maternal health H.R. 4336, Easy Enrollment Act of 2019 (Bera)- aligning enrollment for exchange plans with tax returns H.R. 4768, Home Visiting to Reduce Maternal Mortality and Morbidity Act (David) - maternal health H.R. 4900, Telehealth Across State Lines Act of 2019 (Roe) - telehealth H.R. 4932, Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019 (Thompson) - telehealth H.R. 4995, Maternal Health Quality Improvement Act of 2019 (Engel) - maternal health outcomes H.R. 5190, STAR Act (Harder) - telemedicine assistance for rural health clinics and health centers H.R. 5257, Telehealth Expansion Act of 2019 (Cox) - establish FCC telehealth program H.R. 5473, Enhance Access to Support Essential Behavioral Health Services Act (Bilirakis) - telehealth Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to Patient-Centered Outcomes Research Institute (PCORI) re-authorization; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; telemedicine; rural health; issues related to Managed Long Term Services and Supports (MLTSS); issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to caregivers; and other issues relating to health care reform implementation.

HR 3502 Protecting People From Surprise Medical Bills Act (all sections of full text)(support) S 1266 Protecting Patients from Surprise Medical Bills Act (all sections of full text)(support) S 1531 Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 (all sections of full text)(support) S 1895 Lower Health Care Costs Act, Title I (all sections of full text)(oppose) Monitored HR 3062 Patient Access to Higher Quality Health Care Act of 2019 Monitored HR 861 The End Surprise Billing Act of 2019 Monitored HR 3630 No Surprises Act Monitored implementation of Sec. 6001 of the Affordable Care Act of 2010 Monitored discussions pertinent to health care group purchasing organizations (GPOs) role in helping to prevent drug shortages Monitored Executive Order #13877 Improving Price Quality Transparency in American Healthcare To Put Patients First Monitored HR 4379 Under-Performing Directories that Affect Treating Emergencies Act Monitored HR 1897 MOMMA's Act ("Mothers and Offspring Mortality and Morbidity Awareness Act") Monitored HR 1551 Quality Care for Moms and Babies Act Monitored HR 2902 Maternal Care Access and Reducing Emergencies Act Monitored HR 2602 Healthy MOMMIES Act Monitored HR 4995 Maternal Health Quality Improvement Act of 2019 Monitored S 2408 Telehealth Across State Lines Act of 2019 Monitored S 2741 Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 Monitored HR 4932 Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019

Client expense: Not reported · Firm income: $260,000

Hospital Group Purchasing - Advocated in support of hospital group purchasing organizations and maintaining the GPO safe harbor. Prescription Drug Pricing - Engaged to clarify provisions in the House (H.R. 3) and Senate (S. 2543) drug pricing bills. Supported passage of legislation that would promote competition among prescription drug manufacturers: The CREATES Act (H.R. 965; S. 340); the FAST Generics Act (H.R. 985); the Biologic Patent Transparency Act (S.659); the Affordable Prescriptions for Patients Act (S. 1416). 340B Drug Pricing Program - Supported maintaining adequate reimbursement for hospitals purchasing prescription drugs through the 340B Drug Pricing Program. Advocated for preserving the current structure of the program and retaining the current prime vendor. Surprise Billing - Supported inclusion of provisions to provide for an independent dispute resolution process in legislation to address surprise bills (H.R. 3630; H.R. 2328; S. 1895). Health Care Costs - Monitored the development and release of the S. 1895, the Lower Health Care Costs Act. Health Care Data Utilization - conducted an educational briefing to illustrate how hospitals utilize data resources to identify health care quality improvement opportunities. Rural Health Care Issues - Offered support for the following legislation that would make improvements to rural health care access: Critical Access Hospital Regulatory Relief (S. 586/H.R. 1041) Rural Hospital Regulatory Relief Act (S. 895/H.R. 3416) Rural Health Clinic Modernization Act (S. 1037/H.R. 2788) Telehealth Across State Lines Act (S. 2408/H.R.4900) CONNECT For Health Act (S. 2741/H.R.4932) Conrad State 30 and Physician Access Reauthorization Act (S. 948/H.R.2895)

Client expense: $180,000 · Firm income: Not reported

S. 116, Modernizing Obstetric Medicine Standards Act of 2019 (MOMS Act) (Gillibrand)-maternal health S. 916, Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) (Durbin) -maternal health S. 1012, The Protecting Jessica Grubbs Legacy Act (Capito) - confidential sharing of substance use disorder information S. 1770, Resilience Investment, Support, and Expansion from Trauma Act (RISE from Trauma Act) (Durbin) - trauma care S. 1895, Lower Health Care Costs Act (Alexander-Murray) - surprise medical billing, prescription drug prices, transparency, public health initiatives, exchange of health information, mental health parity, pharmacy benefit manager (PBM) issues, provider directories, disclosure of proprietary information S. 2408, Telehealth Across State Lines Act of 2019 (Blackburn)- telehealth H.R. 506, Hospital Competition Act (Banks) - hospital consolidation H.R. 525, Strengthening the Health Care Fraud Prevention Task Force Act (Walden) - codification of Healthcare Fraud Prevention Partnership H.R. 861, End Surprise Billing Act (Doggett) - surprise medical bills H.R. 1395, Youth Mental Health Services Act (Roe) - mental health for students H.R. 1409, Transparency in All Health Care Pricing Act (Perlmutter) - transparency in health care pricing H.R. 1897, Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMAs Act) (Kelly) -maternal health H.R. 2062, Overdose Prevention and Patient Safety Act (Blumenauer) - confidential sharing of substance use disorder information H.R. 2740, HHS Appropriations (DeLauro) - funding for HHS programs and agencies H.R. 3030, Patient-Centered Outcomes Research Extension Act (DeGette) - PCORI reauthorization H.R. 3180, Resilience Investment, Support, and Expansion from Trauma Act (RISE from Trauma Act) (Davis) -trauma care H.R. 3439, Protecting Access to Information for Effective & Necessary Treatment and Services Act (Beyer) - PCORI reauthorization H.R. 4004, Social Determinants Accelerator Act of 2019 (Bustos)- social determinants of health H.R. 4040, Protecting Access to Spinal Surgeries Act (Lewis)- site neutral IPPS payments H.R. 4215, Excellence in Maternal Health Act of 2019 (Bucshon)- maternal health H.R. 4336, Easy Enrollment Act of 2019 (Bera)- aligning enrollment for exchange plans with tax returns Regulatory Issues: HIPAA administrative simplification issues, including standards for privacy, security, and electronic transactions and code sets (including ICD-10), identifiers including the health plan identifier, enforcement; cybersecurity; FEHBP enrollment data clearinghouse initiative, the enrollment reconciliation process, and a related OPM reimbursement factor for records that cannot be reconciled; issues relating to health insurance plan participation in FEHBP, including contract requirements; issues relating to similarly sized subscriber group (SSSG) and MLR requirements under the FEHBP; implementation of the health savings account provisions of the Medicare Act; issues related to Medicare Secondary Payer requirements; issues related to Patient-Centered Outcomes Research Institute (PCORI) re-authorization; issues related to health care price transparency; issues related to all payor claims databases; issues related to implementation of the National Health Information Infrastructure; electronic health records, personal health records, and similar technologies; issues relating to market consolidation; issues related to hospital and provider consolidation; issues related to trauma-informed care; issues related to medical management; issues relating to quality improvement; issues relating to the national health data stewardship; issues relating to hospital outpatient measurement and reporting; prescription drug pricing; issues related to the collection of race and ethnicity data; issues related to medical loss ratios; reference pricing; review of rates for reasonableness; preexisting condition insurance plans; issues relating to antitrust; issues relating to surprise medical bills; accountable care organizations; provider non-discrimination; coverage of preventive services; contraceptive coverage; pre-existing condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; issues relating to the annual fee on health insurance providers; health plan automatic enrollment requirements; issues related to qualified health plans including certification and rate filing templates; health insurance market rules; reinsurance, risk corridors, and risk adjustment; dependent coverage; summary of benefits and coverage disclosures; benefit and payment parameters; essential health benefits, actuarial value, and accreditation; NQF reauthorization; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations; issues related to supplemental products; issues related to HIPAA excepted benefits; issues related to short term limited duration products; issues related to the federally-facilitated marketplaces (i.e., Exchanges/formerly referred to as the web portal); issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); issues related to association health plans; issues related to cost-sharing reductions (CSRs); issues related to the refundable credit for coverage under a qualified health plan; issues related to small employer group size; issues related to Certificate of Public Advantage; issues relating to veterans health care; issues relating to family caregivers; and other issues relating to health care reform implementation.

HR 3502 Protecting People from Surprise Medical Bills Act (all sections of full text)(support) S1266 Protecting Patients from Surprise Medical Bills Act (all sections of full text)(support) S1531 Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 (all sections of full text)(support) S1895 Lower Health Care Costs Act, Title I (all sections of full text)(oppose) S 2543 Prescription Drug Pricing Reduction Act, Sec. 109 Monitored HR 3 Lower Drug Cost Now Act of 2019 Monitored HR 3062 Patient Access to Higher Quality Health Care Act of 2019 Monitored HR 861 The End Surprise Billing Act of 2019 Monitored HR 3630 No Surprises Act Monitored implementation of Sec. 6001 of the Affordable Care Act of 2010 Monitored discussions pertinent to health care group purchasing organizations (GPOs) role in helping to prevent drug shortages Monitored Executive Order #13877 Improving Price Quality Transparency in American Healthcare To Put Patients First Monitored HR 4379 Under Performing Directories that Affect Treating Emergencies Act Monitored HR 1897 MOMMA's Act ("Mothers and Offspring Mortality and Morbidity Awareness Act") Monitored HR 1551 Quality Care for Moms and Babies Act Monitored HR 2902 Maternal Care Access and Reducing Emergencies Act Monitored HR 2602 Healthy MOMMIES Act Monitored S 2408 Telehealth Across State Lines Act of 2019

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

HR 3502 Protecting People From Surprise Medical Bills Act (all sections of full text)(support) S 1266 Protecting Patients from Surprise Medical Bills Act (all sections of full text)(support) S 1531 Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 (all sections of full text)(support) S 1895 Lower Health Care Costs Act, Title I (all sections of full text)(oppose) S 2543 Prescription Drug Pricing Reduction Act, Sec. 109 Monitored HR 3 Lower Drug Costs Now Act of 2019 Monitored HR 3062 Patient Access to Higher Quality Health Care Act of 2019 Monitored HR 861 The End Surprise Billing Act of 2019 Monitored HR 3630 No Surprises Act Monitored implementation of Sec. 6001 of the Affordable Care Act of 2010 Monitored discussions pertinent to health care group purchasing organizations (GPOs) role in helping to prevent drug shortages Monitored Executive Order #13877 Improving Price Quality Transparency in American Healthcare To Put Patients First Monitored HR 4379 Under Performing Directories that Affect Treating Emergencies Act Monitored HR 1897 MOMMA's Act ("Mothers and Offspring Mortality and Morbidity Awareness Act") Monitored HR 1551 Quality Care for Moms and Babies Act Monitored HR 2902 Maternal Care Access and Reducing Emergencies Act Monitored HR 2602 Healthy MOMMIES Act Monitored S 2408 Telehealth Across State Lines Act of 2019

Client expense: Not reported · Firm income: $130,000