Competitive Health Insurance Reform Act of 2019

Price transparency, out-of-network reimbursement of emergency medical services, surprise medical bills H.R.861-End Surprise Billing Act of 2019 H.R.1418-Competitive Health Insurance Reform Act of 2019 H.R.2328-Reauthorizing and Extending Americas Community Health Act H.R.3107-Improving Seniors Timely Access to Care Act of 2019 H.R.3502-Protecting People From Surprise Medical Bills Act H.R.3630-No Surprises Act H.R.5800-Ban Surprise Billing Act H.R.5826-Consumer Protections Against Surprise Medical Bills Act of 2020 S.350-Competitive Health Insurance Reform Act of 2019 S.1266-Protecting Patients from Surprise Medical Bills Act S.1531-Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 S.1895-Lower Health Care Costs Act

Client expense: $340,838 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Price transparency, out-of-network reimbursement of emergency medical services, surprise medical bills H.R.861-End Surprise Billing Act of 2019 H.R.1418-Competitive Health Insurance Reform Act of 2019 H.R.2328-Reauthorizing and Extending Americas Community Health Act H.R.3107-Improving Seniors Timely Access to Care Act of 2019 H.R.3502-Protecting People From Surprise Medical Bills Act H.R.3630-No Surprises Act H.R.5800-Ban Surprise Billing Act H.R.5826-Consumer Protections Against Surprise Medical Bills Act of 2020 S.350-Competitive Health Insurance Reform Act of 2019 S.1266-Protecting Patients from Surprise Medical Bills Act S.1531-Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 S.1895-Lower Health Care Costs Act

Client expense: $391,824 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Price transparency, out-of-network reimbursement of emergency medical services, surprise medical bills Opioids, pain management Federal funding for Substance Use Disorder treatments Drug Shortages H.R.451-Dont Break Up the T-Band Act of 2020 H.R.501-Poison Center Network Enhancement Act of 2019 H.R.861-End Surprise Billing Act of 2019 H.R.925-The Heroes Act H.R.1301-Mental Health Telemedicine Expansion Act H.R.1309-Workplace Violence Prevention for Health Care and Social Service Workers Act H.R.1418-Competitive Health Insurance Reform Act of 2019 H.R.1554-Resident Education Deferred Interest (REDI) Act H.R.1646-Helping Emergency Responders Overcome (HERO) Act H.R.1682-Improving Access to Medicare Coverage Act of 2019 H.R.1767-Excellence in Mental Health and Addiction Treatment Expansion Act H.R.2281-Easy Medication Access and Treatment (MAT) for Opioid Addiction Act H.R.2328-Reauthorizing and Extending Americas Community Health Act H.R.2464-End the Cycle of Violence Act of 2019 H.R.2482-Mainstreaming Addiction Treatment Act of 2019 H.R.2519-Improving Mental Health Access from the Emergency Department Act of 2019 H.R.2550-Prevent Blood Loss with Emergency Equipment Devices Act of 2019 H.R.2569-Comprehensive Addiction Resources Emergency Act of 2019 H.R.3107-Improving Seniors Timely Access to Care Act of 2019 H.R.3417-Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 H.R.3502-Protecting People From Surprise Medical Bills Act H.R.3630-No Surprises Act H.R.3935-Protecting Patients Transportation to Care Act H.R.3984-Health Care Safety Net Enhancement Act of 2019 H.R.4194-National Suicide Hotline Designation Act of 2019 H.R.4861-Effective Suicide Screening and Assessment in the Emergency Department Act of 2019 H.R.4932-Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019 H.R.5619-Suicide Prevention Act H.R.5727-Research Empirical Solutions to End Ambulance Reversals from Closed Hospitals (RESEARCH) Act of 2020 H.R.5800-Ban Surprise Billing Act H.R.5826-Consumer Protections Against Surprise Medical Bills Act of 2020 H.R.5855-Bipartisan Solution to Cyclical Violence Act of 2020 H.R.6663-Truth in Healthcare Marketing Act of 2020 H.R.6800-Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act H.R.6910-Emergency Room Hero and Patient Safety Act H.R.6930-Manufacturing API, Drugs, and Excipients (MADE) in America Act of 2020 H.R.7059-Coronavirus Provider Protection Act H.R.7255-Coronavirus Health Care Worker Wellness Act of 2020 H.R.7574-Strengthening Americas Strategic National Stockpile Act of 2020 H.R.7819-Eliminating the Provider Relief Fund Tax Penalties Act of 2020 H.R.8094-Dr. Lorna Breen Health Care Provider Protection Act S.289-Rural Physician Workforce Production Act of 2019 S.299-Geriatrics Workforce Improvement Act S.350-Competitive Health Insurance Reform Act of 2019 S.618-Medicare Choices Empowerment and Protection Act S.753-Improving Access to Medicare Coverage Act of 2019 S.824-Excellence in Mental Health and Addiction Treatment Expansion Act S.851-Workplace Violence Prevention for Health Care and Social Service Workers Act S.1199-Poison Center Network Enhancement Act of 2019 S.1266-Protecting Patients from Surprise Medical Bills Act S.1334-Improving Mental Health Access from the Emergency Department S.1350-Good Samaritan Health Professionals Act of 2019 S.1365-Comprehensive Addiction Resources Emergency Act of 2019 S.1531-Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 S.1895-Lower Health Care Costs Act S.2074-Mainstreaming Addiction Treatment Act of 2019 S.2661-National Suicide Hotline Designation Act of 2020 S.2741-Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 S.3006-Effective Suicide Screening and Assessment in the Emergency Department Act of 2019 S.3143-Magnet Injury Prevention Act S.3198-Suicide Prevention Act S.3346-Prevent Blood Loss with Emergency Equipment Devices Act of 2020 S.4349-Dr. Lorna Breen Health Care Provider Protection Act

Client expense: $391,824 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support HR 1763/ S 348, Resident Physician Shortage Reduction Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose HR 506,Hospital Competition Act of 2019, a bill to amend title XVIII of the Social Security Act to increase hospital competition; Statement submitted to the House Judiciary on the hearing "Diagnosing the Problem: Exploring the Effects of Consolidation and Anticompetitive Conduct in Health Care Markets"; Support HR 965/ S340, Creating and Restoring Equal Access to Equivalent Samples Act of 2019 or the CREATES Act of 2019, a bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products; Support HR 986/ S466 Protecting Americans with Preexisting Conditions Act of 2019, a bill provide that certain guidance related to waivers for State innovation under the Patient Protection and Affordable Care Act shall have no force or effect; Support HR 987 Strengthening Health Care and Lowering Prescription Drug Costs Act, a bill to amend the Patient Protection and Affordable Care Act to provide for Federal Exchange outreach and educational activities; Support HR 938 Bringing Low-cost Options and Competition while Keeping Incentives for New Generics Act of 2019 or the BLOCKING Act of 2019, a bill to amend the Federal Food, Drug, and Cosmetic Act, with respect to eligibility for approval of a subsequent generic drug, to remove the barrier to that approval posed by the 180-day exclusivity period afforded to a first generic applicant that has not yet received final approval, and for other purposes; Support HR 1010, a bill to provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force or effect; Support HR 1499 Protecting Consumer Access to Generic Drugs Act of 2019, a bill to prohibit brand name drug manufacturers from compensating generic drug manufacturers to delay the entry of a generic drug into the market, and to prohibit biological product manufacturers from compensating biosimilar and interchangeable product manufacturers to delay entry of biosimilar and interchangeable products, and for other purposes; Support HR 1425 State Health Care Premium Reduction Act, a bill to amend the Patient Protection and Affordable Care Act to provide for a Improve Health Insurance Affordability Fund to provide for certain reinsurance payments to lower premiums in the individual health insurance market; Support HR 1386/ S 1905 Expand Navigators Resources for Outreach, Learning, and Longevity Act of 2019 or the ENROLL Act of 2019,a bill to amend the Patient Protection and Affordable Care Act to provide for additional requirements with respect to the navigator program, and for other purposes; Support HR 1520 Purple Book Continuity Act of 2019, a bill to amend the Public Health Service Act to provide for the publication of a list of licensed biological products, and for other purposes; Support HR 1503 Orange Book Transparency Act of 2019A bill that would increase transparency for the patent status of both approved biological products and approved drugs; Support HR 2439/ HR 3414 Opioid Workforce Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the opioid crisis; Submitted statement to the House Committee on Ways and Means Overcoming Racial Disparities and Social Determinants in the Maternal Mortality Crisis sharing information regarding hospitals and health systems efforts to address maternal morbidity and mortality, as we seek ways to improve outcomes and reduce health inequities for expectant and new mothers, and give their children the best possible start in life; Submitted oral and written testimony to the House Committee on Ways and Means Subcommittee on Health Hearing on Protecting Patients from Surprise Medical Bills. Protecting patients from surprise medical bills is a top priority and we have adopted a set of guiding principles to use as we evaluate legislative proposals: Define surprise bills, Protect the patient financially, Ensure patient access to emergency care, Preserve the role of private negotiation, Remove the patient from health plan/provider negotiations, Educate patients about their health care coverage, Ensure patients have access to comprehensive provider networks and accurate network information, and Support state laws that work; Letters submitted to the Energy & Commerce Committee in response to the request for comments on their surprise billing discussion draft. Concerned with the Committees draft legislations approach to determining reimbursement for out-of-network providers. Once the patient is protected from surprise bills, providers and insurers should then be permitted to negotiate payment rates for services provided. We strongly oppose approaches that would impose arbitrary rates on providers. We look forward to continuing to work with the Committee on solutions to stop surprise medical bills; Letter sent to the HELP Committee in response to the Lower Health Care Costs Act of 2019 discussion draft about our concerns about several of the proposals that would allow the government to intrude into private commercial contracts between providers and insurers. For example, several of the provisions could undermine value-based purchasing arrangements aimed directly at improving the quality of care while reducing costs. We strongly urge the Committee to remove these provisions; Submitted oral and written testimony to the House Committee on Energy and Commerce, Subcommittee on Health Hearing on No More Surprises: Protecting Patients from Surprise Medical Bills asking that the Committee preserve the ability of providers and insurers to negotiate private contracts and not establish a fixed payment amount for out-of-network services; Oppose HR 1309 Workplace Violence Prevention for Health Care and Social Service Workers Act, a bill to direct the Secretary of Labor to issue an occupational safety and health standard that requires covered employers within the health care and social service industries to develop and implement a comprehensive workplace violence prevention plan, and for other purposes; Concerns about S.1531, Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 or the STOP Surprise Medical Bills Act of 2019, to amend the Public Health Service Act to provide protections for health insurance consumers from surprise billing; Concerns about S. 1895 Lower Health Care Costs Act Letter addressed concerns about the legislative provision that sets a benchmark rate in statute for the out-of-network payments, as well as provisions that seek to change privately negotiated contracting arrangements between hospitals and insurance companies; Support HR 3425, Advancing Medical Resident Training in Community Hospitals Act of 2019, to amend title XVIII of the Social Security Act to establish rules for payment for graduate medical education (GME) costs for hospitals that establish a new medical residency training program after hosting resident rotators for short durations; Expressed concerns regarding the provisions that reduce reimbursements to providers and hospitals that administer drugs the Prescription Drug Pricing Reduction Act (PDPRA) of 2019: including about Section 107, Medicare Part B Rebate by Manufacturers for Drugs or Biologicals with Prices Increasing Faster than Inflation, Section 110, Establishment of Maximum Add-on Payment for Drugs, Biologicals, and Biosimilars, this provision would establish $1,000 as the maximum add-on amount that a provider can be paid for a separately payable drug, biological or biosimilar, Section 111, Treatment of Drug Administration Services Furnished by an Off-Campus Outpatient Department of a Provider, the site neutral payment reduction would cut aggregate hospital payments; Support S. 2091, Backlog Elimination, Legal Immigration, and Employment Visa Enhancement Act, this legislation would increase the total number of employment-based visas from 140,000 to 270,000 and ensure that critical health care workers needed in the U.S. have access to employment-based visas by carving out health care workers in designated shortage occupations from the limit; Support S 350, The Competitive Health Insurance Reform Act of 2019, a bill to restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers; Submitted statement to Subcommittee on Health of the Committee on Energy and Commerce for the hearing on Improving Maternal Health: Legislation to Advance Prevention Efforts and Access to Care; Concerns with S. 386 and HR 1044, Fairness for High-Skilled Immigrants Act of 2019, this bill increases the per-country cap on family-based immigrant visas from 7% of the total number of such visas available that year to 15%, and eliminates the 7% cap for employment-based immigrant visas. It also removes an offset that reduced the number of visas for individuals from China; Support H.R. 4538, Closing Loopholes for Orphan Drugs Act, a bill to amend title III of the Public Health Service Act to limit the orphan drug exclusion under the drug discount program under section 340B of such title; Discussions of provisions we support and those we recommend be changes in a draft bill called the Mitigating Existing Drug Shortages (MEDS) Act; Discussions in support of the allowing states to designate hospitals as necessary providers for purposes of waiving the critical access hospital mileage requirements; Provided comments to W&M on legislation to expand Health Profession Opportunity Grants; Support S. 2723, The Mitigating Emergency Drug Shortages (MEDS) Act, a bill to amend Sec. 506C of the Federal Food, Drug, and Cosmetic Act which strengthens requirements for drug manufacturers to disclose the root causes and expected duration of shortages, extends reporting requirements to active pharmaceutical ingredients manufacturers, requires manufacturers have contingency plans to ensure ongoing supply, develops recommendations to incentivize manufacturers to enter the market for drugs in shortage and examines the national security risks of shortages; Discuss DEA reductions in annual quotas for opioid products used by hospitals for sedation and pain management; Meeting with the Office of the Assistant Secretary of Preparedness and Response (ASPR) to discuss developments in the hospital preparedness program, the pilot projects for the Regional Disaster Healthcare System and other issues; Rural access to health care, including identifying core services needed in rural communities, outlining approaches and considerations for delivering those services, and examining access and quality in the rural context; ONCs proposed rule to implement the 21st Century Cures provision on information blocking; Supported members serving on the HHS Quality Summit panel, which was convened by the Deputy Secretary to gather input regarding how to improve and energize quality and safety improvement activities across health care system; Discussion with HHS on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussion with HHS about the work of Aligning for Health to address social determinants of health; Support S 2902, Strengthening Our Rural Health Workforce Act of 2019, a bill to enhance the rural health workforce; Meetings and correspondence with staff members of Senate Financing Committee on a proposal to support rural health care access (REH, re-opening necessary provider CAH, infrastructure funding); Letter to Ways & Means committee Rural and Underserved Communities Health Task Force in response to RFI on factors that contribute to health outcomes in these areas, examples of successful models and lessons from the field that address access and outcomes, and considerations for the unique circumstances of rural and underserved communities; Letter to Energy and Commerce Members regarding health information technology priorities; Letter of Support to Senate Appropriations on funding for the Centers for Disease Control and Prevention and the National Institutes of Health to study gun violence; Support S.2741 and H.R. 4932,Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, a bill to amend title XVIII of the Social Security Act to expand access to telehealth services, and for other purposes; Support S 2603, Resolving Extended Limbo for Immigrant Employees and Families (RELIEF) Act, a bill to amend the Immigration and Nationality Act to end the immigrant visa backlog, and for other purposes; Support HR 4995, Maternal Health Quality Improvement Act of 2019, a bill to amend the Public Health Service Act to improve obstetric care and maternal health outcomes, and for other purposes; Concerns with HR 5800,Ban Surprise Billing Act, a bill to address surprise medical bills that relies on a median in-network rate to resolve out-of-network payments and allows for an independent dispute resolution process to determine the final payment. Concerned with the Committee's legislative approach to determining reimbursement for out-of-network providers. Oppose approaches that would impose arbitrary rates on providers, which could have significant consequences far beyond the scope of surprise medical bills. It is the insurers' responsibility to maintain comprehensive provider networks, and a default payment rate would remove incentives for health plans to contract with providers or to offer fair terms; Support HR 5826, Consumer Protections Against Surprise Medical Bills Act, a bill that prohibits providers from balance billing patients for emergency services or medical care the patient reasonably could have expected to be in-network, and from charging patients more than the in-network cost-sharing amount. Rather than rely on a benchmark payment rate to determine out-of-network reimbursement, the legislation provides a period for health plans and providers to negotiate out-of-network reimbursement, followed by a mediated dispute resolution process if necessary; Letter urging HHS to take regulatory actions to help hospitals and health systems prepare and respond to COVID-19; Letter requesting $100 billion to prepare and respond to COVID-19; Letter urging the Department of Labor to accurately define health care provider when promulgating regulations implementing key sections of the Families First Coronavirus Response Act; Letter sent to the President asking for the use of the Defense Production Act to increase the production of medical supplies and equipment; Letter to HHS regarding $100 billion emergency fund, asking HHS and CMS to directly and expediently distribute to rural and urban hospitals and health systems funds from the Public Health and Social Services Emergency Fund that were designated for providers in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES Act increased funding by $100 billion in order to reimburse eligible health care providers for health care-related expenses or lost revenues that are attributable to COVID-19. In the letter, we urged HHS and CMS to immediately distribute funding to all hospital types in the US - with additional funding going to COVID-19 hotspots; Letter urging Congress to modernize the Stafford Act as part of its next COVID-19 legislative package to allow all hospitals to recoup financial losses from this pandemic and future disasters; Letter to the Federal Reserve System, the Federal Deposit Insurance Corporation and the Office of the Comptroller of the Currency requesting they, as primary federal regulators for insured depository institutions, take prompt action to assist health care providers on the front line of the COVID-19 pandemic should the need to do so arise; Letter to the Secretary of the Treasury and the Federal Reserve Chair of the Board of Governors urging a supplement to the New Main Street Loan Facility term sheet with prompt guidance to ensure that access to this critically-necessary loan facility will be attainable for hospitals without delay; Letter was sent to the SBA urging it to ensure that small- and mid-size public hospitals, including those that have both nonprofit and public designations, are allowed to apply for and receive loans under the newly-authorized SBA Paycheck Protection Program; Letter in response to FEMAs request for input on establishing a voluntary agreement, under the Defense Production Act, of key private sector stakeholders relevant to responding to COVID-19, urging that such an agreement account for the full breadth of COVID-19 medical supply and equipment needs; Support H.R. 6474/S.3838 Healthcare Broadband Expansion During COVID-19 Act, a bill that would provide an additional $2 billion in funding for the FCC Rural Health Care program and increase the subsidy for health care providers from 65 to 85 percent. This legislation also simplifies the program to allow for more efficient application processes and disbursement of much needed funding; Support HR 6654 Emergency COVID-19 Telehealth Response Act, a bill that would codify an expanded list of providers to deliver and bill for telehealth services during the PHE; Support HR 7233Knowing the Efficiency and Efficacy of Permanent (KEEP) Telehealth Options Act of 2020, a bill that would require the Department of Health and Human Services and the Government Accountability Office (GAO) to conduct studies to provide information about the expanded use of telehealth during the COVID-19 pandemic; Letter to Senate HELP Committee in response to request for feedback on preparing for next pandemic; Discussion about telehealth waivers and flexibilities with HHS; Discussion about CARES provider relief fund distributions with HHS; Oppose HR 6559/ S 3677 COVID-19 Every Worker Protection Act of 2020, a bill to require the Occupational Safety and Health Administration to promulgate an emergency temporary standard to protect employees from occupational exposure to SARS-CoV-2, and for other purposes; Joint letter with ANA urging Congress to act quickly to get needed resources into the health care system, so that hospitals, nurses and physicians responding to COVID-19 are able to continue to provide treatments, front-line health care personnel are able to provide care and patients are able access health care services; Statement to Committee on Ways and Means for the hearing on The Disproportionate Impact of COVID-19 on Communities of Color urging Congress to employ the resources of the National Institute on Minority Health and Health Disparities - which is congressionally-mandated to coordinate the research of the other National Institutes of Healths centers and institutes related to minority health - to research and develop approaches to specifically address the COVID-19 needs of minority populations; Advocate with Congress for full forgiveness of COVID-19 related accelerated payments received by hospitals; Support S 3781Pharmaceutical Accountability, Responsibility, and Transparency (PART) Act, a bill to increase reporting of, help mitigate potential shortages related to, and promote, accountability and transparency for pharmaceuticals and medical devices; Support S 3780 Help Onshore Manufacturing Efficiencies (HOME) for Drugs and Devices Act, a bill to encourage domestic advanced manufacturing of critical drugs and devices in order to address economic, health, and security concerns, combat shortages of critical drugs and devices, and promote increased domestic diversification of, and independence from foreign reliance on, pharmaceutical and medical device supply chains; Support S.3763 Pandemic Responder Service Award Act, a bill to establish the Pandemic Responder Service Award program to express our gratitude to front-line health care workers; Support HR 6788/ S 3599 Healthcare Workforce Resilience Act, a bill to enhance our Nations nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas; Urged support for joint House and Senate letter to the Administration asking for flexibility for hospitals with respect to J-1 and H-1B visa programs; Letter to Senate Finance Committee to address the important issue of maternal health and the opportunity to provide suggestions regarding how to improve maternal health in this country; Support the Temporary Reciprocity to Ensure Access to Treatment Act, a bill that allows for the temporary reciprocity for treatment by medical professionals licensed in one state to patients in other states; Letter urging the Senate to include in the next COVID-19 relief bill provisions to strengthen the federal response for racial and ethnic minority and marginalized communities, which are disproportionately affected by the pandemic;Letter asking Congress to allocate as part of the next COVID-19 relief package at least an additional $100 billion to the emergency relief fund to provide direct funding to front line health care personnel and providers to continue to respond to this pandemic; Letter sent to HHS urging them to direct HRSA to take action to stop three drug manufacturers from limiting the distribution of 340B drugs to 340B covered entities. These drug manufacturers have taken separate actions to either limit the distribution of 340B drugs or require 340B covered entities provide claims level data for investigatory purposes if that 340B covered entity uses a contract pharmacy arrangement; Letter to the Congressional Leadership asking them to not to include in the next COVID-19 relief package any surprise medical billing legislation - such as a reimbursement rate set in statute - that would further destabilize hospitals finances during the pandemic; Support S 4507, Getting Early Treatment and Comprehensive Assessments Reduces Emergencies Act of 2020 or the GET CARE Act of 2020, a bill to amend the Public Health Service Act to provide for a national campaign to raise awareness of the importance of seeking preventive health services and the utilization of such services; Comment letter addressing concerns on the proposed rule from the Departments of the Treasury, Labor and Health and Human Services that would allow certain grandfathered health plans to increase patient cost-sharing beyond current limits, without losing their grandfathered status; Letter urging the Administration to work with the AHA and Congress to create a future for telehealth that allows not only clinicians, but also hospitals and health systems, to code and bill for virtual services. We further urge CMS and HHS to continue to provide hospitals with the flexibility for annual beneficiary consent to telehealth treatment to be obtained at the same time, and not necessarily before, services are furnished; Support HR 8061,Community Immunity During COVID-19 Act of 2020, a bill that would provide funding to state and local health departments to work with community providers and organizations to increase immunization rates for Advisory Committee on Immunization Practices (ACIP)-recommended vaccines during the COVID-19 public health emergency; Letter again expressing concern with recent actions taken by several major drug manufacturers to limit the distribution of certain 340B drugs to our hospital members. While we understand that the HRSA is further investigating these actions, we urge swift and decisive action to halt these pernicious tactics so as to prevent other manufacturers from following suit; Comment letter outlining our concerns about the ability of hospital systems to distribute provider relief funds among the parent and subsidiaries. HHS published certain FAQs that place problematic restrictions on the use of CARES Act provider relief fund dollars. Specifically, the FAQs restrict the ability of a hospital system to allocate the funds throughout its system where COVID-19 related expenses and lost revenues are occurring; Submitted comments in response to HRSAs RFI on Health Professional Shortage Area (HPSA) scoring. HPSA scores are important for rural hospitals and clinics ability to recruit physicians and other clinicians, namely from the National Health Service Corps (NHSC) program. Letter asking HHS to reinstate the COVID-19 Provider Relief Fund reporting requirements; Support S 4349, Dr. Lorna Breen Health Care Provider Protection Act, a bill to address behavioral health and well-being among health care professionals; Support S. 3595Ensuring Understanding of COVID-19 to Protect Public Health Act, a bill that directs the NIH to conduct a longitudinal study on mild, moderate, and severe cases of COVID-19 on a diverse patient population.

Client expense: $4,460,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

H.R. 748 - CARES Act -Courtney - COVID-19 coverage H.R. 1418 - Competitive Health Insurance Reform Act of 2020 - DeFazio - antitrust laws, health insurance, McCarran-Ferguson H.R. 3630 - No Surprises Act - Pallone - surprise medical billing H.R. 3784 - Air Ambulance Affordability Act of 2019 - Neguse - air ambulances H.R. 4223 - Protecting Patients from Surprise Medical Bills Act - Spano - surprise medical billing H.R. 5121 - Healthcare Cost Transparency Act - Beyer - provider price comparison tool H.R. 5239 - Prescription Drug Price Reporting Act - Joyce - reporting on drug expenditures and price changes under group health plans H.R. 5575 - Primary and Behavioral Health Care Access Act of 2020 -Underwood - coverage of primary care and behavioral health visits H.R. 6005 - Know the Price Act - Malinowski - health plan transparency H.R. 6173 - Covering Coronavirus Test Act of 2020 - DeGette - COVID-19 testing coverage H.R. 6193 - Medication Access in Emergencies Act of 2020 - Pappas - coverage of prescription drugs during emergency periods H.R. 6201 - Families First Coronavirus Response Act - Lowey - includes several provisions related to COVID-19 testing coverage H.R. 6213 - No Cost for COVID-19 Testing Act - Wilson - COVID-19 testing coverage H.R. 6214 - To amend title XVIII of the Social Security Act to provide for coverage of testing for COVID-19 at no cost sharing under the Medicare Advantage program - Kind - Medicare Advantage coverage of COVID-19 related visits and testing H.R. 6222 - Ensuring Affordable COVID-19 Preventive Care Act of 2020 - Schakowsky - coverage of certain new preventative services related to COVID-19 H.R. 6231 - Ensuring Access to COVID-19 Preventive Care Act of 2020 - Bucshon - coverage of certain vaccines and testing services during the COVID-19 emergency H.R. 6299 - Rapid Coverage of COVID-19 Vaccine Act of 2020 - Courtney - COVID-19 coverage H.R. 6317 - To provide for special enrollment periods during public health emergencies, coverage of services related to public health emergencies, and for other purposes - Doggett - special enrollment periods in public health emergency H.R. 6338 - To waive high deductible health plan requirements for health savings accounts -Budd - HDHP coverage during COVID H.R. 6486- Care for COVID-19 Act 2.0 -Ruiz - COVID H.R. 6514 - Worker Health Coverage Protection Act - Scott - COVID H.R. 6518 - Stop Health Premium Spikes Act of 2020 - Peters - risk corridors H.R. 6532 - COVID Special Enrollment Act of 2020 - Doggett - COVID H.R. 6568 - Coverage for COVID-19 Treatment Act of 2020 - Rochester - COVID H.R. 6644 - To require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for services furnished via telehealth if such services would be covered if furnished in-person during the COVID-19 emergency. -Schrier - COVID H.R. 6674 - Medicare Crisis Program Act of 2020 -Jayapal - COVID H.R. 6712 - American Healthshare Plans Act of 2020 - Curtis - health share pools H.R. 6810 - Health Care Protection Act -Davis - COVID H.R. 7006 - Improving Care in Home Health Agencies Act - Velazquez - home health services H.R. 7267 - To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to prohibit a group health plan and a health insurance issuer offering group or individual health insurance coverage from reducing contracted rates, or terminating contracts, with health care providers during a public health emergency. - Porter - ERISA H.R. 7475 - Ensuring FEHBP Coverage During Pandemic Act - Vela - special enrollment period H.R. 7539 - Strengthening Behavioral Health Parity Act - Kennedy - strengthen mental health and SUD benefits H.R. 7647 - To provide for a COVID-19-related delay regarding annual limitation on cost-sharing for group health plans and individual and small group health insurance coverage - McEachin - drug manufacturer support applied to patient out-of-pocket limit H.R. 7659 - Ensuring Parity in MA for Audio-Only Telehealth Act of 2020 - Sewell - inclusion of certain audio-only diagnoses in the determination of risk adjustment for MA plans H.R. 7676 - Health Care Prices Revealed and Information to Consumers Explained Transparency Act - Flores - hospital and insurer price transparency H.R. 7722 - Matts Act - Fortenberry - limit price of insulin drugs accessible for those enrolled in group or indiv. health insurance coverage, group health plans, uninsured H.R. 7921 - Connecting Communities to Grant Opportunities Act of 2020 - Velazquez - navigator programs H.R. 7942 - Public Health Emergency COBRA Extension Act -Sanchez - COBRA extension H.R. 8060 - Tele-Mental Health Improvement Act - Trone - parity in mental health and SUD service under private insurance H.R. 8181 - Jack Reynolds Memory MediGap Expansion - Axne - Medigap coverage for Medicare ESRD H.R. 8308 - Telehealth Coverage and Payment Parity Act - Phillips - coverage for services furnished through telehealth H.R. 8330 - No Surprise Bills for New Moms Act - Porter - health coverage of newborns H.R. 8527 - Fair Care Act of 2020 - Westerman - health care costs and coverage H.R. 8573 - Helping Families Access Pediatric Care Act of 2020 - Schrier - deductibles and outpatient pediatric services H.R. 8615 - ARC Act of 2020 -Payne, Jr. - coverage of peripheral artery disease screening tests H.R. 8875 - Health Insurance Lemon Law Act - Kennedy - special enrollment period for non-compliant health plans S. 350 - Competitive Health Insurance Reform Act of 2019 - Daines - McCarran-Ferguson Act S. 1531 - STOP Surprise Medical Bills Act - Cassidy-Bennet - surprise medical billing S. 1948 - Chronic Disease Management Act - Thune - pre-deductible coverage of chronic disease prevention services S. 2546 - Safe Step Act - Murkowski - Step therapy exceptions S. 3200 - Chronic Disease Management Act of 2020 - Thune - coverage of chronic disease prevention services S. 3383 - Continuing Coverage for Preexisting Conditions Act of 2020 -Kennedy - preexisting conditions S. 3499 - A bill to amend coverage requirements to ensure that no person incurs cost sharing when receiving a test to confirm a COVID-19 infection - Smith - COVID-19 cost -sharing S. 3505 - A bill to require private health insurance to rapidly cover preventive services and vaccines related to the coronavirus - Jones - rapid COVID-19 coverage S. 3536 - A bill to provide for special enrollment periods during public health emergencies, coverage of services related to public health emergencies, and for other purposes - Casey - COVID-19 coverage S. 3610 - American Healthshare Plans Act of 2020 - Paul - health share pools S. 3631 - Relief for Rural Providers During Emergencies Act - Sasse - COVID S. 3741 - Health Care at Home Act of 2020 - Smith - COVID S. 3792 - Tele-Mental Health Improvement Act - Smith - parity S. 3821 - Affordable Health Care Options Act of 2020 - Loeffler - affordability S. 3991 - Coronavirus 2019 Special Enrollment Period Act - Duckworth - SEP S. 4106 - A bill to amend the Public Health Service Act to provide for hospital and insurer price transparency - Braun - price transparency S. 4185 - End Surprise Medical Bills for Air Ambulances Act of 2020 - Wicker - establish an IDR for air ambulance S. 4198 - Affordable Coronavirus Testing Act - Scott - coverage for COVID serology testing S. 4255 - Katherines Lung Cancer Early Detection and Survival Act of 2020 - Smith - group health plans, group and indiv coverage benefits for lung cancer screenings S. 4329 - Continuous Health Coverage for Workers Act - McSally - COBRA continuation coverage S. 4469 - COVID-19 Treatment Coverage Act - Smith - COVID treatment Medicaid/MA/Private/Medicare coverage S. 4506 - Pre-Existing Conditions Protection Act of 2020 - Gardner - coverage of pre-ex conditions under private insurance S. 4521 - Health Care Improvement Act of 2020 - Warner - expand ACA coverage S. 4557 - COVid Enrollment Response Act - Baldwin - assistance enrolling in health care coverage S. 4609 - Vaccine And Coverage Certainty Act - Wyden - coverage of COVID vaccine under Medicare/Medicaid, CHIP S. 4653 - A bill to prevent efforts of the Department of Justice to advocate courts to strike down the Patient Protection and Affordable Care Act - Schumer - ACA S. 4761 - Primary and Behavioral Health Care Access Act of 2020 - King - coverage and cost-sharing S. 4796 - Fair Care Act of 2020 - Braun - health care costs and coverage S. 4820 - Long-Term Care Affordability Act - Pat Toomey - long term care insurance S. 4894 - DOC Access Act of 2019 - Manchin - vision and dental insurance S. 4959 - A bill to increase transparency and access to group health plan and health insurance issuer reporting - Braun - Transparency on pharmacy benefits and drug costs S. 5084 - A bill to increase transparency and access to group health plan and health insurance issuer reporting - Braun - Transparency Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to COBRA continuation coverage; issues related to behavioral health benefits; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to addressing the social determinants of health, including housing, transportation, nutrition, and educational opportunities; issues related to changes to prior authorization regulations, electronic documentation, and related issues; issues relating to Medicaid best price; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.

Client expense: $2,400,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Council of Economic Advisers (CEA), Executive Office of the President (EOP), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of the Vice President of the United States, SENATE, Treasury, Dept of, White House Office

H.R. 1418, Competitive Health Insurance Reform Act, 2019. S. 350, Competitive Health Insurance Reform Act, 2019.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1418 Competitive Health Insurance Reform Act of 2019 (all sections of full text)(support) S 350 Competitive Health Insurance Reform Act of 2019 (all sections of full text)(support)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 342 National Flood Insurance Program Mapping H.R. 420 Marijuana Products Regulation H.R. 469 Flood Insurance Coverage Rates H.R. 470 Mandatory Flood Insurance Coverage Repeal H.R. 471 Private Capital and Reinsurance Markets Risk Transfer H.R. 472 Alternative Flood Insurance Rate Maps H.R. 1402 Flood Maps Preparation Transfer H.R. 1418 Health Insurance Antitrust laws Application H.R. 1595 Cannabis Related Businesses Financial Services H.R. 1666 Private Flood Insurance Coverage H.R. 1689 Climate Change Advisory Commission Establishment H.R. 1756 Auto Insurance Consumer Reports Use Prohibition H.R. 1862 Federal Insurance Office Abolition S. 350 Health Insurance Federal Antitrust laws Application S. 420 Marijuana Products Taxation and Regulation S. 603 Financial Company Supervision Determination H.R. 2048 Consumer Products and Services Pricing H.R. 2318 National Flood Insurance Mapping H.R. 2479 Financial Stability Oversight Council Voting Member H.R. 2578 National Flood Insurance Program Extension Act of 2019 H.R. 2684 Auto Insurance Cost Disparities Study H.R. 3111 National Flood Insurance Reforms H.R. 3167 National Flood Insurance Program Reform H.R. 3183 Crop Insurance Eligibility H.R. 3258 Flood Insurance Rates Review S. 1108 Data Protection Impact Assessments S. 1144 National Flood Insurance Mapping S. 1200 Cannabis Related Business Financial Services Protection S. 1213 Health Insurance Reform Provision S. 1214 Individual and Collective Privacy Rights Protection S. 1520 National Flood Insurance Program Reauthorization S. 1531 Health Insurance Consumer Protections S. 1533 National Flood Insurance Program Reauthorization H.R. 3872 National Flood Insurance Program Reauthorization H.R. 4074 Cannabis Related Business Safe Harbor H.R. 4523 Risk Retention Groups Commercial Insurance Types S. 2088 Flood Area Community Accountability S. 2122 Flood Insurance Program Contract Termination Authority S. 2171 Flood Insurance Agents Continuing Education Requirement S. 2187 National Flood Insurance Program Reauthorization S. 2192 Flood Risk Reduction Funding Assistance S. 2201 Cannabis Related Business Insurers Safe Harbor H.R. 4634 Terrorism Risk Insurance Act Reauthorization H.R. 4652 Individual Market Reinsurance Fund Establishment S. 2877 Terrorism Risk Insurance Act S. 2964 Non Premium Aviation Insurance Authority Extension H.R. 1756 Auto Insurance Consumer Reports Use Prohibition H.R. 3693 Insurance Rate Income Proxies H.R. 5776 Flood Damaged Areas Accountability **Issues lobbied without specific bill number: COVID-19 Related Insurance Legislation, Business Interruption Insurance, Consumer Financial Protection Bureau Oversight of the Insurance Industry, Marijuana Financial Services H.R. 6494 Insurance Coverage for Business Interruption Losses H.R. 6497 Insurance Coverage for Business Interruption Losses H.R. 6800 HEROES Act Workers Compensation Provision H.R. 7011 Pandemic Risk Reinsurance Program H.R. 7412 Insurers Support Temporary Voluntary Program S. 3814 Loan Forgiveness Period Extension **Issues lobbied without specific bill number: Business Continuity Protection Program, COVID-19 personal and commercial insurance response and role, municipal services liability, judicial insurance antitrust consent decree H.R. 7634 Hotel Lease Payments S. 178 Human Rights Violations Condemnation S. 4317 SAFE TO WORK Act S. 4755 Automobile Insurers Income Proxies Prohibition **Issues lobbied without specific bill number: COVID-19 business and entity liability protections, insurance claims personnel inclusion into definition of critical workers

Client expense: $1,200,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Federal Aviation Administration (FAA), Federal Emergency Management Agency (FEMA), Federal Reserve System, HOUSE OF REPRESENTATIVES, Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), SENATE, Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

Competitive Health Insurance Reform Act of 2019 (S 350/HR 1418); DOC Access Act of 2019 (S. 4894); Policies related to a limited Special Enrollment Period in the Federally Facilitated Marketplaces; Policies related to federal subsidization of COBRA premiums.

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

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

ACA implementation (exchange operations and functionality, risk mitigation programs, risk adjustment) ACA reform (individual mandate, cost sharing reduction subsidies, reinsurance transitional policies) Individual market and exchange stabilization Prior authorization and Utilization Management, (H.R. 3107); Hospital Consolidation Privacy and Healthcare Cybersecurity Digital, AI, and Blockchain Social Determinants of Health (SDOH) Mental health and substance use,42 CFR Part 2, Parity and compliance issues; H.R.7539 -Strengthening Behavioral Health Parity Act and the Consolidated Appropriations Act (H.R. 133) Surprise medical billing; Lower Health Care Cost Act of 2019 (S. 1895), and No Surprises Act (H.R. 3630); and the Consolidated Appropriations Act (H.R. 133) Price of prescription drugs Commercial Risk adjustment data validation (RADV) Senate HELP Committee Lower Health Care Costs Act Senate Finance Committee Prescription Drug Pricing Reduction Act; (H.R. 3) Pharmacy Benefit Manager (PBM) operations and practices, Spread pricing, Lower Health Care Cost Act of 2019 (S. 1895) and the Consolidated Appropriations Act (H.R. 133) COVID-19 legislation (Phase I, II, III and other); Families First Coronavirus Response Act (H.R. 6201); Coronavirus Aid, Relief, and Economic Security (CARES) Act; The Heroes Act (H.R. 925 and 6800); HEALS Act (S. 1624); the Consolidated Appropriations Act (H.R. 133); SEPs; Risk Mitigation and Excess Loss; COBRA; Testing and Coverage Mandates Federal Medical Assistance Percentages (FMAP) increase McCarran-Ferguson Act repeal; the Competitive Health Insurance Reform Act of 2020 (S. 350) and Competitive Health Insurance Reform Act of 2019 (H.R. 1418)

Client expense: $1,160,000 · Firm income: Not reported

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

ACA implementation (exchange operations and functionality, risk mitigation programs, risk adjustment) ACA reform (individual mandate, cost sharing reduction subsidies, reinsurance transitional policies) Individual market and exchange stabilization Prior authorization and Utilization Management, (H.R. 3107); Hospital Consolidation Privacy and Healthcare Cybersecurity Digital, AI, and Blockchain Social Determinants of Health (SDOH) Mental health and substance use,42 CFR Part 2, Parity and compliance issues; H.R.7539 -Strengthening Behavioral Health Parity Act and the Consolidated Appropriations Act (H.R. 133) Surprise medical billing; Lower Health Care Cost Act of 2019 (S. 1895), and No Surprises Act (H.R. 3630); and the Consolidated Appropriations Act (H.R. 133) Price of prescription drugs Commercial Risk adjustment data validation (RADV) Senate HELP Committee Lower Health Care Costs Act Senate Finance Committee Prescription Drug Pricing Reduction Act; (H.R. 3) Pharmacy Benefit Manager (PBM) operations and practices, Spread pricing, Lower Health Care Cost Act of 2019 (S. 1895) and the Consolidated Appropriations Act (H.R. 133) COVID-19 legislation (Phase I, II, III and other); Families First Coronavirus Response Act (H.R. 6201); Coronavirus Aid, Relief, and Economic Security (CARES) Act; The Heroes Act (H.R. 925 and 6800); HEALS Act (S. 1624); the Consolidated Appropriations Act (H.R. 133); SEPs; Risk Mitigation and Excess Loss; COBRA; Testing and Coverage Mandates Federal Medical Assistance Percentages (FMAP) increase McCarran-Ferguson Act repeal; the Competitive Health Insurance Reform Act of 2020 (S. 350) and Competitive Health Insurance Reform Act of 2019 (H.R. 1418)

Client expense: $1,160,000 · Firm income: Not reported

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

Public Law 111-203, H.R. 4173- Dodd-Frank Wall Street Reform and Consumer Protection Act. Issue: Implementation and Regulatory reform. Captive Reinsurance Transactions, Insurance Capital Standards and Global Capital Standards. Implementation of S. 2270 - Insurance Capital Standards Clarification Act of 2014. The bill would give the Federal Reserve the authority to tailor capital standards for insurance companies subject to Fed supervision. Issue: Capital Standards, Basel III Implementation of H.R. 748 - the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This bill responds to the COVID-19 (i.e., coronavirus disease 2019) outbreak and its impact on the economy, public health, state and local governments, individuals, and businesses. Issue: CECL, TDR, Remote Online Notarization, SBA loans. H.R. 1832 - Insurance Fairness for First Responders Act of 2019. The bill would establish minimum standards relating to a factor for life insurance eligibility and rates. Issue: underwriting. H.R. 1224 - Living Donor Protection Act of 2019. The bill would promote and protect from discrimination living organ donors. Issue: underwriting. S. 2201/H.R. 4074 - Clarifying Law Around Insurance of Marijuana Act. To create a safe harbor for insurers engaging in the business of insurance in connection with a cannabis-related business. Issue: underwriting, anti-money laundering. H.R. 5265/S. 2621 - Holocaust Insurance Accountability Act of 2019.* H.R. 133 - Consolidated Appropriations Act of 2021. Year-end funding and COVID relief bill. Issue: The CARES Act temporarily suspends the generally accepted accounting principles (GAAP) requirements for the Troubled Debt Restructuring (TDR) classifications on loans. Extends this provision for an additional year, to January 1, 2022. S.4325 - Business of Insurance Regulatory Reform Act of 2020 Issue: Insurance exclusion from CFPB jurisdiction. H.R. 1418/S. 350 - Competitive Health Insurance Reform Act of 2020 Issue: McCarran-Ferguson H.R.___.S._- Empowering States to Protect Seniors from Bad Actors Act. Issue: Senior Protections Issue: National Association of Registered Agents and Brokers (NARAB) board. No bill number assigned. Issue: Housing Finance Reform. No bill number assigned. Issue: Final margin rules for uncleared swaps transactions with respect to seeded investment funds. No bill number assigned.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

Opposed S.350, the Competitive Health Insurance Reform Act of 2020

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

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

INS - Fourth Quarter 2020 Public Law 111-203, H.R. 4173- Dodd-Frank Wall Street Reform and Consumer Protection Act. Issue: Implementation and Regulatory reform. Captive Reinsurance Transactions, Insurance Capital Standards and Global Capital Standards. Implementation of H.R. 748 - the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This bill responds to the COVID-19 (i.e., coronavirus disease 2019) outbreak and its impact on the economy, public health, state and local governments, individuals, and businesses. Issue: CECL, TDR, Remote Online Notarization, SBA loans. Implementation of S. 2270 - Insurance Capital Standards Clarification Act of 2014. The bill would give the Federal Reserve the authority to tailor capital standards for insurance companies subject to Fed supervision. Issue: Capital Standards, Basel III H.R. 1418/S. 350 - Competitive Health Insurance Reform Act of 2020 Issue: McCarran-Ferguson H.R. 1224 - Living Donor Protection Act of 2019. The bill would promote and protect from discrimination living organ donors. Issue: underwriting. H.R. 1832 - Insurance Fairness for First Responders Act of 2019. The bill would establish minimum standards relating to a factor for life insurance eligibility and rates. Issue: underwriting. S. 2201/H.R. 4074 - Clarifying Law Around Insurance of Marijuana Act. To create a safe harbor for insurers engaging in the business of insurance in connection with a cannabis-related business. Issue: underwriting, anti-money laundering. S.4325 - Business of Insurance Regulatory Reform Act of 2020 Issue: Insurance exclusion from CFPB jurisdiction. Issue: National Association of Registered Agents and Brokers (NARAB) board. No bill number assigned. Issue: Housing Finance Reform. No bill number assigned. Issue: Final margin rules for uncleared swaps transactions with respect to seeded investment funds. No bill number assigned.

Client expense: $670,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 3630, The No Surprises Act S 4317, Safe to Work Act HR 7168/S 3547, Creating Capacity for Communities in Need Act S.350, the Competitive Health Insurance Reform Act of 2019

Client expense: $329,804 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.350, Competitive Health Insurance Reform Act of 2019

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

Government targets: Consumer Product Safety Commission (CPSC), HOUSE OF REPRESENTATIVES, SENATE, Transportation, Dept of (DOT)

H.R. 1418/S. 350 Competitive Health Insurance Reform Act

Client expense: Not reported · Firm income: $90,000

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

In support of the Competitive Health Insurance Reform Act of 2019 (HR 1418/S 350) - antitrust reform In support of the Ensuring Lasting Smiles Act (HR 1379/S 560) - insurance coverage for patients with congenital anomalies In support of the Consumer Protections Against Surprise Medical Bills Act (HR 5826) - to prevent surprise billing instances. In support of the Dental and Optometric (DOC) Access Act (HR 3762/S 4894) to prohibit "non-covered services" provisions in dental and vision plans and coverage.

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), Treasury, Dept of

Issues related to H.R. 1418/S. 350, Competitive Health Insurance Reform Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

COVID pandemic response and funding for Medicaid and COBRA; H.R. 748 - Coronavirus Aid, Relief and Economic Security Act; H.R.133 - Consolidated Appropriations Act, 2021. Policies related to operation of the Affordable Care Act Exchanges, including enrollment functions, independent purchase of dental benefits, a special enrollment period, and state applications for 1332 Exchange-related waivers. Competitive Health Insurance Reform Act of 2019 (S 350/HR 1418) The Lower Health Care Costs Act (S. 1895), provisions related to all payer claims database

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

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

H.R. 1418, Competitive Health Insurance Reform Act of 2019 S. 350, Competitive Health Insurance Reform Act of 2019 H.R. 748 Coronavirus Aid, Relief, and Economic Security Act or the CARES Act Implementation H.R. 6201 Families First Coronavirus Response Act Implementation Small business exemptions from Family and Medical Leave Act requirements COVID-19 Guidance for dental practices Adjustment of the fee schedule for registration and reregistration for DEA certification Data Breach Rule

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Federal Communications Commission (FCC), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Indian Health Service, Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Science & Technology Policy (OSTP), SENATE, Small Business Administration (SBA), Treasury, Dept of, U.S. Immigration & Customs Enforcement (ICE), Veterans Affairs, Dept of (VA), White House Office

S.350 & H.R.1418 - Competitive Health Insurance Reform Act of 2019 H.R.3762 - DOC Access Act of 2019 S.560 & H.R.1379 - Ensuring Lasting Smiles Act H.R.6494 - Business Interruption Insurance Coverage Act of 2020

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

Government targets: Centers For Disease Control & Prevention (CDC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Occupational Safety & Health Administration (OSHA), SENATE, Treasury, Dept of

H.R. 342 National Flood Insurance Program Mapping H.R. 420 Marijuana Products Regulation H.R. 469 Flood Insurance Coverage Rates H.R. 470 Mandatory Flood Insurance Coverage Repeal H.R. 471 Private Capital and Reinsurance Markets Risk Transfer H.R. 472 Alternative Flood Insurance Rate Maps H.R. 1402 Flood Maps Preparation Transfer H.R. 1418 Health Insurance Antitrust laws Application H.R. 1595 Cannabis Related Businesses Financial Services H.R. 1666 Private Flood Insurance Coverage H.R. 1689 Climate Change Advisory Commission Establishment H.R. 1756 Auto Insurance Consumer Reports Use Prohibition H.R. 1862 Federal Insurance Office Abolition S. 350 Health Insurance Federal Antitrust laws Application S. 420 Marijuana Products Taxation and Regulation S. 603 Financial Company Supervision Determination H.R. 2048 Consumer Products and Services Pricing H.R. 2318 National Flood Insurance Mapping H.R. 2479 Financial Stability Oversight Council Voting Member H.R. 2578 National Flood Insurance Program Extension Act of 2019 H.R. 2684 Auto Insurance Cost Disparities Study H.R. 3111 National Flood Insurance Reforms H.R. 3167 National Flood Insurance Program Reform H.R. 3183 Crop Insurance Eligibility H.R. 3258 Flood Insurance Rates Review S. 1108 Data Protection Impact Assessments S. 1144 National Flood Insurance Mapping S. 1200 Cannabis Related Business Financial Services Protection S. 1213 Health Insurance Reform Provision S. 1214 Individual and Collective Privacy Rights Protection S. 1520 National Flood Insurance Program Reauthorization S. 1531 Health Insurance Consumer Protections S. 1533 National Flood Insurance Program Reauthorization H.R. 3872 National Flood Insurance Program Reauthorization H.R. 4074 Cannabis Related Business Safe Harbor H.R. 4523 Risk Retention Groups Commercial Insurance Types S. 2088 Flood Area Community Accountability S. 2122 Flood Insurance Program Contract Termination Authority S. 2171 Flood Insurance Agents Continuing Education Requirement S. 2187 National Flood Insurance Program Reauthorization S. 2192 Flood Risk Reduction Funding Assistance S. 2201 Cannabis Related Business Insurers Safe Harbor H.R. 4634 Terrorism Risk Insurance Act Reauthorization H.R. 4652 Individual Market Reinsurance Fund Establishment S. 2877 Terrorism Risk Insurance Act S. 2964 Non Premium Aviation Insurance Authority Extension H.R. 1756 Auto Insurance Consumer Reports Use Prohibition H.R. 3693 Insurance Rate Income Proxies H.R. 5776 Flood Damaged Areas Accountability **Issues lobbied without specific bill number: COVID-19 Related Insurance Legislation, Business Interruption Insurance, Consumer Financial Protection Bureau Oversight of the Insurance Industry, Marijuana Financial Services H.R. 6494 Insurance Coverage for Business Interruption Losses H.R. 6497 Insurance Coverage for Business Interruption Losses H.R. 6800 HEROES Act Workers Compensation Provision H.R. 7011 Pandemic Risk Reinsurance Program H.R. 7412 Insurers Support Temporary Voluntary Program S. 3814 Loan Forgiveness Period Extension **Issues lobbied without specific bill number: Business Continuity Protection Program, COVID-19 personal and commercial insurance response and role, municipal services liability, judicial insurance antitrust consent decree H.R. 7634 Hotel Lease Payments S. 178 Human Rights Violations Condemnation S. 4317 SAFE TO WORK Act S. 4755 Automobile Insurers Income Proxies Prohibition

Client expense: $1,570,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Federal Aviation Administration (FAA), Federal Emergency Management Agency (FEMA), Federal Reserve System, HOUSE OF REPRESENTATIVES, Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), SENATE, Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR), White House Office

HR 1418 and S.350, the Competitive Health Insurance Reform Act of 2019 Incorporate the RUC-recommended work and time incremental increases for the revised office/outpatient visit E/M codes in all the global codes Urge CMS to reassess the pace at which procedures are removed to the Inpatient Only List (IPO) Telehealth policies that promote equal reimbursement with in-person visits

Client expense: $405,402 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support HR 1763/ S 348, Resident Physician Shortage Reduction Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose HR 506,Hospital Competition Act of 2019, a bill to amend title XVIII of the Social Security Act to increase hospital competition; Statement submitted to the House Judiciary on the hearing "Diagnosing the Problem: Exploring the Effects of Consolidation and Anticompetitive Conduct in Health Care Markets";Letter of support for the Senate Workgroups efforts to ensure consumer protections by addressing surprise medical bills and comments on the development of legislation to protect patients from surprise medical bills; Letter urging Congress and the Administration to take further action to help reduce input and administrative costs, as well as maximize the number of insured patients; Support HR 965/ S340, Creating and Restoring Equal Access to Equivalent Samples Act of 2019 or the CREATES Act of 2019, a bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products; Support HR 986/ S466 Protecting Americans with Preexisting Conditions Act of 2019, a bill provide that certain guidance related to waivers for State innovation under the Patient Protection and Affordable Care Act shall have no force or effect; Support HR 987 Strengthening Health Care and Lowering Prescription Drug Costs Act, a bill to amend the Patient Protection and Affordable Care Act to provide for Federal Exchange outreach and educational activities; Support HR 938 Bringing Low-cost Options and Competition while Keeping Incentives for New Generics Act of 2019 or the BLOCKING Act of 2019, a bill to amend the Federal Food, Drug, and Cosmetic Act, with respect to eligibility for approval of a subsequent generic drug, to remove the barrier to that approval posed by the 180-day exclusivity period afforded to a first generic applicant that has not yet received final approval, and for other purposes; Support HR 1010, a bill to provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force or effect; Support HR 1499 Protecting Consumer Access to Generic Drugs Act of 2019, a bill to prohibit brand name drug manufacturers from compensating generic drug manufacturers to delay the entry of a generic drug into the market, and to prohibit biological product manufacturers from compensating biosimilar and interchangeable product manufacturers to delay entry of biosimilar and interchangeable products, and for other purposes; Support HR 1425 State Health Care Premium Reduction Act, a bill to amend the Patient Protection and Affordable Care Act to provide for a Improve Health Insurance Affordability Fund to provide for certain reinsurance payments to lower premiums in the individual health insurance market; Support HR 1386/ S 1905 Expand Navigators Resources for Outreach, Learning, and Longevity Act of 2019 or the ENROLL Act of 2019,a bill to amend the Patient Protection and Affordable Care Act to provide for additional requirements with respect to the navigator program, and for other purposes; Support HR 1520 Purple Book Continuity Act of 2019, a bill to amend the Public Health Service Act to provide for the publication of a list of licensed biological products, and for other purposes; Support HR 1503 Orange Book Transparency Act of 2019A bill that would increase transparency for the patent status of both approved biological products and approved drugs; Support HR 2439/ HR 3414 Opioid Workforce Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the opioid crisis; Submitted statement to the House Committee on Ways and Means Overcoming Racial Disparities and Social Determinants in the Maternal Mortality Crisis sharing information regarding hospitals and health systems efforts to address maternal morbidity and mortality, as we seek ways to improve outcomes and reduce health inequities for expectant and new mothers, and give their children the best possible start in life; Submitted oral and written testimony to the House Committee on Ways and Means Subcommittee on Health Hearing on Protecting Patients from Surprise Medical Bills. Protecting patients from surprise medical bills is a top priority and we have adopted a set of guiding principles to use as we evaluate legislative proposals: Define surprise bills, Protect the patient financially, Ensure patient access to emergency care, Preserve the role of private negotiation, Remove the patient from health plan/provider negotiations, Educate patients about their health care coverage, Ensure patients have access to comprehensive provider networks and accurate network information, and Support state laws that work; Letters submitted to the Energy & Commerce Committee in response to the request for comments on their surprise billing discussion draft. Concerned with the Committees draft legislations approach to determining reimbursement for out-of-network providers. Once the patient is protected from surprise bills, providers and insurers should then be permitted to negotiate payment rates for services provided. We strongly oppose approaches that would impose arbitrary rates on providers. We look forward to continuing to work with the Committee on solutions to stop surprise medical bills; Letter sent to the HELP Committee in response to the Lower Health Care Costs Act of 2019 discussion draft about our concerns about several of the proposals that would allow the government to intrude into private commercial contracts between providers and insurers. For example, several of the provisions could undermine value-based purchasing arrangements aimed directly at improving the quality of care while reducing costs. We strongly urge the Committee to remove these provisions; Submitted oral and written testimony to the House Committee on Energy and Commerce, Subcommittee on Health Hearing on No More Surprises: Protecting Patients from Surprise Medical Bills asking that the Committee preserve the ability of providers and insurers to negotiate private contracts and not establish a fixed payment amount for out-of-network services; Oppose HR 1309 Workplace Violence Prevention for Health Care and Social Service Workers Act, a bill to direct the Secretary of Labor to issue an occupational safety and health standard that requires covered employers within the health care and social service industries to develop and implement a comprehensive workplace violence prevention plan, and for other purposes; Concerns about S.1531, Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 or the STOP Surprise Medical Bills Act of 2019, to amend the Public Health Service Act to provide protections for health insurance consumers from surprise billing; Concerns about S. 1895 Lower Health Care Costs Act Letter addressed concerns about the legislative provision that sets a benchmark rate in statute for the out-of-network payments, as well as provisions that seek to change privately negotiated contracting arrangements between hospitals and insurance companies; Support HR 3425, Advancing Medical Resident Training in Community Hospitals Act of 2019, to amend title XVIII of the Social Security Act to establish rules for payment for graduate medical education (GME) costs for hospitals that establish a new medical residency training program after hosting resident rotators for short durations; Expressed concerns regarding the provisions that reduce reimbursements to providers and hospitals that administer drugs the Prescription Drug Pricing Reduction Act (PDPRA) of 2019: including about Section 107, Medicare Part B Rebate by Manufacturers for Drugs or Biologicals with Prices Increasing Faster than Inflation, Section 110, Establishment of Maximum Add-on Payment for Drugs, Biologicals, and Biosimilars, this provision would establish $1,000 as the maximum add-on amount that a provider can be paid for a separately payable drug, biological or biosimilar, Section 111, Treatment of Drug Administration Services Furnished by an Off-Campus Outpatient Department of a Provider, the site neutral payment reduction would cut aggregate hospital payments; Support S. 2091, Backlog Elimination, Legal Immigration, and Employment Visa Enhancement Act, this legislation would increase the total number of employment-based visas from 140,000 to 270,000 and ensure that critical health care workers needed in the U.S. have access to employment-based visas by carving out health care workers in designated shortage occupations from the limit; Support S 350, The Competitive Health Insurance Reform Act of 2019, a bill to restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers; Submitted statement to Subcommittee on Health of the Committee on Energy and Commerce for the hearing on Improving Maternal Health: Legislation to Advance Prevention Efforts and Access to Care; Concerns with S. 386 and HR 1044, Fairness for High-Skilled Immigrants Act of 2019, this bill increases the per-country cap on family-based immigrant visas from 7% of the total number of such visas available that year to 15%, and eliminates the 7% cap for employment-based immigrant visas. It also removes an offset that reduced the number of visas for individuals from China; Support H.R. 4538, Closing Loopholes for Orphan Drugs Act, a bill to amend title III of the Public Health Service Act to limit the orphan drug exclusion under the drug discount program under section 340B of such title; Discussions of provisions we support and those we recommend be changes in a draft bill called the Mitigating Existing Drug Shortages (MEDS) Act; Discussions in support of the allowing states to designate hospitals as necessary providers for purposes of waiving the critical access hospital mileage requirements; Provided comments to W&M on legislation to expand Health Profession Opportunity Grants; Support S. 2723, The Mitigating Emergency Drug Shortages (MEDS) Act, a bill to amend Sec. 506C of the Federal Food, Drug, and Cosmetic Act which strengthens requirements for drug manufacturers to disclose the root causes and expected duration of shortages, extends reporting requirements to active pharmaceutical ingredients manufacturers, requires manufacturers have contingency plans to ensure ongoing supply, develops recommendations to incentivize manufacturers to enter the market for drugs in shortage and examines the national security risks of shortages; Discuss DEA reductions in annual quotas for opioid products used by hospitals for sedation and pain management; Meeting with the Office of the Assistant Secretary of Preparedness and Response (ASPR) to discuss developments in the hospital preparedness program, the pilot projects for the Regional Disaster Healthcare System and other issues; Rural access to health care, including identifying core services needed in rural communities, outlining approaches and considerations for delivering those services, and examining access and quality in the rural context; ONCs proposed rule to implement the 21st Century Cures provision on information blocking; Supported members serving on the HHS Quality Summit panel, which was convened by the Deputy Secretary to gather input regarding how to improve and energize quality and safety improvement activities across health care system; Discussion with HHS on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussion with HHS about the work of Aligning for Health to address social determinants of health; Support S 2902, Strengthening Our Rural Health Workforce Act of 2019, a bill to enhance the rural health workforce; Meetings and correspondence with staff members of Senate Financing Committee on a proposal to support rural health care access (REH, re-opening necessary provider CAH, infrastructure funding); Letter to Ways & Means committee Rural and Underserved Communities Health Task Force in response to RFI on factors that contribute to health outcomes in these areas, examples of successful models and lessons from the field that address access and outcomes, and considerations for the unique circumstances of rural and underserved communities; Letter to Energy and Commerce Members regarding health information technology priorities; Letter of Support to Senate Appropriations on funding for the Centers for Disease Control and Prevention and the National Institutes of Health to study gun violence; Support S.2741 and H.R. 4932,Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, a bill to amend title XVIII of the Social Security Act to expand access to telehealth services, and for other purposes; Support S 2603, Resolving Extended Limbo for Immigrant Employees and Families (RELIEF) Act, a bill to amend the Immigration and Nationality Act to end the immigrant visa backlog, and for other purposes; Support HR 4995, Maternal Health Quality Improvement Act of 2019, a bill to amend the Public Health Service Act to improve obstetric care and maternal health outcomes, and for other purposes; Concerns with HR 5800,Ban Surprise Billing Act, a bill to address surprise medical bills that relies on a median in-network rate to resolve out-of-network payments and allows for an independent dispute resolution process to determine the final payment. Concerned with the Committee's legislative approach to determining reimbursement for out-of-network providers. Oppose approaches that would impose arbitrary rates on providers, which could have significant consequences far beyond the scope of surprise medical bills. It is the insurers' responsibility to maintain comprehensive provider networks, and a default payment rate would remove incentives for health plans to contract with providers or to offer fair terms; Support HR 5826, Consumer Protections Against Surprise Medical Bills Act, a bill that prohibits providers from balance billing patients for emergency services or medical care the patient reasonably could have expected to be in-network, and from charging patients more than the in-network cost-sharing amount. Rather than rely on a benchmark payment rate to determine out-of-network reimbursement, the legislation provides a period for health plans and providers to negotiate out-of-network reimbursement, followed by a mediated dispute resolution process if necessary; Letter urging HHS to take regulatory actions to help hospitals and health systems prepare and respond to COVID-19; Letter requesting $100 billion to prepare and respond to COVID-19; Letter urging the Department of Labor to accurately define health care provider when promulgating regulations implementing key sections of the Families First Coronavirus Response Act; Letter sent to the President asking for the use of the Defense Production Act to increase the production of medical supplies and equipment; Letter to HHS regarding $100 billion emergency fund, asking HHS and CMS to directly and expediently distribute to rural and urban hospitals and health systems funds from the Public Health and Social Services Emergency Fund that were designated for providers in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES Act increased funding by $100 billion in order to reimburse eligible health care providers for health care-related expenses or lost revenues that are attributable to COVID-19. In the letter, we urged HHS and CMS to immediately distribute funding to all hospital types in the US - with additional funding going to COVID-19 hotspots; Letter urging Congress to modernize the Stafford Act as part of its next COVID-19 legislative package to allow all hospitals to recoup financial losses from this pandemic and future disasters; Letter to the Federal Reserve System, the Federal Deposit Insurance Corporation and the Office of the Comptroller of the Currency requesting they, as primary federal regulators for insured depository institutions, take prompt action to assist health care providers on the front line of the COVID-19 pandemic should the need to do so arise; Letter to the Secretary of the Treasury and the Federal Reserve Chair of the Board of Governors urging a supplement to the New Main Street Loan Facility term sheet with prompt guidance to ensure that access to this critically-necessary loan facility will be attainable for hospitals without delay; Letter was sent to the SBA urging it to ensure that small- and mid-size public hospitals, including those that have both nonprofit and public designations, are allowed to apply for and receive loans under the newly-authorized SBA Paycheck Protection Program; Letter in response to FEMAs request for input on establishing a voluntary agreement, under the Defense Production Act, of key private sector stakeholders relevant to responding to COVID-19, urging that such an agreement account for the full breadth of COVID-19 medical supply and equipment needs; Support H.R. 6474/S.3838 Healthcare Broadband Expansion During COVID-19 Act, a bill that would provide an additional $2 billion in funding for the FCC Rural Health Care program and increase the subsidy for health care providers from 65 to 85 percent. This legislation also simplifies the program to allow for more efficient application processes and disbursement of much needed funding; Support HR 6654 Emergency COVID-19 Telehealth Response Act, a bill that would codify an expanded list of providers to deliver and bill for telehealth services during the PHE; Support HR 7233Knowing the Efficiency and Efficacy of Permanent (KEEP) Telehealth Options Act of 2020, a bill that would require the Department of Health and Human Services and the Government Accountability Office (GAO) to conduct studies to provide information about the expanded use of telehealth during the COVID-19 pandemic; Letter to Senate HELP Committee in response to request for feedback on preparing for next pandemic; Discussion about telehealth waivers and flexibilities with HHS; Discussion about CARES provider relief fund distributions with HHS; Oppose HR 6559/ S 3677 COVID-19 Every Worker Protection Act of 2020, a bill to require the Occupational Safety and Health Administration to promulgate an emergency temporary standard to protect employees from occupational exposure to SARS-CoV-2, and for other purposes; Joint letter with ANA urging Congress to act quickly to get needed resources into the health care system, so that hospitals, nurses and physicians responding to COVID-19 are able to continue to provide treatments, front-line health care personnel are able to provide care and patients are able access health care services; Statement to Committee on Ways and Means for the hearing on The Disproportionate Impact of COVID-19 on Communities of Color urging Congress to employ the resources of the National Institute on Minority Health and Health Disparities - which is congressionally-mandated to coordinate the research of the other National Institutes of Healths centers and institutes related to minority health - to research and develop approaches to specifically address the COVID-19 needs of minority populations; Advocate with Congress for full forgiveness of COVID-19 related accelerated payments received by hospitals; Support S 3781Pharmaceutical Accountability, Responsibility, and Transparency (PART) Act, a bill to increase reporting of, help mitigate potential shortages related to, and promote, accountability and transparency for pharmaceuticals and medical devices; Support S 3780 Help Onshore Manufacturing Efficiencies (HOME) for Drugs and Devices Act, a bill to encourage domestic advanced manufacturing of critical drugs and devices in order to address economic, health, and security concerns, combat shortages of critical drugs and devices, and promote increased domestic diversification of, and independence from foreign reliance on, pharmaceutical and medical device supply chains; Support S.3763 Pandemic Responder Service Award Act, a bill to establish the Pandemic Responder Service Award program to express our gratitude to front-line health care workers; Support HR 6788/ S 3599 Healthcare Workforce Resilience Act, a bill to enhance our Nations nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas; Urged support for joint House and Senate letter to the Administration asking for flexibility for hospitals with respect to J-1 and H-1B visa programs; Letter to Senate Finance Committee to address the important issue of maternal health and the opportunity to provide suggestions regarding how to improve maternal health in this country; Support the Temporary Reciprocity to Ensure Access to Treatment Act, a bill that allows for the temporary reciprocity for treatment by medical professionals licensed in one state to patients in other states; Letter urging the Senate to include in the next COVID-19 relief bill provisions to strengthen the federal response for racial and ethnic minority and marginalized communities, which are disproportionately affected by the pandemic;Letter asking Congress to allocate as part of the next COVID-19 relief package at least an additional $100 billion to the emergency relief fund to provide direct funding to front line health care personnel and providers to continue to respond to this pandemic; Letter sent to HHS urging them to direct HRSA to take action to stop three drug manufacturers from limiting the distribution of 340B drugs to 340B covered entities. These drug manufacturers have taken separate actions to either limit the distribution of 340B drugs or require 340B covered entities provide claims level data for investigatory purposes if that 340B covered entity uses a contract pharmacy arrangement; Letter to the Congressional Leadership asking them to not to include in the next COVID-19 relief package any surprise medical billing legislation - such as a reimbursement rate set in statute - that would further destabilize hospitals finances during the pandemic; Support S 4507, Getting Early Treatment and Comprehensive Assessments Reduces Emergencies Act of 2020 or the GET CARE Act of 2020, a bill to amend the Public Health Service Act to provide for a national campaign to raise awareness of the importance of seeking preventive health services and the utilization of such services; Comment letter addressing concerns on the proposed rule from the Departments of the Treasury, Labor and Health and Human Services that would allow certain grandfathered health plans to increase patient cost-sharing beyond current limits, without losing their grandfathered status; Letter urging the Administration to work with the AHA and Congress to create a future for telehealth that allows not only clinicians, but also hospitals and health systems, to code and bill for virtual services. We further urge CMS and HHS to continue to provide hospitals with the flexibility for annual beneficiary consent to telehealth treatment to be obtained at the same time, and not necessarily before, services are furnished; Support HR 8061,Community Immunity During COVID-19 Act of 2020, a bill that would provide funding to state and local health departments to work with community providers and organizations to increase immunization rates for Advisory Committee on Immunization Practices (ACIP)-recommended vaccines during the COVID-19 public health emergency; Letter again expressing concern with recent actions taken by several major drug manufacturers to limit the distribution of certain 340B drugs to our hospital members. While we understand that the HRSA is further investigating these actions, we urge swift and decisive action to halt these pernicious tactics so as to prevent other manufacturers from following suit; Comment letter outlining our concerns about the ability of hospital systems to distribute provider relief funds among the parent and subsidiaries. HHS published certain FAQs that place problematic restrictions on the use of CARES Act provider relief fund dollars. Specifically, the FAQs restrict the ability of a hospital system to allocate the funds throughout its system where COVID-19 related expenses and lost revenues are occurring; Submitted comments in response to HRSAs RFI on Health Professional Shortage Area (HPSA) scoring. HPSA scores are important for rural hospitals and clinics ability to recruit physicians and other clinicians, namely from the National Health Service Corps (NHSC) program. Letter asking HHS to reinstate the COVID-19 Provider Relief Fund reporting requirements.

Client expense: $4,860,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Competitive Health Insurance Reform Act of 2019 (S 350/HR 1418); Policies related to a limited Special Enrollment Period (SEP) in the Federally Facilitated Marketplaces; Policies related to federal subsidization of COBRA premiums.

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

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

Competitive Health Insurance Reform Act of 2019 (S 350/HR 1418); Policies related to a limited Special Enrollment Period (SEP) in the Federally Facilitated Marketplaces; Policies related to federal subsidization of COBRA premiums.

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

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

H.R. 1418, Competitive Health Insurance Reform Act, 2019. S. 350, Competitive Health Insurance Reform Act, 2019.

Client expense: $300,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 1418 Competitive Health Insurance Reform Act of 2019 (all sections of full text)(support) S 350 Competitive Health Insurance Reform Act of 2019 (all sections of full text)(support)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

In support of the Competitive Health Insurance Reform Act of 2019 (HR 1418/S 350) - antitrust reform In support of the Ensuring Lasting Smiles Act (HR 1379/S 560) - insurance coverage for patients with congenital anomalies In support of the Consumer Protections Against Surprise Medical Bills Act (HR 5826) - to prevent surprise billing instances. In support of the Dental and Optometric (DOC) Access Act (HR 3762) to prohibit "non-covered services" provisions in dental and vision plans and coverage.

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), Treasury, Dept of

H.R. 1418, Competitive Health Insurance Reform Act of 2019 S. 350, Competitive Health Insurance Reform Act of 2019 H.R. 748 Coronavirus Aid, Relief, and Economic Security Act or the CARES Act Implementation H.R. 6201 Families First Coronavirus Response Act Implementation Small business exemptions from Family and Medical Leave Act requirements COVID-19 Guidance for dental practices Adjustment of the fee schedule for registration and reregistration for DEA certification

Client expense: $610,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Federal Communications Commission (FCC), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Indian Health Service, Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Science & Technology Policy (OSTP), SENATE, Small Business Administration (SBA), Treasury, Dept of, U.S. Immigration & Customs Enforcement (ICE), Veterans Affairs, Dept of (VA), White House Office

Price transparency, out-of-network reimbursement of emergency medical services, surprise medical bills Opioids, pain management Federal funding for Substance Use Disorder treatments Drug Shortages P.L.116-139-Paycheck Protection Program and Health Care Enhancement Act P.L.116-142-Paycheck Protection Program Flexibility Act of 2020 H.R.501-Poison Center Network Enhancement Act of 2019 H.R.861-End Surprise Billing Act of 2019 H.R.1301-Mental Health Telemedicine Expansion Act H.R.1309-Workplace Violence Prevention for Health Care and Social Service Workers Act H.R.1418-Competitive Health Insurance Reform Act of 2019 H.R.1554-Resident Education Deferred Interest (REDI) Act H.R.1682-Improving Access to Medicare Coverage Act of 2019 H.R.1767-Excellence in Mental Health and Addiction Treatment Expansion Act H.R.2281-Easy Medication Access and Treatment (MAT) for Opioid Addiction Act H.R.2328-Reauthorizing and Extending Americas Community Health Act H.R.2464-End the Cycle of Violence Act of 2019 H.R.2482-Mainstreaming Addiction Treatment Act of 2019 H.R.2519-Improving Mental Health Access from the Emergency Department Act of 2019 H.R.2550-Prevent Blood Loss with Emergency Equipment Devices Act of 2019 H.R.2569-Comprehensive Addiction Resources Emergency Act of 2019 H.R.3107-Improving Seniors Timely Access to Care Act of 2019 H.R.3417-Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 H.R.3502-Protecting People From Surprise Medical Bills Act H.R.3630-No Surprises Act H.R.3984-Health Care Safety Net Enhancement Act of 2019 H.R.4861-Effective Suicide Screening and Assessment in the Emergency Department Act of 2019 H.R.4932-Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019 H.R.5800-Ban Surprise Billing Act H.R.5826-Consumer Protections Against Surprise Medical Bills Act of 2020 H.R.6800-Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act H.R.6910-Emergency Room Hero and Patient Safety Act H.R.7059-Coronavirus Provider Protection Act H.R.7255-Coronavirus Health Care Worker Wellness Act of 2020 S.289-Rural Physician Workforce Production Act of 2019 S.299-Geriatrics Workforce Improvement Act S.350-Competitive Health Insurance Reform Act of 2019 S.618-Medicare Choices Empowerment and Protection Act S.753-Improving Access to Medicare Coverage Act of 2019 S.824-Excellence in Mental Health and Addiction Treatment Expansion Act S.851-Workplace Violence Prevention for Health Care and Social Service Workers Act S.1199-Poison Center Network Enhancement Act of 2019 S.1266-Protecting Patients from Surprise Medical Bills Act S.1334-Improving Mental Health Access from the Emergency Department S.1350-Good Samaritan Health Professionals Act of 2019 S.1365-Comprehensive Addiction Resources Emergency Act of 2019 S.1531-Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 S.1895-Lower Health Care Costs Act S.2074-Mainstreaming Addiction Treatment Act of 2019 S.2741-Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 S.3006-Effective Suicide Screening and Assessment in the Emergency Department Act of 2019 S.3143-Magnet Injury Prevention Act S.3346-Prevent Blood Loss with Emergency Equipment Devices Act of 2020

Client expense: $314,376 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Price transparency, out-of-network reimbursement of emergency medical services, surprise medical bills H.R.861-End Surprise Billing Act of 2019 H.R.1418-Competitive Health Insurance Reform Act of 2019 H.R.2328-Reauthorizing and Extending Americas Community Health Act H.R.3107-Improving Seniors Timely Access to Care Act of 2019 H.R.3502-Protecting People From Surprise Medical Bills Act H.R.3630-No Surprises Act H.R.5800-Ban Surprise Billing Act H.R.5826-Consumer Protections Against Surprise Medical Bills Act of 2020 S.350-Competitive Health Insurance Reform Act of 2019 S.1266-Protecting Patients from Surprise Medical Bills Act S.1531-Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 S.1895-Lower Health Care Costs Act

Client expense: $314,376 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Price transparency, out-of-network reimbursement of emergency medical services, surprise medical bills H.R.861-End Surprise Billing Act of 2019 H.R.1418-Competitive Health Insurance Reform Act of 2019 H.R.2328-Reauthorizing and Extending Americas Community Health Act H.R.3107-Improving Seniors Timely Access to Care Act of 2019 H.R.3502-Protecting People From Surprise Medical Bills Act H.R.3630-No Surprises Act H.R.5800-Ban Surprise Billing Act H.R.5826-Consumer Protections Against Surprise Medical Bills Act of 2020 S.350-Competitive Health Insurance Reform Act of 2019 S.1266-Protecting Patients from Surprise Medical Bills Act S.1531-Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 S.1895-Lower Health Care Costs Act

Client expense: $595,871 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Price transparency, out-of-network reimbursement of emergency medical services, surprise medical bills Opioids, pain management Federal funding for Substance Use Disorder treatments Drug Shortages H.R.501-Poison Center Network Enhancement Act of 2019 H.R.861-End Surprise Billing Act of 2019 H.R.1301-Mental Health Telemedicine Expansion Act H.R.1309-Workplace Violence Prevention for Health Care and Social Service Workers Act H.R.1418-Competitive Health Insurance Reform Act of 2019 H.R.1554-Resident Education Deferred Interest (REDI) Act H.R.1682-Improving Access to Medicare Coverage Act of 2019 H.R.1767-Excellence in Mental Health and Addiction Treatment Expansion Act H.R.2281-Easy Medication Access and Treatment (MAT) for Opioid Addiction Act H.R.2328-Reauthorizing and Extending Americas Community Health Act H.R.2464-End the Cycle of Violence Act of 2019 H.R.2482-Mainstreaming Addiction Treatment Act of 2019 H.R.2519-Improving Mental Health Access from the Emergency Department Act of 2019 H.R.2550-Prevent Blood Loss with Emergency Equipment Devices Act of 2019 H.R.2569-Comprehensive Addiction Resources Emergency Act of 2019 H.R.3107-Improving Seniors Timely Access to Care Act of 2019 H.R.3417-Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 H.R.3502-Protecting People From Surprise Medical Bills Act H.R.3630-No Surprises Act H.R.3984-Health Care Safety Net Enhancement Act of 2019 H.R.4861-Effective Suicide Screening and Assessment in the Emergency Department Act of 2019 H.R.4932-Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019 H.R.5800-Ban Surprise Billing Act H.R.5826-Consumer Protections Against Surprise Medical Bills Act of 2020 S.289-Rural Physician Workforce Production Act of 2019 S.299-Geriatrics Workforce Improvement Act S.350-Competitive Health Insurance Reform Act of 2019 S.618-Medicare Choices Empowerment and Protection Act S.753-Improving Access to Medicare Coverage Act of 2019 S.824-Excellence in Mental Health and Addiction Treatment Expansion Act S.851-Workplace Violence Prevention for Health Care and Social Service Workers Act S.1199-Poison Center Network Enhancement Act of 2019 S.1266-Protecting Patients from Surprise Medical Bills Act S.1334-Improving Mental Health Access from the Emergency Department S.1350-Good Samaritan Health Professionals Act of 2019 S.1365-Comprehensive Addiction Resources Emergency Act of 2019 S.1531-Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 S.1895-Lower Health Care Costs Act S.2074-Mainstreaming Addiction Treatment Act of 2019 S.2741-Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 S.3006-Effective Suicide Screening and Assessment in the Emergency Department Act of 2019 S.3143-Magnet Injury Prevention Act S.3346-Prevent Blood Loss with Emergency Equipment Devices Act of 2020

Client expense: $595,871 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.350 & H.R.1418 - Competitive Health Insurance Reform Act of 2019 H.R.3762 - DOC Access Act of 2019 S.560 & H.R.1379 - Ensuring Lasting Smiles Act H.R.6494 - Business Interruption Insurance Coverage Act of 2020

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

Government targets: Centers For Disease Control & Prevention (CDC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Occupational Safety & Health Administration (OSHA), SENATE, Treasury, Dept of

Support HR 1763/ S 348, Resident Physician Shortage Reduction Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose HR 506,Hospital Competition Act of 2019, a bill to amend title XVIII of the Social Security Act to increase hospital competition; Statement submitted to the House Judiciary on the hearing "Diagnosing the Problem: Exploring the Effects of Consolidation and Anticompetitive Conduct in Health Care Markets";Letter of support for the Senate Workgroups efforts to ensure consumer protections by addressing surprise medical bills and comments on the development of legislation to protect patients from surprise medical bills; Letter urging Congress and the Administration to take further action to help reduce input and administrative costs, as well as maximize the number of insured patients; Support HR 965/ S340, Creating and Restoring Equal Access to Equivalent Samples Act of 2019 or the CREATES Act of 2019, a bill to promote competition in the market for drugs and biological products by facilitating the timely entry of lower-cost generic and biosimilar versions of those drugs and biological products; Support HR 986/ S466 Protecting Americans with Preexisting Conditions Act of 2019, a bill provide that certain guidance related to waivers for State innovation under the Patient Protection and Affordable Care Act shall have no force or effect; Support HR 987 Strengthening Health Care and Lowering Prescription Drug Costs Act, a bill to amend the Patient Protection and Affordable Care Act to provide for Federal Exchange outreach and educational activities; Support HR 938 Bringing Low-cost Options and Competition while Keeping Incentives for New Generics Act of 2019 or the BLOCKING Act of 2019, a bill to amend the Federal Food, Drug, and Cosmetic Act, with respect to eligibility for approval of a subsequent generic drug, to remove the barrier to that approval posed by the 180-day exclusivity period afforded to a first generic applicant that has not yet received final approval, and for other purposes; Support HR 1010, a bill to provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force or effect; Support HR 1499 Protecting Consumer Access to Generic Drugs Act of 2019, a bill to prohibit brand name drug manufacturers from compensating generic drug manufacturers to delay the entry of a generic drug into the market, and to prohibit biological product manufacturers from compensating biosimilar and interchangeable product manufacturers to delay entry of biosimilar and interchangeable products, and for other purposes; Support HR 1425 State Health Care Premium Reduction Act, a bill to amend the Patient Protection and Affordable Care Act to provide for a Improve Health Insurance Affordability Fund to provide for certain reinsurance payments to lower premiums in the individual health insurance market; Support HR 1386/ S 1905 Expand Navigators Resources for Outreach, Learning, and Longevity Act of 2019 or the ENROLL Act of 2019,a bill to amend the Patient Protection and Affordable Care Act to provide for additional requirements with respect to the navigator program, and for other purposes; Support HR 1520 Purple Book Continuity Act of 2019, a bill to amend the Public Health Service Act to provide for the publication of a list of licensed biological products, and for other purposes; Support HR 1503 Orange Book Transparency Act of 2019A bill that would increase transparency for the patent status of both approved biological products and approved drugs; Support HR 2439/ HR 3414 Opioid Workforce Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the opioid crisis; Submitted statement to the House Committee on Ways and Means Overcoming Racial Disparities and Social Determinants in the Maternal Mortality Crisis sharing information regarding hospitals and health systems efforts to address maternal morbidity and mortality, as we seek ways to improve outcomes and reduce health inequities for expectant and new mothers, and give their children the best possible start in life; Submitted oral and written testimony to the House Committee on Ways and Means Subcommittee on Health Hearing on Protecting Patients from Surprise Medical Bills. Protecting patients from surprise medical bills is a top priority and we have adopted a set of guiding principles to use as we evaluate legislative proposals: Define surprise bills, Protect the patient financially, Ensure patient access to emergency care, Preserve the role of private negotiation, Remove the patient from health plan/provider negotiations, Educate patients about their health care coverage, Ensure patients have access to comprehensive provider networks and accurate network information, and Support state laws that work; Letters submitted to the Energy & Commerce Committee in response to the request for comments on their surprise billing discussion draft. Concerned with the Committees draft legislations approach to determining reimbursement for out-of-network providers. Once the patient is protected from surprise bills, providers and insurers should then be permitted to negotiate payment rates for services provided. We strongly oppose approaches that would impose arbitrary rates on providers. We look forward to continuing to work with the Committee on solutions to stop surprise medical bills; Letter sent to the HELP Committee in response to the Lower Health Care Costs Act of 2019 discussion draft about our concerns about several of the proposals that would allow the government to intrude into private commercial contracts between providers and insurers. For example, several of the provisions could undermine value-based purchasing arrangements aimed directly at improving the quality of care while reducing costs. We strongly urge the Committee to remove these provisions; Submitted oral and written testimony to the House Committee on Energy and Commerce, Subcommittee on Health Hearing on No More Surprises: Protecting Patients from Surprise Medical Bills asking that the Committee preserve the ability of providers and insurers to negotiate private contracts and not establish a fixed payment amount for out-of-network services; Oppose HR 1309 Workplace Violence Prevention for Health Care and Social Service Workers Act, a bill to direct the Secretary of Labor to issue an occupational safety and health standard that requires covered employers within the health care and social service industries to develop and implement a comprehensive workplace violence prevention plan, and for other purposes; Concerns about S.1531, Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 or the STOP Surprise Medical Bills Act of 2019, to amend the Public Health Service Act to provide protections for health insurance consumers from surprise billing; Concerns about S. 1895 Lower Health Care Costs Act Letter addressed concerns about the legislative provision that sets a benchmark rate in statute for the out-of-network payments, as well as provisions that seek to change privately negotiated contracting arrangements between hospitals and insurance companies; Support HR 3425, Advancing Medical Resident Training in Community Hospitals Act of 2019, to amend title XVIII of the Social Security Act to establish rules for payment for graduate medical education (GME) costs for hospitals that establish a new medical residency training program after hosting resident rotators for short durations; Expressed concerns regarding the provisions that reduce reimbursements to providers and hospitals that administer drugs the Prescription Drug Pricing Reduction Act (PDPRA) of 2019: including about Section 107, Medicare Part B Rebate by Manufacturers for Drugs or Biologicals with Prices Increasing Faster than Inflation, Section 110, Establishment of Maximum Add-on Payment for Drugs, Biologicals, and Biosimilars, this provision would establish $1,000 as the maximum add-on amount that a provider can be paid for a separately payable drug, biological or biosimilar, Section 111, Treatment of Drug Administration Services Furnished by an Off-Campus Outpatient Department of a Provider, the site neutral payment reduction would cut aggregate hospital payments; Support S. 2091, Backlog Elimination, Legal Immigration, and Employment Visa Enhancement Act, this legislation would increase the total number of employment-based visas from 140,000 to 270,000 and ensure that critical health care workers needed in the U.S. have access to employment-based visas by carving out health care workers in designated shortage occupations from the limit; Support S 350, The Competitive Health Insurance Reform Act of 2019, a bill to restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers; Submitted statement to Subcommittee on Health of the Committee on Energy and Commerce for the hearing on Improving Maternal Health: Legislation to Advance Prevention Efforts and Access to Care; Concerns with S. 386 and HR 1044, Fairness for High-Skilled Immigrants Act of 2019, this bill increases the per-country cap on family-based immigrant visas from 7% of the total number of such visas available that year to 15%, and eliminates the 7% cap for employment-based immigrant visas. It also removes an offset that reduced the number of visas for individuals from China; Support H.R. 4538, Closing Loopholes for Orphan Drugs Act, a bill to amend title III of the Public Health Service Act to limit the orphan drug exclusion under the drug discount program under section 340B of such title; Discussions of provisions we support and those we recommend be changes in a draft bill called the Mitigating Existing Drug Shortages (MEDS) Act; Discussions in support of the allowing states to designate hospitals as necessary providers for purposes of waiving the critical access hospital mileage requirements; Provided comments to W&M on legislation to expand Health Profession Opportunity Grants; Support S. 2723, The Mitigating Emergency Drug Shortages (MEDS) Act, a bill to amend Sec. 506C of the Federal Food, Drug, and Cosmetic Act which strengthens requirements for drug manufacturers to disclose the root causes and expected duration of shortages, extends reporting requirements to active pharmaceutical ingredients manufacturers, requires manufacturers have contingency plans to ensure ongoing supply, develops recommendations to incentivize manufacturers to enter the market for drugs in shortage and examines the national security risks of shortages; Discuss DEA reductions in annual quotas for opioid products used by hospitals for sedation and pain management; Meeting with the Office of the Assistant Secretary of Preparedness and Response (ASPR) to discuss developments in the hospital preparedness program, the pilot projects for the Regional Disaster Healthcare System and other issues; Rural access to health care, including identifying core services needed in rural communities, outlining approaches and considerations for delivering those services, and examining access and quality in the rural context; ONCs proposed rule to implement the 21st Century Cures provision on information blocking; Supported members serving on the HHS Quality Summit panel, which was convened by the Deputy Secretary to gather input regarding how to improve and energize quality and safety improvement activities across health care system; Discussion with HHS on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussion with HHS about the work of Aligning for Health to address social determinants of health; Support S 2902, Strengthening Our Rural Health Workforce Act of 2019, a bill to enhance the rural health workforce; Meetings and correspondence with staff members of Senate Financing Committee on a proposal to support rural health care access (REH, re-opening necessary provider CAH, infrastructure funding); Letter to Ways & Means committee Rural and Underserved Communities Health Task Force in response to RFI on factors that contribute to health outcomes in these areas, examples of successful models and lessons from the field that address access and outcomes, and considerations for the unique circumstances of rural and underserved communities; Letter to Energy and Commerce Members regarding health information technology priorities; Letter of Support to Senate Appropriations on funding for the Centers for Disease Control and Prevention and the National Institutes of Health to study gun violence; Support S.2741 and H.R. 4932,Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019, a bill to amend title XVIII of the Social Security Act to expand access to telehealth services, and for other purposes; Support S 2603, Resolving Extended Limbo for Immigrant Employees and Families (RELIEF) Act, a bill to amend the Immigration and Nationality Act to end the immigrant visa backlog, and for other purposes; Support HR 4995, Maternal Health Quality Improvement Act of 2019, a bill to amend the Public Health Service Act to improve obstetric care and maternal health outcomes, and for other purposes; Concerns with HR 5800,Ban Surprise Billing Act, a bill to address surprise medical bills that relies on a median in-network rate to resolve out-of-network payments and allows for an independent dispute resolution process to determine the final payment. Concerned with the Committee's legislative approach to determining reimbursement for out-of-network providers. Oppose approaches that would impose arbitrary rates on providers, which could have significant consequences far beyond the scope of surprise medical bills. It is the insurers' responsibility to maintain comprehensive provider networks, and a default payment rate would remove incentives for health plans to contract with providers or to offer fair terms; Support HR 5826, Consumer Protections Against Surprise Medical Bills Act, a bill that prohibits providers from balance billing patients for emergency services or medical care the patient reasonably could have expected to be in-network, and from charging patients more than the in-network cost-sharing amount. Rather than rely on a benchmark payment rate to determine out-of-network reimbursement, the legislation provides a period for health plans and providers to negotiate out-of-network reimbursement, followed by a mediated dispute resolution process if necessary; Letter urging HHS to take regulatory actions to help hospitals and health systems prepare and respond to COVID-19; Letter requesting $100 billion to prepare and respond to COVID-19; Letter urging the Department of Labor to accurately define health care provider when promulgating regulations implementing key sections of the Families First Coronavirus Response Act; Letter sent to the President asking for the use of the Defense Production Act to increase the production of medical supplies and equipment; Letter to HHS regarding $100 billion emergency fund, asking HHS and CMS to directly and expediently distribute to rural and urban hospitals and health systems funds from the Public Health and Social Services Emergency Fund that were designated for providers in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The CARES Act increased funding by $100 billion in order to reimburse eligible health care providers for health care-related expenses or lost revenues that are attributable to COVID-19. In the letter, we urged HHS and CMS to immediately distribute funding to all hospital types in the US - with additional funding going to COVID-19 hotspots; Letter urging Congress to modernize the Stafford Act as part of its next COVID-19 legislative package to allow all hospitals to recoup financial losses from this pandemic and future disasters; Letter to the Federal Reserve System, the Federal Deposit Insurance Corporation and the Office of the Comptroller of the Currency requesting they, as primary federal regulators for insured depository institutions, take prompt action to assist health care providers on the front line of the COVID-19 pandemic should the need to do so arise; Letter to the Secretary of the Treasury and the Federal Reserve Chair of the Board of Governors urging a supplement to the New Main Street Loan Facility term sheet with prompt guidance to ensure that access to this critically-necessary loan facility will be attainable for hospitals without delay; Letter was sent to the SBA urging it to ensure that small- and mid-size public hospitals, including those that have both nonprofit and public designations, are allowed to apply for and receive loans under the newly-authorized SBA Paycheck Protection Program; Letter in response to FEMAs request for input on establishing a voluntary agreement, under the Defense Production Act, of key private sector stakeholders relevant to responding to COVID-19, urging that such an agreement account for the full breadth of COVID-19 medical supply and equipment needs; Support H.R. 6474/S.3838 Healthcare Broadband Expansion During COVID-19 Act, a bill that would provide an additional $2 billion in funding for the FCC Rural Health Care program and increase the subsidy for health care providers from 65 to 85 percent. This legislation also simplifies the program to allow for more efficient application processes and disbursement of much needed funding; Support HR 6654 Emergency COVID-19 Telehealth Response Act, a bill that would codify an expanded list of providers to deliver and bill for telehealth services during the PHE; Support HR 7233Knowing the Efficiency and Efficacy of Permanent (KEEP) Telehealth Options Act of 2020, a bill that would require the Department of Health and Human Services and the Government Accountability Office (GAO) to conduct studies to provide information about the expanded use of telehealth during the COVID-19 pandemic; Letter to Senate HELP Committee in response to request for feedback on preparing for next pandemic; Discussion about telehealth waivers and flexibilities with HHS; Discussion about CARES provider relief fund distributions with HHS; Oppose HR 6559/ S 3677 COVID-19 Every Worker Protection Act of 2020, a bill to require the Occupational Safety and Health Administration to promulgate an emergency temporary standard to protect employees from occupational exposure to SARS-CoV-2, and for other purposes; Joint letter with ANA urging Congress to act quickly to get needed resources into the health care system, so that hospitals, nurses and physicians responding to COVID-19 are able to continue to provide treatments, front-line health care personnel are able to provide care and patients are able access health care services; Statement to Committee on Ways and Means for the hearing on The Disproportionate Impact of COVID-19 on Communities of Color urging Congress to employ the resources of the National Institute on Minority Health and Health Disparities - which is congressionally-mandated to coordinate the research of the other National Institutes of Healths centers and institutes related to minority health - to research and develop approaches to specifically address the COVID-19 needs of minority populations; Advocate with Congress for full forgiveness of COVID-19 related accelerated payments received by hospitals; Support S 3781Pharmaceutical Accountability, Responsibility, and Transparency (PART) Act, a bill to increase reporting of, help mitigate potential shortages related to, and promote, accountability and transparency for pharmaceuticals and medical devices; Support S 3780 Help Onshore Manufacturing Efficiencies (HOME) for Drugs and Devices Act, a bill to encourage domestic advanced manufacturing of critical drugs and devices in order to address economic, health, and security concerns, combat shortages of critical drugs and devices, and promote increased domestic diversification of, and independence from foreign reliance on, pharmaceutical and medical device supply chains; Support S.3763 Pandemic Responder Service Award Act, a bill to establish the Pandemic Responder Service Award program to express our gratitude to front-line health care workers; Support HR 6788/ S 3599 Healthcare Workforce Resilience Act, a bill to enhance our Nations nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas; Urged support for joint House and Senate letter to the Administration asking for flexibility for hospitals with respect to J-1 and H-1B visa programs; Letter to Senate Finance Committee to address the important issue of maternal health and the opportunity to provide suggestions regarding how to improve maternal health in this country; Support the Temporary Reciprocity to Ensure Access to Treatment Act, a bill that allows for the temporary reciprocity for treatment by medical professionals licensed in one state to patients in other states.

Client expense: $4,260,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

HR 1418 and S.350, the Competitive Health Insurance Reform Act of 2019

Client expense: $464,047 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 342 National Flood Insurance Program Mapping H.R. 420 Marijuana Products Regulation H.R. 469 Flood Insurance Coverage Rates H.R. 470 Mandatory Flood Insurance Coverage Repeal H.R. 471 Private Capital and Reinsurance Markets Risk Transfer H.R. 472 Alternative Flood Insurance Rate Maps H.R. 1402 Flood Maps Preparation Transfer H.R. 1418 Health Insurance Antitrust laws Application H.R. 1595 Cannabis Related Businesses Financial Services H.R. 1666 Private Flood Insurance Coverage H.R. 1689 Climate Change Advisory Commission Establishment H.R. 1756 Auto Insurance Consumer Reports Use Prohibition H.R. 1862 Federal Insurance Office Abolition S. 350 Health Insurance Federal Antitrust laws Application S. 420 Marijuana Products Taxation and Regulation S. 603 Financial Company Supervision Determination H.R. 2048 Consumer Products and Services Pricing H.R. 2318 National Flood Insurance Mapping H.R. 2479 Financial Stability Oversight Council Voting Member H.R. 2578 National Flood Insurance Program Extension Act of 2019 H.R. 2684 Auto Insurance Cost Disparities Study H.R. 3111 National Flood Insurance Reforms H.R. 3167 National Flood Insurance Program Reform H.R. 3183 Crop Insurance Eligibility H.R. 3258 Flood Insurance Rates Review S. 1108 Data Protection Impact Assessments S. 1144 National Flood Insurance Mapping S. 1200 Cannabis Related Business Financial Services Protection S. 1213 Health Insurance Reform Provision S. 1214 Individual and Collective Privacy Rights Protection S. 1520 National Flood Insurance Program Reauthorization S. 1531 Health Insurance Consumer Protections S. 1533 National Flood Insurance Program Reauthorization H.R. 3872 National Flood Insurance Program Reauthorization H.R. 4074 Cannabis Related Business Safe Harbor H.R. 4523 Risk Retention Groups Commercial Insurance Types S. 2088 Flood Area Community Accountability S. 2122 Flood Insurance Program Contract Termination Authority S. 2171 Flood Insurance Agents Continuing Education Requirement S. 2187 National Flood Insurance Program Reauthorization S. 2192 Flood Risk Reduction Funding Assistance S. 2201 Cannabis Related Business Insurers Safe Harbor H.R. 4634 Terrorism Risk Insurance Act Reauthorization H.R. 4652 Individual Market Reinsurance Fund Establishment S. 2877 Terrorism Risk Insurance Act S. 2964 Non Premium Aviation Insurance Authority Extension H.R. 1756 Auto Insurance Consumer Reports Use Prohibition H.R. 3693 Insurance Rate Income Proxies H.R. 5776 Flood Damaged Areas Accountability **Issues lobbied without specific bill number: COVID-19 Related Insurance Legislation, Business Interruption Insurance, Consumer Financial Protection Bureau Oversight of the Insurance Industry, Marijuana Financial Services H.R. 6494 Insurance Coverage for Business Interruption Losses H.R. 6497 Insurance Coverage for Business Interruption Losses H.R. 6800 HEROES Act Workers Compensation Provision H.R. 7011 Pandemic Risk Reinsurance Program H.R. 7412 Insurers Support Temporary Voluntary Program S. 3814 Loan Forgiveness Period Extension **Issues lobbied without specific bill number: Business Continuity Protection Program, COVID-19 personal and commercial insurance response and role, municipal services liability, judicial insurance antitrust consent decree

Client expense: $2,090,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Federal Aviation Administration (FAA), Federal Emergency Management Agency (FEMA), Federal Reserve System, HOUSE OF REPRESENTATIVES, Internal Revenue Service (IRS), Natl Economic Council (NEC), Natl Labor Relations Board (NLRB), SENATE, Transportation, Dept of (DOT), Treasury, Dept of, U.S. Trade Representative (USTR)

Competitive Health Insurance Reform Act of 2019 (S 350/HR 1418); Policies related to a limited Special Enrollment Period (SEP) in the Federally Facilitated Marketplaces; Policies related to federal subsidization of COBRA premiums.

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

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

HR 1418 Competitive Health Insurance Reform Act of 2019 (all sections of full text)(support) S 350 Competitive Health Insurance Reform Act of 2019 (all sections of full text)(support)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1418, Competitive Health Insurance Reform Act, 2019. S. 350, Competitive Health Insurance Reform Act, 2019.

Client expense: $330,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 1418, Competitive Health Insurance Reform Act of 2019 S. 350, Competitive Health Insurance Reform Act of 2019 H.R. 748 Coronavirus Aid, Relief, and Economic Security Act or the CARES Act Implementation H.R. 6201 Families First Coronavirus Response Act. Implementation Small business exemptions from Family and Medical Leave Act requirements

Client expense: $600,000 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Environmental Protection Agency (EPA), Federal Communications Commission (FCC), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Indian Health Service, Internal Revenue Service (IRS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Science & Technology Policy (OSTP), SENATE, Small Business Administration (SBA), Treasury, Dept of, U.S. Immigration & Customs Enforcement (ICE), Veterans Affairs, Dept of (VA), White House Office

In support of the Competitive Health Insurance Reform Act of 2019 (HR 1418/S 350) - antitrust reform In support of the Ensuring Lasting Smiles Act (HR 1379/S 560) - insurance coverage for patients with congenital anomalies Shared with members of Congress the association's principals related to surprise billing occurrences. In support of the Dental and Optometric (DOC) Access Act (HR 3762) to prohibit "non-covered services" provisions in dental and vision plans and coverage. Ask Congress to pass Business Interruption Insurance Coverage Act (HR 6494) to enhance business interruption insurance policies related to COVID-19.

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

Government targets: Centers For Disease Control & Prevention (CDC), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), SENATE, Small Business Administration (SBA), Treasury, Dept of, White House Office