Healthcare Workforce Resilience Act

The Affordable Care Act (P.L. 111-148, P.L. 111-152): Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Advocated against a December 2018 ruling by a federal judge in Texas that the entire Affordable Care Act (ACA) is unconstitutional. Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Medicare Payments to Physicians: Urged that Congress provide incentives to physicians who transform their practices into Advanced Alternative Payment Models and continue to provide stability for physicians in the MIPS program. Specifically, Congress should extend the five percent Qualified Alternative Payment Model participant bonus beyond the 2022 performance year, replace the zero percent baseline payment updates under Medicare with positive updates. Urged congressional committees with jurisdiction over Medicare to exercise their oversight authority and urge CMS to expedite approval of more Advanced APMS, particularly those that work for small and specialty practices and to simplify the scoring structure and reporting requirements under the Merit-Based Incentive Payment System (MIPS) in order to fulfill Congress intent of a more streamlined program that reduces burdens on physicians; Supported S.2648, the Rural ACO Improvement Act, amends title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program (MSSP) to ensure that all ACOs have an equal opportunity to share in savings regardless of their geographic location; Provided recommendations to CMS on the Merit-based Incentive Payment System Value Pathway (MVP), which aims to reduce reporting burden and complexity within MIPS while improving the accuracy and effectiveness of performance measurement. The College noted specifically that a robust, multi-year transition period will be critical to the success of the MVP, that it does not support making the MVP mandatory, that CMS should continue to support numerous reporting mechanisms, including qualified registries and clinical data registries, which have been instrumental in developing specialty-specific performance measures, among other things. Urged support for H.R. 8505, a bill to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule; Urged that any legislation to hold some Medicare physician payment codes harmless from budget neutrality do so for just one year and to allow evaluation and management increases, along with GPC1X codes to go into effect. Regarding CMS proposed 2022 Medicare Physician Fee Schedule and Quality Payment Program (QPP) rules, expressed support for extending some of the services and increased flexibility for telehealth through the end of 2023, namely some audio-only services that were allowed during the COVID-19 public health emergency (PHE), support for collecting additional data on health equity issues to analyze disparities that occur across their programs, support for including chronic care management as one of the seven MIPS Value Pathways (MVPs) for 2023. FY2022 Appropriations: Urged Congress to support $10 billion for the Centers for Disease Control and Preventions programs in the FY 2022 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as $50 million in funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for: Health Resources Services Administration (HRSA), $9.2 billion; Title VII, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA), $71 million; National Health Service Corps (NHSC), $860 million in total program funding; Agency for Healthcare Research and Quality (AHRQ), $500 million; Centers for Medicare and Medicaid Services (CMS), Program Operations for Federal Exchanges, $296.5 million. Also, urged support for the VA, Veterans Health Administration (VHA), $103.1 billion, which includes the following within the VHA -- VA, VHA, Medical Services, $66.2 billion, VA, VHA, Medical Community Care, $20.7 billion, VA, VHA, Medical and Prosthetic Research; $902 million. COVID-19: Urged congressional appropriators to provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the virus that is commensurate with the public health emergency that the virus represents. Urged the administration to explore regulatory and other actions that would make COVID-19 testing free-of-charge to patients covered by both public and private insurance plans, including ACA-compliant plans offered through the insurance exchanges, and to waive co-pays and deductibles for patients seeing physicians for symptoms that may be indicative of COVID-19 or who are hospitalized for treatment. Urged CMS to utilize a national disaster recovery program that would pay doctors 110% of Medicare rates for caring for uninsured patients who have been infected with SARS-CoV-2. Expressed support to Congress and the administration for a variety of COVID-related bills from the 116th Congress as follows: the Families First Coronavirus Response Act, H.R. 6201, and other stimulus reforms related to COVID-19 including: Emergency paid leave benefits, paid sick days for public health emergencies, coverage of testing for COVID-19, waiving of cost sharing under Medicare, Medicare Advantage, Medicaid, and CHIP, increasing the federal FMAP under Medicaid, providing reimbursement for CPT codes 99441 - 99443, which are telephone evaluation and management services, expediting entrance of international medical graduates who are citizens of other nations (non-US IMGs) into the country and ensuring that lawfully present non-U.S. IMGs are not negatively impacted by the COVID-19 pandemic, funding for physician practices under the Public Health and Social Service Emergency Fund (PHSSEF), providing tax relief, grants, and loans to small and medium size practices impacted by COVID-19, increasing funding for personal protective equipment (PPE), ensuring Medicaid pay parity with Medicare for primary care services; Urged support for the Student Loan Forgiveness for Frontline Health Workers Act, H.R. 6720, introduced May 5, 2020 by Representative Carolyn B. Maloney (D-NY) which would eliminate graduate school debt for healthcare workers, including physicians and medical students, who are providing direct patient care in response to the COVID-19 pandemic; Urged support for H.R. 7059, the Coronavirus Provider Protection Act, which extend liability protections to those who provide care in good faith during the COVID-19 public health emergency (plus a reasonable time, such as 60 days, after the emergency declaration ends), and not in situations of gross negligence or willful misconduct. The College also urged that pay parity between telephone claims and in-person visits and between all telehealth and in-person visits be maintained after the PHE is lifted. This extension-either continued by CMS or mandated by Congress-should last at least through the end of 2021, or until such a time when effective vaccines and treatments are widely available, with an option to extend it even further, or consider making permanent, based on the experience and learnings of patients and physicians who are utilizing these visits. Urged congress to mitigate the impact of covid across racial and ethnic minority populations by collect covid-19 and racial disparity data, equitably distribute covid-19 vaccines and treatments, protect essential workers, permanently expand access to family and medical leave, address environmental and social drivers of health, integrate primary care and behavioral health, improve mental health parity with increased federal oversight and enforcement, make naloxone more available to prevent overdose, expand medication-assisted treatment (mat) for physicians, establish a national prescription drug monitoring program (PDMP); urged support for administering COVID-19 vaccinations to all eligible immigrants in Customs and Border Protection (CBP) custody. American Rescue Plan (ARP) Act (H.R. 1319): Urged support for various provisions within the ARP to provide incentives for states to expand Medicaid by temporarily increasing the states base FMAP by five percentage points for two years for states that newly expand Medicaid. Urged support for allowing states, for five years, to extend Medicaid eligibility (and CHIP eligibility) to women for 12 months postpartum. Urged support to require Medicaid coverage of COVID-19 vaccines and treatment without beneficiary cost sharing with vaccines matched at a 100 percent federal medical assistance percentage (FMAP) through one year after the end of the PHE. Urged support for $46 billion to HHS to detect, diagnose, trace, and monitor COVID-19 infections, and for other activities necessary to mitigate the spread of COVID-19. Urged support to subsidize the health coverage of people earning up to 150 percent of the federal poverty level (FPL) under the ACA and those on unemployment insurance for a period of two years. Urged support for waiving VA cost sharing and copayments for medical treatment until September 30, 2021. Womens Health: Urged Congress to support, H.R. 958, the Protecting Moms Who Served Act, which would provide critical support for maternity care coordination programs to address the clinical and nonclinical perinatal needs of veterans and ensure effective coordination between VA and non-VA facilities in the delivery of maternity care and other health care services. Urged HHS to promptly finalize new Title X regulations that ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminates medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protects funding for and ensures consistent treatment of qualified service sites. Urged support for mandatory, permanent extension of postpartum Medicaid coverage, from 60 days to 12 months after delivery. Urged support for the Womens Health Protection Act of 2021 (H.R. 3755 and S. 1975), bills that would protect a persons ability to determine whether to continue or end a pregnancy and to protect the health care clinicians ability to provide abortion services free from medically unnecessary restrictions such as waiting periods, biased counselling and admitting privilege requirements for clinicians. Expand Health Coverage and Affordability: Urged Congress to support H.R. 340, the Incentivizing Medicaid Expansion Act of 2021, to expand federal matching assistance for states that choose to expand Medicaid, regardless of when such expansion takes place. Introduce and pass the companion bill in the Senate and H.R. 369, the Health Care Affordability Act of 2021, to permanently expand eligibility for higher premium tax credits under the ACA. Train and Support Frontline Physicians during and after COVID-19: Urged Congress to support H.R. 2256/S. 834, the Resident Physician Reduction Shortage Act of 2021, to increase the number of GME slots by at least 2,000 per year over seven years (14,000 slots) for specialties facing shortages, including internal medicine; H.R. 1554 (116th Congress), the Resident Education Deferred Interest Act, to allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program; S. 948, the Conrad State 30 and Physician Access Reauthorization Act (116th Congress) and S. 3599 (116th Congress), the Healthcare Workforce Resilience Act, to support the COVID-19 response workforce by expediting visas for international medical graduates (IMGs) to enter the U.S. for training and patient care, permanently authorizing the Conrad 30 Program, and providing a pathway for IMGs and their families already in the U.S to obtain permanent residency status; H.R. 2418, the Student Loan Forgiveness for Frontline Health Workers Act, to forgive student loans for physicians and other clinicians who are on the frontlines of providing care to COVID-19 patients or helping the health care system cope with the COVID-19 public health emergency; H.R. 1667/S. 610, the Dr. Lorna Breen Health Care Provider Protection Act, to address the behavioral health and well-being of physicians, including depression, suicides and burnout. Support the Value of Primary and Comprehensive Care: Urged Congress to Continue to fund the 3.75 percent increase to all physicians services that was approved by Congress at the end of last year to prevent CY2022 budget neutrality cuts for physician services, including primary care visits and other evaluation and management services; Ensure that any legislation that addresses budget neutrality treats all services fairly and equitably; Pass H.R. 1025, the Kids Access to Primary Care Act, to increase access to health coverage for Medicaid patients by achieving payment parity for primary care services under Medicaid and Medicare; Extend the five percent bonus that physicians receive if they meet performance expectations in Advanced APMs that is set to expire at the end of 2022; Act before the end of CY2021 to prevent scheduled cuts for physician services, including primary care, resulting from budget sequestration and pay-as-you go budget rules. Improve Access to Prescription Drugs and Reduce Costs: Urged Congress to support S. 898, the Fair Drug Pricing Act, to require drug companies to disclose and provide more information about imminent drug-price increases, including data about research and development costs; S. 833, the Empowering Medicare Seniors to Negotiate Drug Prices Act of 2021, to help to reduce drug prices and out-of-pocket costs by allowing the federal government to negotiate lower drug prices on behalf of Medicare beneficiaries; S. 141, the End Taxpayer Subsidies for Drug Ads Act, to end the federal tax deduction that pharmaceutical companies use to pay for drug advertising; S. 464/H.R. 2163, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Support Essential Public Health and Research Initiatives: Urged Congress to support H.R. 8, the Bipartisan Background Checks Act that would establish new background check requirements for firearm transfers between private parties; H.R. 3076/S. 506, the Extreme Risk Protection Order Act from the 116th Congress, to establish a grant program to help states and Indian tribes implement extreme risk protection order laws and expands categories of individuals who are prohibited from receiving, possessing, shipping, or transporting a firearm; H.R. 3271/S. 1702, the Climate Change Health Protection and Promotion Act that would take important steps to mitigate the harmful impact of climate change on health. Promote Health Equity, Social Justice, and Eliminate Disparities: Urged Congress to support H.R. 1280, the George Floyd Justice in Policing Act of 2021, to overhaul qualified immunity for law enforcement, prohibit racial profiling on the part of law enforcement and ban no-knock warrants in federal drug cases and chokeholds and carotid holds at the federal level; H.R. 5, the Equality Act, to prohibit discrimination based on sex, sexual orientation and gender identity in public accommodations and facilities, education, federal housing credit and the jury system; H.R. 666/S. 162, the Anti-Racism in Public Health Act of 2021, to establish within the CDC a National Center on Anti-racism and Health for data collection and research and a law enforcement violence prevention program; H.R. 959/S. 346, the Black Maternal Health Momnibus Act of 2021, to reduce preventable maternal mortality and severe maternal morbidity in the U.S. and close disparities in maternal health outcomes, particularly among pregnant minority women. Expand Access to Telehealth Services and Promote Patient Safety/Privacy; Urged Congress to support H.R. 2903/S. 1512, the CONNECT for Health Act, to remove arbitrary barriers to telehealth services such as geographic and site of service restrictions; S. 168/H.R. 708, the Temporary Reciprocity to Ensure Access to Treatment Act or the TREAT Act, to ensure that telehealth services can be provided across states lines after the public health emergency ends; Urged appropriators to include adequate funding in FY2022 to support expansion of broadband capabilities nationwide, especially to rural and underserved communities, and to remove the ban on adoption of a national unique health identifier standard. Veterans Administration: Expressed concerns to the VA about its efforts to develop National Standards of Practice for physicians and other health professionals that supersede state scope of practice and licensure laws; expressed that the VA has not provided a transparent process by which public stakeholders are provided an adequate opportunity to review and provide meaningful input into the standards of practice. Infrastructure Investment: Expressed support with Congress for several provisions in the bipartisan Infrastructure Investment and Jobs Act, legislation that makes sweeping and historic investments in this nations infrastructure; Applauded provisions that would improve public health specifically to ensure all Americans have access to safe drinking water, broadband services that provide vital access to telehealth services, as well as investment in clean energy to reverse the negative health effects associated with climate change. Surprise Medical Billing: Voiced support for the decision of CMS to provide protections for patients from surprise bills in situations where they need an ambulance, especially in a perceived emergency; voiced support for CMS approach that emergency services provided by out-of-network emergency facilities and out-of-network provider organizations, and certain non-emergency services furnished by out-of-network provider organizations at certain in-network facilities, must be calculated based on a recognized amount which is generally the lesser of the Qualifying Payment Amount (QPA) - the plans median in-network rate for the item or service, or an all-payer model agreement between CMS and the state; urged CMS to include in the Independent Dispute Resolution process described in future sub-regulatory guidance that health plans have an affirmative obligation to pay fairly and appropriately for services provided in and out of network.

Client expense: $102,561 · 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, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA)

S. 3548, CARES Act: To provide emergency assistance and health care response for individuals, families, and businesses affected by the 2020 coronavirus pandemic; Practice Support/Grants to Practice S. 3599, Healthcare Workforce Resilience Act: Foreign physician immigration status H.R. 3021, Coronavirus Provider Protection Act: Medical liability Public Law No: 116-142, Paycheck Protection Program Flexibility Act of 2020 H.R. 2630, Extending Temporary Emergency Scheduling of Fentanyl Analogues Act: Opioids H.R. 3502, Protecting People From Surprise Medical Bills Act: Surprise Medical Bills H.R. 3173, Improving Seniors' Timely Access to Care Act of 2019: Pre-authorization S. 1895, Lower Health Care Costs Act S. 445, Mainstreaming Addiction Treatment Act of 2021: Opioids H.R. 4387, Maternal Health Quality Improvement Act of 2021: Maternal health H.R. 1565, Saving Lives, Saving Costs S. 1475, Saving Lives, Saving Costs S. 610, Dr. Lorna Breen Health Care Provider Protection Act: Physician wellness H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act: Physician wellness S. 987, CARA 3.0 Act of 2021: Opioids H.R. 3259, NOPAIN Act: Opioids S. 586, NOPAIN Act: Opioids S. 1292, Non-Opioid Directive Act: Opioids FY 2021 LHHS Appropriations: Fiscal Year 2021 Appropriations for Subcommittee on Labor, Health and Human Services Outside Witness Testimony Affordable Care Act reform efforts H.R. 1628, American Health Care Act of 2017 S. Amdt. 1030 to H.R. 1628, "Graham-Cassidy" Better Care Reconciliation Act of 2017 H.R. 1492, Medical Controlled Substances Transportation Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 3545, Overdose Prevention and Patient Safety Act H.R. 3446, Restoring Board Immunity Act of 2017: Professional Licensing 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records: appropriate access to patient information essential for providing whole-person care H.R.3928, Truth in Healthcare Marketing Act of 2017 H.R. 4122, Resident Education Deferred Interest Act (REDI Act): Student loan relief H.R. 2418, Student Loan Forgiveness for Frontline Health Workers Act: Student loan relief H.R. 842, Protecting the Right to Organize Act of 2021: PRO Act, labor protections 21st Century Cures Initiative H.R. 4369, National Centers of Excellence in Continuous Pharmaceutical Manufacturing Act: Drug shortages DEA Scheduling Propofol Comparative Effectiveness Research - PCORI HITECH Implementation, Electronic Health Records, Final and Proposed Rules, HIT Meaningful Use HHS/OIG Anesthesia Practice Arrangements, Company Model FDA Safe Use Initiative Pain Management FTC Letters to States re: Interventional Pain Medicine & Advanced Practice Nurses & Competition in Healthcare Anesthesia Research Funding (Pediatric and others) Scope of Practice FDA Operating Room Fires Naloxone FDA Opioids Prescription Drug Abuse FDA Network of Experts NIH Interagency Pain Research Coordinating Committee USP - US Pharmacopeia National Pain Strategy Nondiscrimination Compounding FDA Nominations to Advisory Committees (Anesthesia Drugs, Anesthesia Devices, Compounding) Agency for Healthcare Research and Quality (AHRQ) funding Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Sequestration Opioids and opioid abuse; Brain health Certified Anesthesiologist Assistants Blood management COVID-19: Increased supply of PPE and ventilators, funding for physician practices impacted by the cancellation of elective surgeries, unique role of anesthesiologists in responding to COVID-19 pandemic, medical liability, scope of Practice (waiver of federal supervision requirement under the Emergency Declaration), insurance moratorium; COVID Update Memorandum 4/21/20 Centre for Clinical and Applied Services Provision Research

Client expense: $320,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

The Affordable Care Act (P.L. 111-148, P.L. 111-152): Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Advocated against a December 2018 ruling by a federal judge in Texas that the entire Affordable Care Act (ACA) is unconstitutional. Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Medicare Payments to Physicians: Urged that Congress provide incentives to physicians who transform their practices into Advanced Alternative Payment Models and continue to provide stability for physicians in the MIPS program. Specifically, Congress should extend the five percent Qualified Alternative Payment Model participant bonus beyond the 2022 performance year, replace the zero percent baseline payment updates under Medicare with positive updates. Urged congressional committees with jurisdiction over Medicare to exercise their oversight authority and urge CMS to expedite approval of more Advanced APMS, particularly those that work for small and specialty practices and to simplify the scoring structure and reporting requirements under the Merit-Based Incentive Payment System (MIPS) in order to fulfill Congress intent of a more streamlined program that reduces burdens on physicians; Supported S.2648, the Rural ACO Improvement Act, amends title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program (MSSP) to ensure that all ACOs have an equal opportunity to share in savings regardless of their geographic location; Provided recommendations to CMS on the Merit-based Incentive Payment System Value Pathway (MVP), which aims to reduce reporting burden and complexity within MIPS while improving the accuracy and effectiveness of performance measurement. The College noted specifically that a robust, multi-year transition period will be critical to the success of the MVP, that it does not support making the MVP mandatory, that CMS should continue to support numerous reporting mechanisms, including qualified registries and clinical data registries, which have been instrumental in developing specialty-specific performance measures, among other things. Urged support for H.R. 8505, a bill to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule; Urged that any legislation to hold some Medicare physician payment codes harmless from budget neutrality do so for just one year and to allow evaluation and management increases, along with GPC1X codes to go into effect. FY2022 Appropriations: Urged Congress to support $10 billion for the Centers for Disease Control and Preventions programs in the FY 2022 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as $50 million in funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for: Health Resources Services Administration (HRSA), $9.2 billion; Title VII, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA), $71 million; National Health Service Corps (NHSC), $860 million in total program funding; Agency for Healthcare Research and Quality (AHRQ), $500 million; Centers for Medicare and Medicaid Services (CMS), Program Operations for Federal Exchanges, $296.5 million. Also, urged support for the VA, Veterans Health Administration (VHA), $103.1 billion, which includes the following within the VHA -- VA, VHA, Medical Services, $66.2 billion, VA, VHA, Medical Community Care, $20.7 billion, VA, VHA, Medical and Prosthetic Research; $902 million. COVID-19: Urged congressional appropriators to provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the virus that is commensurate with the public health emergency that the virus represents. Urged the administration to explore regulatory and other actions that would make COVID-19 testing free-of-charge to patients covered by both public and private insurance plans, including ACA-compliant plans offered through the insurance exchanges, and to waive co-pays and deductibles for patients seeing physicians for symptoms that may be indicative of COVID-19 or who are hospitalized for treatment. Urged CMS to utilize a national disaster recovery program that would pay doctors 110% of Medicare rates for caring for uninsured patients who have been infected with SARS-CoV-2. Expressed support to Congress and the administration for a variety of COVID-related bills from the 116th Congress as follows: the Families First Coronavirus Response Act, H.R. 6201, and other stimulus reforms related to COVID-19 including: Emergency paid leave benefits, paid sick days for public health emergencies, coverage of testing for COVID-19, waiving of cost sharing under Medicare, Medicare Advantage, Medicaid, and CHIP, increasing the federal FMAP under Medicaid, providing reimbursement for CPT codes 99441 - 99443, which are telephone evaluation and management services, expediting entrance of international medical graduates who are citizens of other nations (non-US IMGs) into the country and ensuring that lawfully present non-U.S. IMGs are not negatively impacted by the COVID-19 pandemic, funding for physician practices under the Public Health and Social Service Emergency Fund (PHSSEF), providing tax relief, grants, and loans to small and medium size practices impacted by COVID-19, increasing funding for personal protective equipment (PPE), ensuring Medicaid pay parity with Medicare for primary care services; Urged support for the Student Loan Forgiveness for Frontline Health Workers Act, H.R. 6720, introduced May 5, 2020 by Representative Carolyn B. Maloney (D-NY) which would eliminate graduate school debt for healthcare workers, including physicians and medical students, who are providing direct patient care in response to the COVID-19 pandemic; Urged support for H.R. 7059, the Coronavirus Provider Protection Act, which extend liability protections to those who provide care in good faith during the COVID-19 public health emergency (plus a reasonable time, such as 60 days, after the emergency declaration ends), and not in situations of gross negligence or willful misconduct. The College also urged that pay parity between telephone claims and in-person visits and between all telehealth and in-person visits be maintained after the PHE is lifted. This extension-either continued by CMS or mandated by Congress-should last at least through the end of 2021, or until such a time when effective vaccines and treatments are widely available, with an option to extend it even further, or consider making permanent, based on the experience and learnings of patients and physicians who are utilizing these visits. Urged congress to mitigate the impact of covid across racial and ethnic minority populations by collect covid-19 and racial disparity data, equitably distribute covid-19 vaccines and treatments, protect essential workers, permanently expand access to family and medical leave, address environmental and social drivers of health, integrate primary care and behavioral health, improve mental health parity with increased federal oversight and enforcement, make naloxone more available to prevent overdose, expand medication-assisted treatment (mat) for physicians, establish a national prescription drug monitoring program (PDMP). American Rescue Plan (ARP) Act (H.R. 1319): Urged support for various provisions within the ARP to provide incentives for states to expand Medicaid by temporarily increasing the states base FMAP by five percentage points for two years for states that newly expand Medicaid. Urged support for allowing states, for five years, to extend Medicaid eligibility (and CHIP eligibility) to women for 12 months postpartum. Urged support to require Medicaid coverage of COVID-19 vaccines and treatment without beneficiary cost sharing with vaccines matched at a 100 percent federal medical assistance percentage (FMAP) through one year after the end of the PHE. Urged support for $46 billion to HHS to detect, diagnose, trace, and monitor COVID-19 infections, and for other activities necessary to mitigate the spread of COVID-19. Urged support to subsidize the health coverage of people earning up to 150 percent of the federal poverty level (FPL) under the ACA and those on unemployment insurance for a period of two years. Urged support for waiving VA cost sharing and copayments for medical treatment until September 30, 2021. Patient Identifier: Urged Congress to reject the inclusion of outdated rider language in Section 510 of the Fiscal Year 2022 Labor, Health and Human Services, and Education and Related Agencies (Labor-HHS) Appropriations bill that prohibits the US Department of Health and Human Services (HHS) from spending any federal dollars to promulgate or adopt a national unique health identifier standard. Womens Health: Urged Congress to support, H.R. 958, the Protecting Moms Who Served Act, which would provide critical support for maternity care coordination programs to address the clinical and nonclinical perinatal needs of veterans and ensure effective coordination between VA and non-VA facilities in the delivery of maternity care and other health care services. Urged HHS to promptly finalize new Title X regulations that ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminates medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protects funding for and ensures consistent treatment of qualified service sites. Expand Health Coverage and Affordability: Urged Congress to support H.R. 340, the Incentivizing Medicaid Expansion Act of 2021, to expand federal matching assistance for states that choose to expand Medicaid, regardless of when such expansion takes place. Introduce and pass the companion bill in the Senate and H.R. 369, the Health Care Affordability Act of 2021, to permanently expand eligibility for higher premium tax credits under the ACA. Train and Support Frontline Physicians during and after COVID-19: Urged Congress to support H.R. 2256/S. 834, the Resident Physician Reduction Shortage Act of 2021, to increase the number of GME slots by at least 2,000 per year over seven years (14,000 slots) for specialties facing shortages, including internal medicine; H.R. 1554 (116th Congress), the Resident Education Deferred Interest Act, to allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program; S. 948, the Conrad State 30 and Physician Access Reauthorization Act (116th Congress) and S. 3599 (116th Congress), the Healthcare Workforce Resilience Act, to support the COVID-19 response workforce by expediting visas for international medical graduates (IMGs) to enter the U.S. for training and patient care, permanently authorizing the Conrad 30 Program, and providing a pathway for IMGs and their families already in the U.S to obtain permanent residency status; H.R. 2418, the Student Loan Forgiveness for Frontline Health Workers Act, to forgive student loans for physicians and other clinicians who are on the frontlines of providing care to COVID-19 patients or helping the health care system cope with the COVID-19 public health emergency; H.R. 1667/S. 610, the Dr. Lorna Breen Health Care Provider Protection Act, to address the behavioral health and well-being of physicians, including depression, suicides and burnout. Support the Value of Primary and Comprehensive Care: Urged Congress to Continue to fund the 3.75 percent increase to all physicians services that was approved by Congress at the end of last year to prevent CY2022 budget neutrality cuts for physician services, including primary care visits and other evaluation and management services; Ensure that any legislation that addresses budget neutrality treats all services fairly and equitably; Pass H.R. 1025, the Kids Access to Primary Care Act, to increase access to health coverage for Medicaid patients by achieving payment parity for primary care services under Medicaid and Medicare; Extend the five percent bonus that physicians receive if they meet performance expectations in Advanced APMs that is set to expire at the end of 2022; Act before the end of CY2021 to prevent scheduled cuts for physician services, including primary care, resulting from budget sequestration and pay-as-you go budget rules. Improve Access to Prescription Drugs and Reduce Costs: Urged Congress to support S. 898, the Fair Drug Pricing Act, to require drug companies to disclose and provide more information about imminent drug-price increases, including data about research and development costs; S. 833, the Empowering Medicare Seniors to Negotiate Drug Prices Act of 2021, to help to reduce drug prices and out-of-pocket costs by allowing the federal government to negotiate lower drug prices on behalf of Medicare beneficiaries; S. 141, the End Taxpayer Subsidies for Drug Ads Act, to end the federal tax deduction that pharmaceutical companies use to pay for drug advertising; S. 464/H.R. 2163, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Support Essential Public Health and Research Initiatives: Urged Congress to support H.R. 8, the Bipartisan Background Checks Act that would establish new background check requirements for firearm transfers between private parties; H.R. 3076/S. 506, the Extreme Risk Protection Order Act from the 116th Congress, to establish a grant program to help states and Indian tribes implement extreme risk protection order laws and expands categories of individuals who are prohibited from receiving, possessing, shipping, or transporting a firearm; H.R. 3271/S. 1702, the Climate Change Health Protection and Promotion Act that would take important steps to mitigate the harmful impact of climate change on health. Promote Health Equity, Social Justice, and Eliminate Disparities: Urged Congress to support H.R. 1280, the George Floyd Justice in Policing Act of 2021, to overhaul qualified immunity for law enforcement, prohibit racial profiling on the part of law enforcement and ban no-knock warrants in federal drug cases and chokeholds and carotid holds at the federal level; H.R. 5, the Equality Act, to prohibit discrimination based on sex, sexual orientation and gender identity in public accommodations and facilities, education, federal housing credit and the jury system; H.R. 666/S. 162, the Anti-Racism in Public Health Act of 2021, to establish within the CDC a National Center on Anti-racism and Health for data collection and research and a law enforcement violence prevention program; H.R. 959/S. 346, the Black Maternal Health Momnibus Act of 2021, to reduce preventable maternal mortality and severe maternal morbidity in the U.S. and close disparities in maternal health outcomes, particularly among pregnant minority women. Expand Access to Telehealth Services and Promote Patient Safety/Privacy; Urged Congress to support H.R. 2903/S. 1512, the CONNECT for Health Act, to remove arbitrary barriers to telehealth services such as geographic and site of service restrictions; S. 168/H.R. 708, the Temporary Reciprocity to Ensure Access to Treatment Act or the TREAT Act, to ensure that telehealth services can be provided across states lines after the public health emergency ends; Urged appropriators to include adequate funding in FY2022 to support expansion of broadband capabilities nationwide, especially to rural and underserved communities, and to remove the ban on adoption of a national unique health identifier standard.

Client expense: $248,306 · 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, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS)

The Affordable Care Act (P.L. 111-148, P.L. 111-152): Expanding coverage and improving Medicare benefits; Providing needed protections to guard against insurance practices that unfairly limit, deny or rescind coverage based on health status; public and private health insurers should encourage preventive health care by providing full coverage, with no cost-sharing, for preventive services recommended by an expert advisory group, such as the U.S. Preventive Services Task Force; Ensuring access to primary care physicians; and beginning to bend the cost curve; Prohibiting insurers from excluding or charging excessive rates to children based on pre-existing conditions, which later will be expanded to all persons; Covering young adults on their parents' plans; Eliminating lifetime and annual limits on health insurance coverage; Requiring that health insurers spend more on patient care and less on administration; support enactment of S. 248, the Empowering States to Innovate Act, which amends the Patient Protection and Affordable Care Act (ACA) to: (1) allow states to apply for waivers of certain health insurance coverage requirements in such Act (including requirements for the establishment of qualified health plans and health insurance exchanges) for plan years beginning on or after January 1, 2014 (currently, January 1, 2017), and (2) require the waiver application process to begin not later than 180 days after the enactment of this Act; Phasing out the Medicare Part D doughnut hole; Eliminating patient cost-sharing for preventive services offered by Medicare or private insurers; Increasing Medicare and Medicaid payments to primary care physicians; Supporting the Patient-Centered Outcomes Research Institute to help physicians and patients make care decisions based on the best available evidence; Supporting the Center on Medicare and Medicaid Innovation to fund pilots of delivery models to improve outcomes and reduce costs, including patient-centered medical homes; Advocated against a December 2018 ruling by a federal judge in Texas that the entire Affordable Care Act (ACA) is unconstitutional. Access to Primary Care in the Context of Comprehensive Healthcare Reform Legislation (H.R. 3962/H.R. 3590/H.R. 4872): Provide sliding scale subsidies based on income to buy coverage from qualified plans; Qualified plans should: provide evidence-based benefits, including preventive services; and be prohibited from excluding persons with pre-existing conditions, charging them more, cherry-picking enrollees, or cancelling or failing to renew coverage; Expand Medicaid to cover all persons below the Federal Poverty Level and ensure fair payments to participating physicians; As coverage becomes affordable, all persons should participate and coverage should be guaranteed; Responsibility for financing should be shared by individuals, employers and government. Medicare payment models that re-align incentives to support effective, efficient, patient-centered, coordinated care. Priority should be given to models designed to support the value of services provided by primary care physicians as well as to models that would create incentives, across physician specialties and sites of services, to improve the quality, effectiveness, and efficiency of care provided. Policy criteria for selecting the most promising models for pilot testing should be developed, in consultation with outside experts; The Patient-Centered Medical Home (PCMH), which has shown great promise in meeting the policy objectives suggested above, should be among the models selected for broader testing on a national pilot basis; the use of the medical home model for treatment or services under private health plans, the requirement of health plans to provide incentives to promote and report on medical home services provided, the establishment of community health teams and a primary care extension program to educate and support primary care practices in the delivery of medical home services, and the establishment of a demonstration project to educate physicians and other clinicians in training in the competencies required to deliver care consistent with the medical home care model. Medicare Payments to Physicians: Urged that Congress provide incentives to physicians who transform their practices into Advanced Alternative Payment Models and continue to provide stability for physicians in the MIPS program. Specifically, Congress should extend the five percent Qualified Alternative Payment Model participant bonus beyond the 2022 performance year, replace the zero percent baseline payment updates under Medicare with positive updates. Urged congressional committees with jurisdiction over Medicare to exercise their oversight authority and urge CMS to expedite approval of more Advanced APMS, particularly those that work for small and specialty practices and to simplify the scoring structure and reporting requirements under the Merit-Based Incentive Payment System (MIPS) in order to fulfill Congress intent of a more streamlined program that reduces burdens on physicians; Supported S.2648, the Rural ACO Improvement Act, amends title XVIII of the Social Security Act to improve the benchmarking process for the Medicare Shared Savings Program (MSSP) to ensure that all ACOs have an equal opportunity to share in savings regardless of their geographic location; Provided recommendations to CMS on the Merit-based Incentive Payment System Value Pathway (MVP), which aims to reduce reporting burden and complexity within MIPS while improving the accuracy and effectiveness of performance measurement. The College noted specifically that a robust, multi-year transition period will be critical to the success of the MVP, that it does not support making the MVP mandatory, that CMS should continue to support numerous reporting mechanisms, including qualified registries and clinical data registries, which have been instrumental in developing specialty-specific performance measures, among other things. Urged support for H.R. 8505, a bill to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule; Urged that any legislation to hold some Medicare physician payment codes harmless from budget neutrality do so for just one year and to allow evaluation and management increases, along with GPC1X codes to go into effect. FY2022 Appropriations: Urged Congress to support $10 billion for the Centers for Disease Control and Preventions programs in the FY 2022 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as $50 million in funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for: Health Resources Services Administration (HRSA), $9.2 billion; Title VII, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA), $71 million; National Health Service Corps (NHSC), $860 million in total program funding; Agency for Healthcare Research and Quality (AHRQ), $500 million; Centers for Medicare and Medicaid Services (CMS), Program Operations for Federal Exchanges, $296.5 million. Also, urged support for the VA, Veterans Health Administration (VHA), $103.1 billion, which includes the following within the VHA -- VA, VHA, Medical Services, $66.2 billion, VA, VHA, Medical Community Care, $20.7 billion, VA, VHA, Medical and Prosthetic Research; $902 million. COVID-19: Urged congressional appropriators to provide the highest possible funding level for research, prevention, control, and treatment of illnesses associated with the virus that is commensurate with the public health emergency that the virus represents. Urged the administration to explore regulatory and other actions that would make COVID-19 testing free-of-charge to patients covered by both public and private insurance plans, including ACA-compliant plans offered through the insurance exchanges, and to waive co-pays and deductibles for patients seeing physicians for symptoms that may be indicative of COVID-19 or who are hospitalized for treatment. Urged CMS to utilize a national disaster recovery program that would pay doctors 110% of Medicare rates for caring for uninsured patients who have been infected with SARS-CoV-2. Expressed support to Congress and the administration for a variety of COVID-related bills from the 116th Congress as follows: the Families First Coronavirus Response Act, H.R. 6201, and other stimulus reforms related to COVID-19 including: Emergency paid leave benefits, paid sick days for public health emergencies, coverage of testing for COVID-19, waiving of cost sharing under Medicare, Medicare Advantage, Medicaid, and CHIP, increasing the federal FMAP under Medicaid, providing reimbursement for CPT codes 99441 - 99443, which are telephone evaluation and management services, expediting entrance of international medical graduates who are citizens of other nations (non-US IMGs) into the country and ensuring that lawfully present non-U.S. IMGs are not negatively impacted by the COVID-19 pandemic, funding for physician practices under the Public Health and Social Service Emergency Fund (PHSSEF), providing tax relief, grants, and loans to small and medium size practices impacted by COVID-19, increasing funding for personal protective equipment (PPE), ensuring Medicaid pay parity with Medicare for primary care services; Urged support for the Student Loan Forgiveness for Frontline Health Workers Act, H.R. 6720, introduced May 5, 2020 by Representative Carolyn B. Maloney (D-NY) which would eliminate graduate school debt for healthcare workers, including physicians and medical students, who are providing direct patient care in response to the COVID-19 pandemic; Urged support for H.R. 7059, the Coronavirus Provider Protection Act, which extend liability protections to those who provide care in good faith during the COVID-19 public health emergency (plus a reasonable time, such as 60 days, after the emergency declaration ends), and not in situations of gross negligence or willful misconduct. The College also urged that pay parity between telephone claims and in-person visits and between all telehealth and in-person visits be maintained after the PHE is lifted. This extension-either continued by CMS or mandated by Congress-should last at least through the end of 2021, or until such a time when effective vaccines and treatments are widely available, with an option to extend it even further, or consider making permanent, based on the experience and learnings of patients and physicians who are utilizing these visits. Urged congress to mitigate the impact of covid across racial and ethnic minority populations by collect covid-19 and racial disparity data, equitably distribute covid-19 vaccines and treatments, protect essential workers, permanently expand access to family and medical leave, address environmental and social drivers of health, integrate primary care and behavioral health, improve mental health parity with increased federal oversight and enforcement, make naloxone more available to prevent overdose, expand medication-assisted treatment (mat) for physicians, establish a national prescription drug monitoring program (PDMP). American Rescue Plan (ARP) Act (H.R. 1319): Urged support for various provisions within the ARP to provide incentives for states to expand Medicaid by temporarily increasing the states base FMAP by five percentage points for two years for states that newly expand Medicaid. Urged support for allowing states, for five years, to extend Medicaid eligibility (and CHIP eligibility) to women for 12 months postpartum. Urged support to require Medicaid coverage of COVID-19 vaccines and treatment without beneficiary cost sharing with vaccines matched at a 100 percent federal medical assistance percentage (FMAP) through one year after the end of the PHE. Urged support for $46 billion to HHS to detect, diagnose, trace, and monitor COVID-19 infections, and for other activities necessary to mitigate the spread of COVID-19. Urged support to subsidize the health coverage of people earning up to 150 percent of the federal poverty level (FPL) under the ACA and those on unemployment insurance for a period of two years. Urged support for waiving VA cost sharing and copayments for medical treatment until September 30, 2021. Patient Identifier: Urged Congress to reject the inclusion of outdated rider language in Section 510 of the Fiscal Year 2022 Labor, Health and Human Services, and Education and Related Agencies (Labor-HHS) Appropriations bill that prohibits the US Department of Health and Human Services (HHS) from spending any federal dollars to promulgate or adopt a national unique health identifier standard. Womens Health: Urged Congress to support, H.R. 958, the Protecting Moms Who Served Act, which would provide critical support for maternity care coordination programs to address the clinical and nonclinical perinatal needs of veterans and ensure effective coordination between VA and non-VA facilities in the delivery of maternity care and other health care services. Urged HHS to promptly finalize new Title X regulations that ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminates medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protects funding for and ensures consistent treatment of qualified service sites. Expand Health Coverage and Affordability: Urged Congress to support H.R. 340, the Incentivizing Medicaid Expansion Act of 2021, to expand federal matching assistance for states that choose to expand Medicaid, regardless of when such expansion takes place. Introduce and pass the companion bill in the Senate and H.R. 369, the Health Care Affordability Act of 2021, to permanently expand eligibility for higher premium tax credits under the ACA. Train and Support Frontline Physicians during and after COVID-19: Urged Congress to support H.R. 2256/S. 834, the Resident Physician Reduction Shortage Act of 2021, to increase the number of GME slots by at least 2,000 per year over seven years (14,000 slots) for specialties facing shortages, including internal medicine; H.R. 1554 (116th Congress), the Resident Education Deferred Interest Act, to allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program; S. 948, the Conrad State 30 and Physician Access Reauthorization Act (116th Congress) and S. 3599 (116th Congress), the Healthcare Workforce Resilience Act, to support the COVID-19 response workforce by expediting visas for international medical graduates (IMGs) to enter the U.S. for training and patient care, permanently authorizing the Conrad 30 Program, and providing a pathway for IMGs and their families already in the U.S to obtain permanent residency status; H.R. 2418, the Student Loan Forgiveness for Frontline Health Workers Act, to forgive student loans for physicians and other clinicians who are on the frontlines of providing care to COVID-19 patients or helping the health care system cope with the COVID-19 public health emergency; H.R. 1667/S. 610, the Dr. Lorna Breen Health Care Provider Protection Act, to address the behavioral health and well-being of physicians, including depression, suicides and burnout. Support the Value of Primary and Comprehensive Care: Urged Congress to Continue to fund the 3.75 percent increase to all physicians services that was approved by Congress at the end of last year to prevent CY2022 budget neutrality cuts for physician services, including primary care visits and other evaluation and management services; Ensure that any legislation that addresses budget neutrality treats all services fairly and equitably; Pass H.R. 1025, the Kids Access to Primary Care Act, to increase access to health coverage for Medicaid patients by achieving payment parity for primary care services under Medicaid and Medicare; Extend the five percent bonus that physicians receive if they meet performance expectations in Advanced APMs that is set to expire at the end of 2022; Act before the end of CY2021 to prevent scheduled cuts for physician services, including primary care, resulting from budget sequestration and pay-as-you go budget rules. Improve Access to Prescription Drugs and Reduce Costs: Urged Congress to support S. 898, the Fair Drug Pricing Act, to require drug companies to disclose and provide more information about imminent drug-price increases, including data about research and development costs; S. 833, the Empowering Medicare Seniors to Negotiate Drug Prices Act of 2021, to help to reduce drug prices and out-of-pocket costs by allowing the federal government to negotiate lower drug prices on behalf of Medicare beneficiaries; S. 141, the End Taxpayer Subsidies for Drug Ads Act, to end the federal tax deduction that pharmaceutical companies use to pay for drug advertising; S. 464/H.R. 2163, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Support Essential Public Health and Research Initiatives: Urged Congress to support H.R. 8, the Bipartisan Background Checks Act that would establish new background check requirements for firearm transfers between private parties; H.R. 3076/S. 506, the Extreme Risk Protection Order Act from the 116th Congress, to establish a grant program to help states and Indian tribes implement extreme risk protection order laws and expands categories of individuals who are prohibited from receiving, possessing, shipping, or transporting a firearm; H.R. 3271/S. 1702, the Climate Change Health Protection and Promotion Act that would take important steps to mitigate the harmful impact of climate change on health. Promote Health Equity, Social Justice, and Eliminate Disparities: Urged Congress to support H.R. 1280, the George Floyd Justice in Policing Act of 2021, to overhaul qualified immunity for law enforcement, prohibit racial profiling on the part of law enforcement and ban no-knock warrants in federal drug cases and chokeholds and carotid holds at the federal level; H.R. 5, the Equality Act, to prohibit discrimination based on sex, sexual orientation and gender identity in public accommodations and facilities, education, federal housing credit and the jury system; H.R. 666/S. 162, the Anti-Racism in Public Health Act of 2021, to establish within the CDC a National Center on Anti-racism and Health for data collection and research and a law enforcement violence prevention program; H.R. 959/S. 346, the Black Maternal Health Momnibus Act of 2021, to reduce preventable maternal mortality and severe maternal morbidity in the U.S. and close disparities in maternal health outcomes, particularly among pregnant minority women. Expand Access to Telehealth Services and Promote Patient Safety/Privacy; Urged Congress to support H.R. 2903/S. 1512, the CONNECT for Health Act, to remove arbitrary barriers to telehealth services such as geographic and site of service restrictions; S. 168/H.R. 708, the Temporary Reciprocity to Ensure Access to Treatment Act or the TREAT Act, to ensure that telehealth services can be provided across states lines after the public health emergency ends; Urged appropriators to include adequate funding in FY2022 to support expansion of broadband capabilities nationwide, especially to rural and underserved communities, and to remove the ban on adoption of a national unique health identifier standard.

Client expense: $98,181 · 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, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS)

S.3548, CARES Act: To provide emergency assistance and health care response for individuals, families, and businesses affected by the 2020 coronavirus pandemic; Practice Support/Grants to Practice S.3599, Healthcare Workforce Resilience Act: Foreign physician immigration status H.R. 7059, Coronavirus Provider Protection Act: Liability protection for healthcare providers Public Law No: 116-142, Paycheck Protection Program Flexibility Act of 2020 S.3201, Temporary Reauthorization and Study of the Emergency Scheduling of Fentanyl Analogues Act: Letter to Congressional Leadership regarding Fentanyl S.2723, Mitigating Emergency Drug Shortages Act: reducing drug shortages H.R. 3502, Protecting People From Surprise Medical Bills Act: Surprise Medical Bills H.R. 2500, National Defense Authorization Act for Fiscal Year 2020: Krishnamoorthi amdt on drug shortages H.R. 3107, Improving Seniors' Timely Access to Care Act of 2019: pre-authorization S. 1895, Lower Health Care Costs Act H.R. 3692, Addiction Treatment Access Improvement Act of 2017: Medically assisted treatment; opioids H.R. 5761, Ending Maternal Mortality Act of 2018: Maternal mortality H.R. 5718, Perioperative Reduction of Opioids Act: Opioids H.R. 5197, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S. 2516, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S.2680, Opioid Crisis Response Act of 2018: Medically assisted treatment; opioids S.2456, CARA 2.0 Act of 2018: Medically assisted treatment; opioids H.R. 1565, Saving Lives, Saving Costs S.1475, Saving Lives, Saving Costs S.4349, Dr. Lorna Breen Health Care Provider Protection Act: physician health Comprehensive Addiction and Recovery Act of 2016 (PL 114-198) FY 2021 LHHS Appropriations: Fiscal Year 2021 Appropriations for Subcommittee on Labor, Health and Human Services Outside Witness Testimony Affordable Care Act reform efforts H.R. 1628, American Health Care Act of 2017 S. Amdt. 1030 to H.R. 1628, "Graham-Cassidy" Better Care Reconciliation Act of 2017 H.R. 1492, Medical Controlled Substances Transportation Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 3545, Overdose Prevention and Patient Safety Act H.R. 3446, Restoring Board Immunity Act of 2017: Professional Licensing S.2260, Opioids and STOP Pain Initiative ACT:opioids 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records: appropriate access to patient information essential for providing whole-person care H.R.3928, Truth in Healthcare Marketing Act of 2017 H.R. 1554, REDI Act: student loan debt repayment for residents H.R.842, Protecting the Right to Organize Act of 2021: PRO Act, labor protections 21st Century Cures Initiative Drug Shortages - FDA, DEA, HHS, CMS, GAO, House Energy and Commerce Committee, Senate HELP Committee DEA Scheduling Propofol Comparative Effectiveness Research - PCORI HITECH Implementation, Electronic Health Records, Final and Proposed Rules, HIT Meaningful Use HHS/OIG Anesthesia Practice Arrangements, Company Model FDA Safe Use Initiative Pain Management FTC Letters to States re: Interventional Pain Medicine & Advanced Practice Nurses & Competition in Healthcare Anesthesia Research Funding (Pediatric and others) Scope of Practice FDA Operating Room Fires Naloxone FDA Opioids Prescription Drug Abuse FDA Network of Experts NIH Interagency Pain Research Coordinating Committee FDA SMART TOTS - pediatric anesthesia research USP - US Pharmacopeia National Pain Strategy Nondiscrimination Compounding FDA Nominations to Advisory Committees (Anesthesia Drugs, Anesthesia Devices, Compounding) Agency for Healthcare Research and Quality (AHRQ) funding Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Sequestration Opioids and opioid abuse; Brain health Certified Anesthesiologist Assistants Blood management COVID-19: Increased supply of PPE and ventilators, Funding for physician practices impacted by the cancellation of elective surgeries, unique role of anesthesiologists in responding to COVID-19 pandemic, medical liability, Scope of Practice (Waiver of federal supervision requirement under the Emergency Declaration), insurance moratorium; COVID Update Memorandum 4/21/20 Centre for Clinical and Applied Services Provision Research

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Healthcare Workforce Resilience Act, S. 3599 (Support)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Child Tax Credit/Earned Income Tax Credit - The Omnibus and COVID Relief and Response Act, HR 133 (Support) Mixed Status Family Eligibility - The Omnibus and COVID Relief and Response Act, HR 133 (Support) American Citizen Coronavirus Relief Act, S. 4071 (Support) Healthcare Workforce Resilience Act, S. 3599 (Support)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Healthcare Workforce Resilience Act, S. 3599 (Support)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Child Tax Credit/Earned Income Tax Credit - The Omnibus and COVID Relief and Response Act, HR 133 (Support) Mixed Status Family Eligibility - The Omnibus and COVID Relief and Response Act, HR 133 (Support) American Citizen Coronavirus Relief Act, S. 4071 (Support) Healthcare Workforce Resilience Act, S. 3599 (Support)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 948, Conrad State 30 and Physician Access Reauthorization Act, all provisions H.R. 2895, Conrad State 30 and Physician Access Reauthorization Act, all provisions H.R. 6788, Healthcare Workforce Resilience Act, all provisions S. 3599, Healthcare Workforce Resilience Act, all provisions Executive Orders related to immigration/international medical graduates J-1 Visa/duration of status USCIS collection and use of biometrics H-1B Visas

Client expense: $3,870,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), SENATE, Veterans Affairs, Dept of (VA), White House Office

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

Child Tax Credit/Earned Income Tax Credit - The Omnibus and COVID Relief and Response Act, HR 133 (Support) Mixed Status Family Eligibility - The Omnibus and COVID Relief and Response Act, HR 133 (Support) American Citizen Coronavirus Relief Act, S. 4071 (Support) Healthcare Workforce Resilience Act, S. 3599 (Support)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Healthcare Workforce Resilience Act, S. 3599 (Support)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare Reimbursement. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response to the outbreak. Monitoring and outreach on legislative activity related to the HEALS Act (S. 4317 - S. 4324). Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor implementation of 21st Century Cures Act (P.L. 114-255). House Draft, Department of Defense Appropriations Act, FY 2021. Senate Draft, Department of Defense Appropriations Act, FY 2021. H.R. 3, Lower Drug Costs Now Act of 2019. H.R.748, CARES Act (P.L. 116-136) and other legislation related to the policies in reaction to the national health crisis. H.R.7010, Paycheck Protection Program Flexibility Act of 2020 (P.L. 116-142). H.R. 1158, FY2020 Consolidated Appropriations Act (Defense, CJS, FSGG, Homeland Security). H.R. 1554, REDI Act. H.R. 2087, To amend title XVIII of the Social Security Act to require certain manufacturers to report drug pricing information with respect to drugs under the Medicare program, and for other purposes. H.R. 2279, Safe Step Act. H.R. 2693, To amend title XVIII of the Social Security Act to improve access to, and utilization of, bone mass measurement benefits under part B of the Medicare program by establishing a minimum payment amount under such part for bone mass measurement. H.R. 2781, Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness for Health Act of 2019. H.R. 3107, Improving Seniors' Timely Access to Care Act of 2019. H.R. 4378, FY2020 Continuing Appropriations Resolution (P.L. 116-59). S. 64, Preserve Access to Affordable Generics and Biosimilars Act. S. 283, Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2019. S. 1391, Fair Accountability and Innovative Research Drug Pricing Act of 2019. S. 2543, Prescription Drug Pricing Reduction Act of 2019. S. 2546, Safe Step Act. H.R. 1763, Resident Physician Shortage Reduction Act. S. 348, Resident Physician Shortage Reduction Act. H.R. 6788, Workforce Resilience Act. S. 3599, Workforce Resilience Act. H.R. 5741, Strengthening Innovation in Medicare and Medicaid Act. H.R. 8505, To amend title XVIII of the Social Security Act to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule, and for other purposes H.R. 8702, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 H.R. 6644/S. 3741, Health Care at Home Act H.R. 4932/S. 2741, The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act H.R. 266, Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139). S. 4014, The Prioritized Paycheck Protection Program (P4) Act. S. 4116, A bill to extend the authority for commitments for the paycheck protection program and separate amounts authorized for other loans under section 7(a) of the Small Business Act, and for other purposes (P.L. 116-147). S.4775, Delivering Immediate Relief to America's Families, Schools and Small Businesses Act. H.R. 6800, The Heroes Act. H.R. 8337 - Continuing Appropriations Act, 2021 and Other Extensions Act (P.L. 116-159). P.L. 116-260, FY2021 Omnibus and COVID Relief and Response Act. H.R. 133: Consolidated Appropriations Act, 2021.

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare Reimbursement. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response to the outbreak. Monitoring and outreach on legislative activity related to the HEALS Act (S. 4317 - S. 4324). Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor implementation of 21st Century Cures Act (P.L. 114-255). House Draft, Department of Defense Appropriations Act, FY 2021. Senate Draft, Department of Defense Appropriations Act, FY 2021. H.R. 3, Lower Drug Costs Now Act of 2019. H.R.748, CARES Act (P.L. 116-136) and other legislation related to the policies in reaction to the national health crisis. H.R.7010, Paycheck Protection Program Flexibility Act of 2020 (P.L. 116-142). H.R. 1158, FY2020 Consolidated Appropriations Act (Defense, CJS, FSGG, Homeland Security). H.R. 1554, REDI Act. H.R. 2087, To amend title XVIII of the Social Security Act to require certain manufacturers to report drug pricing information with respect to drugs under the Medicare program, and for other purposes. H.R. 2279, Safe Step Act. H.R. 2693, To amend title XVIII of the Social Security Act to improve access to, and utilization of, bone mass measurement benefits under part B of the Medicare program by establishing a minimum payment amount under such part for bone mass measurement. H.R. 2781, Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness for Health Act of 2019. H.R. 3107, Improving Seniors' Timely Access to Care Act of 2019. H.R. 4378, FY2020 Continuing Appropriations Resolution (P.L. 116-59). S. 64, Preserve Access to Affordable Generics and Biosimilars Act. S. 283, Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2019. S. 1391, Fair Accountability and Innovative Research Drug Pricing Act of 2019. S. 2543, Prescription Drug Pricing Reduction Act of 2019. S. 2546, Safe Step Act. H.R. 1763, Resident Physician Shortage Reduction Act. S. 348, Resident Physician Shortage Reduction Act. H.R. 6788, Workforce Resilience Act. S. 3599, Workforce Resilience Act. H.R. 5741, Strengthening Innovation in Medicare and Medicaid Act. H.R. 8505, To amend title XVIII of the Social Security Act to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule, and for other purposes H.R. 8702, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 H.R. 6644/S. 3741, Health Care at Home Act H.R. 4932/S. 2741, The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act H.R. 266, Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139). S. 4014, The Prioritized Paycheck Protection Program (P4) Act. S. 4116, A bill to extend the authority for commitments for the paycheck protection program and separate amounts authorized for other loans under section 7(a) of the Small Business Act, and for other purposes (P.L. 116-147). S.4775, Delivering Immediate Relief to America's Families, Schools and Small Businesses Act. H.R. 6800, The Heroes Act. H.R. 8337 - Continuing Appropriations Act, 2021 and Other Extensions Act (P.L. 116-159). P.L. 116-260, FY2021 Omnibus and COVID Relief and Response Act. H.R. 133: Consolidated Appropriations Act, 2021.

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare Reimbursement. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response to the outbreak. Monitoring and outreach on legislative activity related to the HEALS Act (S. 4317 - S. 4324). Monitor implementation of the Patient Protection and Affordable Care Act (P.L. 111-148). Monitor implementation of Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114-10). Monitor implementation of 21st Century Cures Act (P.L. 114-255). House Draft, Department of Defense Appropriations Act, FY 2021. Senate Draft, Department of Defense Appropriations Act, FY 2021. H.R. 3, Lower Drug Costs Now Act of 2019. H.R.748, CARES Act (P.L. 116-136) and other legislation related to the policies in reaction to the national health crisis. H.R.7010, Paycheck Protection Program Flexibility Act of 2020 (P.L. 116-142). H.R. 1158, FY2020 Consolidated Appropriations Act (Defense, CJS, FSGG, Homeland Security). H.R. 1554, REDI Act. H.R. 2087, To amend title XVIII of the Social Security Act to require certain manufacturers to report drug pricing information with respect to drugs under the Medicare program, and for other purposes. H.R. 2279, Safe Step Act. H.R. 2693, To amend title XVIII of the Social Security Act to improve access to, and utilization of, bone mass measurement benefits under part B of the Medicare program by establishing a minimum payment amount under such part for bone mass measurement. H.R. 2781, Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness for Health Act of 2019. H.R. 3107, Improving Seniors' Timely Access to Care Act of 2019. H.R. 4378, FY2020 Continuing Appropriations Resolution (P.L. 116-59). S. 64, Preserve Access to Affordable Generics and Biosimilars Act. S. 283, Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2019. S. 1391, Fair Accountability and Innovative Research Drug Pricing Act of 2019. S. 2543, Prescription Drug Pricing Reduction Act of 2019. S. 2546, Safe Step Act. H.R. 1763, Resident Physician Shortage Reduction Act. S. 348, Resident Physician Shortage Reduction Act. H.R. 6788, Workforce Resilience Act. S. 3599, Workforce Resilience Act. H.R. 5741, Strengthening Innovation in Medicare and Medicaid Act. H.R. 8505, To amend title XVIII of the Social Security Act to provide for a one-year waiver of budget neutrality adjustments under the Medicare physician fee schedule, and for other purposes H.R. 8702, Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 H.R. 6644/S. 3741, Health Care at Home Act H.R. 4932/S. 2741, The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act H.R. 266, Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139). S. 4014, The Prioritized Paycheck Protection Program (P4) Act. S. 4116, A bill to extend the authority for commitments for the paycheck protection program and separate amounts authorized for other loans under section 7(a) of the Small Business Act, and for other purposes (P.L. 116-147). S.4775, Delivering Immediate Relief to America's Families, Schools and Small Businesses Act. H.R. 6800, The Heroes Act. H.R. 8337 - Continuing Appropriations Act, 2021 and Other Extensions Act (P.L. 116-159). P.L. 116-260, FY2021 Omnibus and COVID Relief and Response Act. H.R. 133: Consolidated Appropriations Act, 2021.

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

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

Monitor healthcare cost initiatives; Health information technology & healthcare privacy issues; Issues related to privacy in the healthcare space; Continued monitoring of implementation of Public Law 116-123, Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020; Continued monitoring of implementation of Public Law 116-127, Families First Coronavirus Response Act; Continued monitoring of implementation of Public Law 116-136, CARES Act - proposals related to physician and provider relief; H.R, 6800, The Heroes Act (including Medicare Accelerated Payment program, increased FMAP payments, COBRA coverage, increased funding for HHS Provider Fund, changes to the Paycheck Protection Program, medical liability reform); S. 3599 - Healthcare Workforce Resilience Act; H.R. 925, The Heroes Act; Issues related to national health information technology standards; H.R. 133, Consolidated Appropriations Act, 2021 (Public Law 116-260)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6, American Dream and Promise Act of 2019 H.R. 60, Better Agriculture Resources Now (BARN) Act H.R. 250, Legal Workforce Act H.R. 549, Venezuela TPS Act of 2019 H.R. 641/S. 175, Agricultural Worker Program Act of 2019 H.R. 648, Consolidated Appropriations Act, 2019 H.R. 748, Coronavirus Aid, Relief, and Economic Security (CARES) Act H.R. 773, To Terminate the EB-5 program H.R. 1044/S. 386, Fairness for High-Skilled Immigrants Act of 2019 H.R. 1158, Consolidated Appropriations Act, 2020 H.R. 1399/S.556, Accountability Through Electronic Verification Act H.R. 1740, Workforce for an Expanding Economy Act H.R. 1778, Dairy and Sheep H-2A Visa Enhancement Act H.R. 1865, Further Consolidated Appropriations Act, 2020 H.R. 1996, Secure Travel Partnership Act of 2019 H.R. 2187, Jobs Originated through Launching Travel (JOLT) Act of 2019 H.R. 2278/S. 1103, Reforming American Immigration for a Strong Economy (RAISE) Act H.R. 2413, Nicaragua TPS Act of 2019 H.R. 2418/H.R. 2877/S. 3134, To add Ireland to the E-3 nonimmigrant visa program H.R. 2658, Commercial Fishing and Seafood Business Act of 2019 H.R. 2783, TPS and DED Protection Act of 2019 H.R. 2813, Asylum Seeker Work Authorization Act of 2019 H.R. 2820, Dream Act of 2019 H.R. 2821, American Promise Act of 2019 H.R. 2895/S. 948, Conrad State 30 and Physician Access Reauthorization Act H.R. 3033, H-4 Employment Protection Act of 2019 H.R. 3055, Further Continuing Appropriations Act, 2020, and Further Health Extenders Act of 2019 H.R. 3319, Paperwork Reduction for Farmers and H-2A Modernization Act H.R. 3401/S. 1900, Emergency Supplemental Appropriations for Humanitarian Assistance and Security at the Southern Border Act, 2019 H.R. 3564, Fairness for High-Skilled Americans Act of 2019 H.R. 3740, AGRI Act of 2019 H.R. 4218, Poland Visa Waiver Act of 2019 H.R. 4482, Protecting America's Food and Agriculture Act of 2019 H.R. 4498, Promoting Tourism to Enhance our Economy Act of 2019 H.R. 5038, Farm Workforce Modernization Act of 2019 H.R. 5174, State Sponsored Visa Pilot Program Act of 2019 H.R. 6379, Take Responsibility for Workers and Families Act H.R. 6395/S. 4049, National Defense Authorization Act for Fiscal Year 2021 H.R. 6507, COVID-19 Employment Authorization Document Extension Act H.R. 6717, Health Care Workforce Protection Act of 2020 H.R. 6788/S. 3599, Healthcare Workforce Resilience Act H.R. 6800, The Heroes Act H.R. 6870, Landscaping Workforce Act of 2020 H.R. 6905, FIRST COVID-19 Care Delivery Act of 2020 H.R. 6993/S. 3770, H-1B and L-1 Visa Reform Act of 2020 H.R. 7508, To provide supplemental appropriations to U.S. Citizenship and Immigration Services, and for other purposes. H.R. 7669, Department of Homeland Security Appropriations Act, 2021 H.R. 8046, Improving Opportunities for New Americans Act of 2020 H.R. 8078, Emergency Stopgap USCIS Stabilization Act H.R. 8089, Emergency Stopgap USCIS Stabilization Act H.R. 8337, Continuing Appropriations Act, 2021 and Other Extensions Act S. 135, Prioritizing Help to Businesses Act S. 301, E-Verify Act of 2019 S. 328, Startup Act S. 599, Singh's Law S. 636, Venezuela Temporary Protected Status Act of 2019 S. 874, Dream Act of 2019 S. 1004, Securing America's Ports of Entry Act of 2019 S. 1744, Keep STEM Talent Act of 2019 S. 1806, Permanent E-Verify Act S. 1887, Paperwork Reduction for Farmers and H-2A Modernization Act S. 2091, Backlog Elimination, Legal Immigration, and Employment Visa Enhancement Act S. 2540, EB-5 Reform and Integrity Act of 2019 S. 2778, Immigrant Investor Program Reform Act S. 2863, E Visa Integrity Act of 2019 S. 2926, Advancing Mutual Interests and Growing Our Success (AMIGOS) Act S. 3470, New Deal for New Americans Act of 2020 S. 3504, A bill to require the Secretary of Homeland Security to extend, until not earlier than September 30, 2021, the requirement that State-issued identification must be compliant with the REAL ID Act of 2005 to be accepted by Federal agencies for certain purposes H.J.Res. 31, Consolidated Appropriations Act, 2019 Potential legislation similar to H.R. 6794/S. 2344, Immigration Innovation Act of 2018 Proposed rule regarding registration requirement for petitioners seeking to file H-1B petitions on behalf of cap-subject aliens (83 Fed. Reg. 62,406-62,447, December 3, 2018) Interim final rule on strengthening the H-1B nonimmigrant visa classification program (85 Fed. Reg. 63,918-63,965, October 8, 2020) Interim final rule on strengthening wage protections for the temporary and permanent employment of certain aliens in the United States, (85 Fed. Reg. 63,872-63,915, October 8, 2020) Proposed rule establishing a fixed time period of admission and an extension of stay procedure for nonimmigrant academic students, exchange visitors, and representatives of foreign information media; 85 Fed. Reg. 60,526-60,598, September 25, 2020) Various issues relating to visa waiver program; H-1B Visa Program; H-1B registration rule; H-2 Visa Program and temporary rule; H-4 rule; L-1 Visa Program; EB-5 Visa Program; EB-5 rule; EB-5 regional center program; H-2A Visa Program; E-Verify program; I-129 form delay request; private-public partnerships with the Department of Homeland Security at land border ports of entry; STEM visa reform; nonimmigrant workers in temporary or seasonal nonagricultural employment; Customs and Border Protection staffing at U.S. ports of entry; border security; immigration policy and reforms; guest worker programs; legalization concepts; visa reform; customs trade facilitation and enforcement; Deferred Action for Childhood Arrivals (DACA) program; extension of temporary protected status (TPS) designations for El Salvador, Honduras, and Haiti; administrative-regulatory efforts related to public charge, notice to appear, H-4 & OPT; supplemental funding for additional Customs and Border Protection (CBP) officers at ports-of-entry; United States Citizenship and Immigration Services (USCIS) decision on electronic registration for the fiscal year (FY) 2021 H-1B cap filing season and stakeholder engagement for the H-1B registration tool; United States Citizenship and Immigration Services (USCIS) fee schedule; United States Citizenship and Immigration Services (USCIS) funding; Presidential Proclamation 9996, suspension of entry as immigrants and nonimmigrants of certain additional persons who pose a risk of transmitting 2019 Novel Coronavirus, March 14, 2020; Presidential Proclamation 10014, suspending entry of immigrants who present risk to the U.S. labor market during the economic recovery following the COVID-19 outbreak, April 22, 2020; Presidential Proclamation 10052, suspending entry of aliens who present a risk to the U.S. labor market following the Coronavirus outbreak, June 22, 2020; Potential recision of the Deferred Action for Childhood Arrivals (DACA) program; comments on modification of registration requirement for petitioners seeking to file cap-subject H-1B petitions; comments on request for 60-Day comment period (30-day extension); high-skilled immigration; lesser skilled immigration; temporary agriculture guest worker; temporary non-agriculture guest worker; optional practical training program; size and administration of employment-based immigrant visa categories; size and administration of family-based immigrant visa categories; expansion of the use of the E-Verify system; employment verification; interior enforcement; family separations; family reunification; temporary suspension of entry of nationals from certain countries; increased vetting of visa applicants; unfair immigration related employment practices; travel issues; trusted traveler programs; biometric entry-exit; increasing the number of ICE officers, border patrol agents and Customs and Border Protection officers; aerial security enhancements; temporary DHS guidance for the I-9 employment verification process in the wake of COVID-19; Department of Labor Guidance on Labor Condition Application requirements in the wake of COVID-19; temporary Department of Labor procedural changes regarding the Permanent Labor Certification process in the wake of COVID-19; State Department policy accommodations regarding the use of interview waivers for H-2 nonimmigrant workers in the wake of COVID-19; temporary United States Citizenship and Immigration Services (USCIS) procedures to provide flexibility with regard to filing deadlines, and temporary USCIS guidelines providing flexibility to wet-ink signatures on USCIS forms and documents; United States Citizenship and Immigration Services (USCIS) funding shortfalls; Customs and Border Protection (CBP) funding shortfalls; clarification of the criteria that makes one eligible for a waiver from the entry restrictions for various employment-based immigrants and nonimmigrants; regulatory proposals that would restrict applicant eligibility for the H-1B program; regulatory proposals that would drastically change how prevailing wage levels are determined for the purposes of obtaining certain employment nonimmigrant and immigrant visas; proposals that would significantly change how cap-subject H-1B petitions will be chosen in the future; regulatory proposals that would change how the period of admission for student visa holders and exchange visa holders is determined; enhanced COVID-19 testing protocols for international air travel; creation/use of digital passports

Client expense: $22,290,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Bureau of Citizenship & Immigration Services (BCIS), Bureau of Industry and Security (BIS), Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Consumer Financial Protection Bureau (CFPB), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Aviation Administration (FAA), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Emergency Management Agency (FEMA), Federal Energy Regulatory Commission (FERC), Federal Reserve System, Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Natl Telecommunications & Information Administration (NTIA), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), Office of the Comptroller of the Currency (OCC), Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office

International medical graduates and visa extensions. H.R. 2895/ S. 948, the Conrad State 30 and Physician Access Reauthorization Act H.R. 6788/S. 3599, the Healthcare Workforce Resilience Act DACA status protections for healthcare workforce members. Efforts to better control confidential therapy records sharing for detained children. Additional efforts RE: child separation.

Client expense: $238,000 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of the Vice President of the United States, SENATE, Veterans Affairs, Dept of (VA), White House Office

Bill # H.R. 647 and S2080: Palliative Care and Hospice Education and Training Act. Establishes Palliative Care and Hospice Education Centers to increase access to palliative care Bill # H.R. 728: Title VIII Nursing Workforce Reauthorization Act.To amend title VIII of the Public Health Service Act to extend advanced education nursing grants to support clinical nurse specialist programs Bill # H.R. 1767 and S824: Excellence in Mental Health and Addiction Treatment Expansion Act. To increase the number of states that may conduct Medicaid demonstration programs to improve access to community mental health services Bill # H.R. 2062 and S1012: Overdose Prevention and Patient Safety Act.Amends the Public Health Service Act to protect the confidentiality of substance use disorder patient records Bill # H.R. 2431 and S2500: Mental Health Professionals Workforce Shortage Loan Repayment Act. Authorizes a loan repayment program for mental health professionals to relieve workforce shortages Bill #H.R. 2482 and S2074: Mainstreaming Addiction Treatment (MAT) Act. Loosens restrictions on doctors prescribing buprenorphine for addiction treatment Bill #H.R. 2895 and S948: Conrad State 30 and Physician Access Reauthorization Act. Reauthorizes the Conrad 30 program through FY 2021 Bill #H.R. 3165 and S1737: Mental Health Parity Compliance Act. To achieve complete implementation of the Mental Health Parity and Addiction Equity Act (federal parity law) Bill #H.R. 4004 and S2986: Social Determinants Accelerator Act. To direct the Secretary of Health and Human Services to establish an interagency council on social determinants of health Bill #H.R. 4468: Nursing Home Workforce Quality Act. To address the shortage of certified nursing assistants (CNAs) Bill #H.R. 4859: Protecting Older Americans from Social Isolation Act. To amend the Older Americans Act to reduce social isolation among older individuals Bill #H.R. 5242: Opioid Settlement Accountability Act. To ensure that opioid settlement funds are used to fight the opioid epidemic, including treatment, prevention, education and enforcement efforts. Bill # H.R. 945 and S286: Mental Health Access Improvement Act. To provide for the coverage of marriage and family therapist services and mental health counselor services under Medicare Bill # H.R. 986:Protecting Americans with Preexisting Conditions Act.To prevent the promotion of short-term, limited duration insurance plans and association health plans Bill #S1399:Title VIII Nursing Workforce Reauthorization Act.To amend title VIII of the Public Health Service Act to extend advanced education nursing grants to support clinical nurse specialist programs Bill #S1895 Lower Health Care Costs Act Bill # HR5640 and S3152:Data Mapping to Save Moms' Lives Act. To require the Federal Communications Commission to incorporate data on maternal health outcomes into its broadband health maps. Bill # S3374: Protecting Jessica Grubbs Legacy Act. Amends the Public Health Service Act to protect the confidentiality of substance use disorder patient records. Bill S3599 and HR6788 Healthcare Workforce Resilience Act to expand the number of immigrant visas available to nurses and physicians Bill # HR748 S3548: Coronavirus Aid, Relief, and Economic Security Act provides financial relief and resources to individuals, families, and businesses impacted by the COVID-19 public health emergency. Bill # 7010 Paycheck protection program flexibility Bill #HR7292 Advanced Accelerated Payment Program forgiveness Bill HR 7077 and S3877 Community Solutions for COVID-19 Act grants to reduce or eliminate disparities HR 8200 Ending health disparities during COVID-19 Bill HR7838 and S4160 To enable certain hospitals participating in 340B drug discount program prior to COVID-19 public health emergency to maintain eligibility

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

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

HR 6788 and S 3599 Healthcare Workforce Resilience act to enhance our nation's nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas.

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

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

Healthcare and COVID-19 measures included in the Consolidated Appropriations Act of 2020 (H.R. 133) Public Health and Social Services Emergency Fund (coronavirus relief packages-H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800, H.R. 6800, HEALS Act, S. 4775, H.R. 133) Provider Relief Fund Reporting Requirements Regulatory relief in light of coronavirus (all coronavirus relief packages - H.R. 6074, H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800, H.R. 6800, HEALS Act, S. 4775, H.R. 133) Healthcare Workforce Resilience Act (S. 3599/H.R. 6788) Hospital Price Transparency (surprise medical bills; public posting of hospital charges; Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First; Final Rule on Price Transparency; Transparency in Coverage Proposed Rule; inpatient prospective payment system rule) Surprise Medical Bills (H.R. 133; H.R. 5826; H.R. 3630; S. 1531) Liability relief (S. 4317; all coronavirus relief packages - H.R. 6074, H.R. 6201, H.R. 748, H.R. 7010, H.R. 6800; H.R. 6800, HEALS Act, S. 4775, H.R. 133) H.R. 7538, Essential Workforce Parity Act (providing liability relief and amending FMLA leave provisions) S. 3763 / H.R. 6953, Pandemic Responder Service Award Act Hospital preparedness program (H.R. 6074) 340B Drug Pricing Program (S. 4160) Public Health Emergency designation Vaccine distribution Maternal Mortality (S. 4949, Supporting Best Practices for Healthy Moms Act)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Health care quality; physician and hospital quality; health care innovation; Patient Protection and Affordable Care Act/health care reform implementation; Affordable Care Act repeal/replace/reform efforts; medical liability reform; unique device identifier policy and post-market surveillance for medical devices; clinical trial design; clinical data registries; HIPAA and registries; federal funding/appropriations for HHS, NIH, AHRQ, CDC, FDA, HRSA and the Childrens Hospital Graduate Medical Education payment program, the Prevention & Public Health Fund, medical research, and prevention; the South Asian Heart Health Awareness and Research Act (HR 3131), research and scholarly communication policy; healthy diet/lifestyle; implementation and oversight of 21st Century Cures Act; data blocking/interoperability of electronic data; health disparities; National Clinical Care Commission Act implementation; Senate price transparency workgroup; reduction/oversight of prior authorization and other administrative burdens (HR 3107); shared decision-making; medical isotope production and supply; digital health/FDA pre-certification; cardiomyopathy education and awareness; peripheral arterial disease (PAD) education and awareness; surprise medical bills/balance billing, including HR 3630, the No Surprises Act; VA Mission Act implementation; COVID-19 and the coronavirus, including HR 6074, the Coronavirus Preparedness and Response Supplemental Appropriations Act, HR 6201, the Families First Coronavirus Response Act and HR 748, the Coronavirus Aid, Relief, and Economic Security Act, Coronavirus Provider Protection Act (HR 7059), Healthcare Workforce Resilience Act (HR 6788/S 3599), and clinician mental health bills Coronavirus Health Care Worker Wellness Act (HR 7255) and Dr. Lorna Breen Health Care Provider Protection Act (HR 8094)

Client expense: $540,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, White House Office

COBRA support S.4653, A bill to protect the healthcare of hundreds of millions of people of the United States and prevent efforts of the Department of Justice to advocate courts to strike down the Patient Protection and Affordable Care Act, Entirety Monitor the following: Executive actions on An America-First Healthcare Plan Executive Order on Lowering Drug Prices by Putting America First Executive Order on Improving Rural Health and Telehealth Access Executive Order on Lowering Prices for Patients by Eliminating Kickbacks to Middlemen Executive Order on Increasing Drug Importation to Lower Prices for American Patients Executive Order on Access to Affordable Life-saving Medications Healthcare extenders: continued delay of cuts to payments supporting disproportionate share hospitals and an extension of funding for Community Health Centers H.R.3, Lower Drug Costs Now Act, Entirety H.R. 1309/S.851, Workplace Violence Prevention for Health Care and Social Service Workers Act, Entirety Affordability of pharmaceuticals, generally Treating gun violence as a public health epidemic related issues S.1357, Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, Entirety Surprise medical billing, generally Nurse Overtime and Patient Safety Act, Entirety H.R.5800, The Ban Surprise Billing Act, Entirety H.R.5826, Consumer Protections Against Surprise Medical Bills Act, Entirety S.696 the National Nurse Act, Entirety H.R. 1425, the Patient Protection and Affordable Care Enhancement Act, Entirety Health Equity Issues during COVID Pandemic S.3763, Pandemic Responder Service Award Act, Entirety H.R.7288, Taxpayer Research and Coronavirus Knowledge Act, Entirety H.R.7296, Make Medications Affordable by Preventing Pandemic Pricegouging Act, Entirety H.R.7113, COVID-19 Emergency Manufacturing Act, Entirety S.3799, HEAL for Immigrant Women and Families Act, Entirety National Infrastructure for Mitigating the Impact of COVID-19 within Racial and Ethnic Minority Communities grant program Support Medicare/ACA enrollment H.R. 6637, Health Equity and Accountability Act, Entirety Nondiscrimination in Health and Health Education Programs and Activities, Final Rule (RIN 0945-AA11) Delivery of healthcare services to students during COVID pandemic Telehealth issues S.3599 Healthcare Workforce Resilience Act Political interference in work of experts H.R.6514, Worker Health Coverage Protection Act Emergency PPE Petition Department of Health and Human Services Regulations/Programs, Proposed Rule: Securing Updated and Necessary Statutory Evaluations Timely (Sunset Proposal)

Client expense: $370,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), General Services Administration (GSA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

HR 133 Consolidate Appropriations Act of 2020:Oppose Medicare financial relief that excludes certain primary care service. HR 2774; S 2783 - Primary Care Patient Protection Act: Create a primary care benefit in high deductible health plans. HR 2815/S 1119 - Teaching Health Centers GME; Community Health Centers; National Health Service Corps; Special Diabetes Program; Special Diabetes Program for Indians: Increased funding, five-year reauthorization. HR 2895/S. 948 - Conrad State 30 & Physician Access Act: Expand program, streamline eligibility. HR 6149/S. 4088 - Kids Access to Primary Care Act/Ensuring Access to Primary Care for Women and Children Act: Increase Medicaid payment rates for primary care. HR 6788/S. 3599 Healthcare workforce Resilience Act: recapture 15,000 unused employment-based physician immigrant visas from prior fiscal years to bolster physician workforce during COVID pandemic. HR 6837/S 3750: Medicare Accelerated and Advance Payments Improvement Act of 2020: Advanced payments to Medicare Part B providers. HR 7059 Coronavirus Provider Protection Act: targeted and limited liability protections for health care providers responding to COVID pandemic. HR 7663/S 4230 - Expansion of telehealth; Protecting Access to Post-COVID-19 Telehealth Act: Expansion of telehealth services for primary care; coverage and payment parity during PHE. H.R. 8061- Community Immunity During COVID-19 Act: Support grants to increase the rates of recommended immunizations. HR 8623/S 4864 - Ensure Medicare and Medicaid coverage of COVID-19 vaccine and all recommended immunizations without cost-sharing. HR 8337 - Continuing Appropriations Act 2021 and Other Extensions Act: Extension of THCGMEs, Medicare Accelerated Payments. S. 4349 - Dr. Lorna Breen Provider Protection Act: Support the wellbeing of frontline physicians during COVID-19. P.L. 116-123 - CORONAVIRUS PREPAREDNESS AND RESPONSE SUPPLEMENTAL APPROPRIATIONS ACT, 2020: Ensure primary care physicians have adequate supplies, finances to serve their patients, are eligible for loans, payment for telehealth services. P.L. 116-127 - The Families First Coronavirus Response Act: Support for small business and non-profits during COVID crisis. P.L. 116-136 - CARES Act: Ensure primary care physicians have adequate supplies, finances to serve their patients, are eligible for Small Business loans, payment for telehealth services. No Bill No. - Congressional Primary Care Caucus: 116th Congress Membership in the bipartisan CPCC. No Bill No. - Teaching Health Centers GME; Community Health Centers; National Health Service Corps; Special Diabetes Program; Special Diabetes Program for Indians: Increased funding, five-year reauthorization. No Bill No. - 501(c)(6) Non-Profits Relief: include emergency financial relief for 501(c)(6) organizations in COVID response legislation. No Bill No. - Emergency financial relief for primary care physicians: additional financial support for primary care clinicians to stabilize our nations primary care infrastructure. No Bill No. - Issues related to increase immunization utilization/distribution: Efforts to support children and adults securing needed immunizations.

Client expense: $701,260 · Firm income: Not reported

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

HR 2895/S. 948 - Conrad State 30 & Physician Access Act: Expand program, streamline eligibility. HR 6788/S. 3599 Healthcare workforce Resilience Act: recapture 15,000 unused employment-based physician immigrant visas from prior fiscal years to bolster physician workforce during COVID pandemic.

Client expense: $701,260 · Firm income: Not reported

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

S. 948, Conrad State 30 and Physician Access Reauthorization Act, all provisions H.R. 2895, Conrad State 30 and Physician Access Reauthorization Act, all provisions H.R. 6788, Healthcare Workforce Resilience Act, all provisions S. 3599, Healthcare Workforce Resilience Act, all provisions Executive Orders related to immigration/international medical graduates J-1 Visa/duration of status USCIS collection and use of biometrics H-1B Visas

Client expense: $4,170,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), SENATE, Veterans Affairs, Dept of (VA), White House Office

Healthcare Workforce Resilience Act (H.R. 6788/S. 3599).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Urged the Centers for Disease Control and Prevention to prioritize immigrants and their families when planning and implementing a COVID-19 vaccine distribution program by addressing fears, removing structural barriers, and inadequate outreach that may cause many to go unvaccinated and exacerbate the devastation and long-term consequences of this public health crisis. (H.R.6788/S.3599) Healthcare Workforce Resilience Act - Urged Congress to consider quick passage of the Health Workforce Resilience Act. This legislation will provide a long-term solution for immigrant workers by recapturing 15,000 unused employment-based immigrant visas from prior years for physicians and 25,000 for professional nurses. By providing a fast track to permanent residency this will allow greater flexibility in work assignments, helping our Catholic facilities extend their healing mission to where the needs are greatest. Removing Barriers to Care During the Novel Coronavirus (COVID-19) Global Pandemic - Urged DHS and its components to remove barriers to healthcare access so that immigrants may safely comply with government recommendations during this global pandemic health crisis. The GRACE Act (H.R. 2146, S. 1088) - Opposed setting a limit on refugee admissions. No Federal Funds for Public Charge Act of 2019 (H.R. 3222) - Supported maintaining the current definition of Public Charge to ensure continued access to Medicaid and other federal assistance programs. American Dream and Promise Act of 2019 (H.R. 6) - Expressed support for young adults who entered the United States as children to be granted a special immigration status, creating a pathway to citizenship.

Client expense: $196,341 · 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, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Natl Institutes of Health (NIH), Office of the Vice President of the United States, President of the U.S., SENATE, Securities & Exchange Commission (SEC), Treasury, Dept of

S. 348/H.R. 1763 Resident Physician Shortage Reduction Act of 2019; all provisions. S. 2443: Investment in Tomorrow's Pediatric Health Care Workforce Act; all provisions. S. 2546 / H.R. 2279: Safe Step Act; all provisions. S. 3599/H.R. 6788: Healthcare Workforce Resilience Act; all provisions. S. 3741/ H.R. 6644: The Health Care at Home Act; all provisions. S. 3993: The Equal Access to Care Act; all provisions. S. 4421/ H.R. 8283: the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act. S. 7819/H.R. 4525 Eliminating the Provider Relief Fund Tax Penalties Act of 2020; all provisions. H.R.133: The Consolidated Appropriations Act, 2021, Division H Title II Department of Health and Human Services; Division BB, Titles I, No Surprises Act. H.R. 2781: Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness (EMPOWER) for Health Act, section 4. H.R. 3502: Protecting People from Surprise Medical Bills Act; all provisions. H.R. 6800: The Heroes Act; Title VI and Title X Division C. H.R. 7059: The Coronavirus Provider Protection Act; all provisions. H.R. 7255: Coronavirus Health Care Worker Wellness Act of 2020; all provisions. Supporting policies to address the COVID-19 public health emergency, including funding for personal protective equipment, maintaining telemedicine coverage, ensuring access to affordable health coverage, and medical liability flexibility relating to COVID-19. Funding for the CDC National Neurological Conditions Surveillance System. Medical research funding related to fetal tissue, AHRQ, and the NIH including the BRAIN Initiative. Funding for Congressionally Directed Medical Research Programs at the DoD. Policy to address surprise medical billing. Promoting interoperability in electronic health records. Maintain work authorization for individuals currently in DACA status during the COVID-19 national emergency and other policies to support health care providers who live, work, and train in the United States but are not US citizens.

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

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

-Issues relating to the reauthorization of the Conrad 30 program (HR 2895/S 948) -Issues relating to passage of S. 3599/H.R. 6788, the Healthcare Workforce Resilience Act

Client expense: Not reported · Firm income: $18,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Immigration issues affecting the healthcare industry including foreign visas; H.R.1044/S.386, Fairness for High-Skilled Immigrants Act of 2019; H.R.748, CARES Act (P.L.116-136), H.R.8337, Continuing Appropriations Act, 2021 and Other Extensions Act; S.3599/H.R.6788, Healthcare Workforce Resilience Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Healthcare and COVID-19 measures included in the Consolidated Appropriations Act of 2020 (H.R. 133) Healthcare Workforce Resilience Act (S. 3599/H.R. 6788) Conrad State 30 & Physician Access Act (H.R. 2895) Public Health and Social Services Emergency Fund (coronavirus relief packages H.R. 133; H.R. 7010, H.R. 6800) Regulatory relief in light of coronavirus (all coronavirus relief packages - H.R. 133; H.R. 6074; H.R. 6201; H.R. 748, H.R. 6800) Transparency (surprise medical bills; public posting of hospital charges; final price transparency rule; inpatient prospective payment system proposed rule; Transparency in Coverage Proposed Rule) Surprise medical billing (H.R. 133; H.R. 5826; H.R. 3630; S. 1531) Liability relief (all coronavirus relief packages - H.R. 133; H.R. 6800; S. 1624; S. 4775) 340B Drug Pricing Program

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

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

Proposals to maintain work authorization for individuals currently in Deferred Action for Childhood Arrivals (DACA) status during the COVID-19 national emergency Healthcare Workforce Resilience Act (H.R. 6788/S. 3599) June 22, 2020 Presidential Proclamation Suspending Entry of Aliens Who Present a Risk to the U.S. Labor Market Following the Coronavirus Outbreak

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), White House Office

Cancer Drug Parity Act (S.741 / H.R.1730) Resident Physician Shortage Reduction Act of 2019 (S. 348/H.R. 1763) Newborn Screening Saves Lives Reauthorization Act of 2019 (H.R. 2507) Implementation of Patient Protection and Affordable Care Act (P.L. 111-148) Hematology and oncology drug research and approval issues Implementation of the Food and Drug Administration Safety and Innovation Act (FDASIA) (P.L. 112-144) Clinical trials regulations and coverage Issues impacting coverage for hematologic diseases and conditions Reimbursement for CAR-T/cellular and gene therapies Issues impacting opioid access/use for patients with hematologic diseases and disorders Issues impacting blood safety/shortages Issues related to convalescent plasma Healthcare Workforce Resilience Act (H.R. 6788/S. 3599) Coronavirus Provider Protection Act (H.R. 7059) Issues related to health equity/disproportionate impact of COVID-19 on minority populations Health Care at Home Act (H.R. 6644/S. 3741) Withdrawal of the United States from the World Health Organization (WHO)

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), U.S. Agency for International Development (USAID), White House Office

Support H.R.1265 & H.R.4468 - Nursing Home Workforce Quality Act- to end the mandatory certified nursing assistant training lock out. Support H.R.2781 - Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness for Health Act of 2019 Support S.299 - Geriatrics Workforce Improvement Act Support H.R.4397 - Direct Creation, Advancement, and Retention of Employment Opportunity Act Support H.R.728 - Title VIII Nursing Workforce Reauthorization Act of 2019 Support H.R.748 - CARES Act Support S. 3599 - Healthcare Workforce Resilience Act Support H.R. 6788- Healthcare Workforce Resilience Act Support H.R 7010 - Paycheck Protection Program Flexibility Act of 2020 Support H.R 6800 - HEROS Act Support H.R 8874 Nurses CARE Act

Client expense: $31,167 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6788/ S. 3599 "Healthcare Workforce Resilience Act" - Support reclaiming unused immigrant Visas to ensure availability of qualified medical personnel

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

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

H.R. 691 H.R. 691: Telehealth Modernization Act of 2015Support H.R. 938: BLOCKING ActSupport S.3599 - Healthcare Workforce Resilience ActSupport

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Childcare Issues related to childcare - no specific bill COVID-19 Pandemic H.R. 6800 - Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act S. 3599/H.R.6788 - Healthcare Workforce Resilience Act H.R. 6793 - Pandemic Production Act H.R. 266 - Paycheck Protection Program and Health Care Enhancement Act H.R.7010 - Paycheck Protection Program Flexibility Act of 2020 H.R.6720 - Student Loan Forgiveness for Frontline Health Workers Act H.R. 7059 - Coronavirus Provider Protection Act H.R. 748 - The Coronavirus Aid, Relief, and Economic Security Act or the CARES Act Issues related to the COVID-19 Pandemic including: - no specific bill Financial assistance for health care providers Medicare Accelerated and Advance Payment Program Medicare and Medicaid payment rates Federal Medicaid Match Liability protection for health care providers Demographic data for the COVID-19 response Access to personal protective equipment (PPE) and medical supplies PPE supply chain improvements Access to testing for COVID-19 Telemedicine/telehealth Small Business Administration loans Support for contact tracing programs Mental and behavioral health Support for programs addressing domestic violence and child maltreatment Support for resident physicians and medical students Student loan forgiveness/debt relief State and local funding General advocacy on a COVID-19 stimulus/relief package FMAP increase in the Families First Coronavirus Response Act (P.L. 116-127) H.R.6793, the Pandemic Production Act (PPA) S.4349/ H.R.8094, the Dr. Lorna Breen Health Care Provider Protection Act H.R.7819 - Eliminating the Provider Relief Fund Tax Penalties Act of 2020 H.R. 8702 Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 S. 5082 - Expanding COVID-19 Testing Capacity Act of 2020 H.R. 133 - Consolidated Appropriations Act, 2021 Immigration Public Charge - no specific bill S. 948/H.R. 2895, Conrad State 30 and Physician Access Reauthorization Act S. 3599/H.R. 6788 - the Healthcare Workforce Resilience Act Interoperability/ONC Issues related to interoperability - no specific bill Medicare/Medicaid The Medicare Access and CHIP Reauthorization Act (MACRA) Medicaid Fiscal Accountability regulation Block Grants - no specific bill Issues related to Medicare Physician Payments H.R. 133 - Consolidated Appropriations Act, 2021 Prior Authorization - no specific bill Publications Open access to information based on publicly funded research OSTP Request for Information - FR Doc. 2020-06622 - Public Access to Peer-Reviewed Scholarly Publications, Data and Code Resulting From Federally Funded Research Issues related to scholarly and scientific publishing and public access H.R. 133 - Consolidated Appropriations Act, 2021 Racial Justice/Health Equity Issues related to racial justice/health care equity - no specific bill Scope of Practice - no specific bill Surprise Billing S. 1895 - Lower Health Care Costs Act H.R. 3630 - No Surprises Act S 1531 - Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 Consumer Protections Against Surprise Medical Bills Act of 2020 - House Ways & Means Issues related to surprise medical billing/out-of-network medical billing No Surprises Act (compromise legislative proposal between House Ways & Means, Energy & Commerce, Education & Labor Committees and Senate HELP committee - no specific bill number) H.R. 133 - Consolidated Appropriations Act, 2021 Telehealth S. 4375, the Telehealth Modernization Act of 2020 Issues related to telehealth - no specific bill Vaccines Issues related to vaccines - no specific bill Regulatory Comments Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2021

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Science & Technology Policy (OSTP), SENATE

Childcare Issues related to childcare - no specific bill COVID-19 Pandemic H.R. 6800 - Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act S. 3599/H.R.6788 - Healthcare Workforce Resilience Act H.R. 6793 - Pandemic Production Act H.R. 266 - Paycheck Protection Program and Health Care Enhancement Act H.R.7010 - Paycheck Protection Program Flexibility Act of 2020 H.R.6720 - Student Loan Forgiveness for Frontline Health Workers Act H.R. 7059 - Coronavirus Provider Protection Act H.R. 748 - The Coronavirus Aid, Relief, and Economic Security Act or the CARES Act Issues related to the COVID-19 Pandemic including: - no specific bill Financial assistance for health care providers Medicare Accelerated and Advance Payment Program Medicare and Medicaid payment rates Federal Medicaid Match Liability protection for health care providers Demographic data for the COVID-19 response Access to personal protective equipment (PPE) and medical supplies PPE supply chain improvements Access to testing for COVID-19 Telemedicine/telehealth Small Business Administration loans Support for contact tracing programs Mental and behavioral health Support for programs addressing domestic violence and child maltreatment Support for resident physicians and medical students Student loan forgiveness/debt relief State and local funding General advocacy on a COVID-19 stimulus/relief package FMAP increase in the Families First Coronavirus Response Act (P.L. 116-127) H.R.6793, the Pandemic Production Act (PPA) S.4349/ H.R.8094, the Dr. Lorna Breen Health Care Provider Protection Act H.R.7819 - Eliminating the Provider Relief Fund Tax Penalties Act of 2020 H.R. 8702 Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 S. 5082 - Expanding COVID-19 Testing Capacity Act of 2020 H.R. 133 - Consolidated Appropriations Act, 2021 Immigration Public Charge - no specific bill S. 948/H.R. 2895, Conrad State 30 and Physician Access Reauthorization Act S. 3599/H.R. 6788 - the Healthcare Workforce Resilience Act Interoperability/ONC Issues related to interoperability - no specific bill Medicare/Medicaid The Medicare Access and CHIP Reauthorization Act (MACRA) Medicaid Fiscal Accountability regulation Block Grants - no specific bill Issues related to Medicare Physician Payments H.R. 133 - Consolidated Appropriations Act, 2021 Prior Authorization - no specific bill Publications Open access to information based on publicly funded research OSTP Request for Information - FR Doc. 2020-06622 - Public Access to Peer-Reviewed Scholarly Publications, Data and Code Resulting From Federally Funded Research Issues related to scholarly and scientific publishing and public access H.R. 133 - Consolidated Appropriations Act, 2021 Racial Justice/Health Equity Issues related to racial justice/health care equity - no specific bill Scope of Practice - no specific bill Surprise Billing S. 1895 - Lower Health Care Costs Act H.R. 3630 - No Surprises Act S 1531 - Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 Consumer Protections Against Surprise Medical Bills Act of 2020 - House Ways & Means Issues related to surprise medical billing/out-of-network medical billing No Surprises Act (compromise legislative proposal between House Ways & Means, Energy & Commerce, Education & Labor Committees and Senate HELP committee - no specific bill number) H.R. 133 - Consolidated Appropriations Act, 2021 Telehealth S. 4375, the Telehealth Modernization Act of 2020 Issues related to telehealth - no specific bill Vaccines Issues related to vaccines - no specific bill Regulatory Comments Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2021

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Science & Technology Policy (OSTP), SENATE

S. 3599/H.R.6788 - Healthcare Workforce Resilience Act Public Charge - no specific bill S. 948/H.R. 2895, Conrad State 30 and Physician Access Reauthorization Act

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Office of Science & Technology Policy (OSTP), SENATE

H.R.6788/S.3599 The Healthcare Workforce Resilience Act Urging the immediate end of family detention and the release of all migrant children and their families Opposing proposed changes in DHS that would threaten the status of J-1 visa holders

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Communications Commission (FCC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), SENATE, Substance Abuse & Mental Health Services Administration (SAMHSA), White House Office

S.3548, CARES Act: To provide emergency assistance and health care response for individuals, families, and businesses affected by the 2020 coronavirus pandemic; Practice Support/Grants to Practice S.3599, Healthcare Workforce Resilience Act: Foreign physician immigration status H.R. 7059, Coronavirus Provider Protection Act: Liability protection for healthcare providers Public Law No: 116-142, Paycheck Protection Program Flexibility Act of 2020 S.3201, Temporary Reauthorization and Study of the Emergency Scheduling of Fentanyl Analogues Act: Letter to Congressional Leadership regarding Fentanyl S.2723, Mitigating Emergency Drug Shortages Act: reducing drug shortages H.R. 3502, Protecting People From Surprise Medical Bills Act: Surprise Medical Bills H.R. 2500, National Defense Authorization Act for Fiscal Year 2020: Krishnamoorthi amdt on drug shortages H.R. 3107, Improving Seniors' Timely Access to Care Act of 2019: pre-authorization S. 1895, Lower Health Care Costs Act H.R. 3692, Addiction Treatment Access Improvement Act of 2017: Medically assisted treatment; opioids H.R. 5761, Ending Maternal Mortality Act of 2018: Maternal mortality H.R. 5718, Perioperative Reduction of Opioids Act: Opioids H.R. 5197, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S. 2516, Alternatives to Opioids (ALTO) in the Emergency Department Act: Medically assisted treatment; opioids S.2680, Opioid Crisis Response Act of 2018: Medically assisted treatment; opioids S.2456, CARA 2.0 Act of 2018: Medically assisted treatment; opioids H.R. 1565, Saving Lives, Saving Costs S.1475, Saving Lives, Saving Costs S.4349, Dr. Lorna Breen Health Care Provider Protection Act: physician health Comprehensive Addiction and Recovery Act of 2016 (PL 114-198) FY 2021 LHHS Appropriations: Fiscal Year 2021 Appropriations for Subcommittee on Labor, Health and Human Services Outside Witness Testimony Affordable Care Act reform efforts H.R. 1628, American Health Care Act of 2017 S. Amdt. 1030 to H.R. 1628, "Graham-Cassidy" Better Care Reconciliation Act of 2017 H.R. 1492, Medical Controlled Substances Transportation Act of 2017 H.R. 1215, Protecting Access to Care Act of 2017 H.R. 3545, Overdose Prevention and Patient Safety Act H.R. 3446, Restoring Board Immunity Act of 2017: Professional Licensing S.2260, Opioids and STOP Pain Initiative ACT:opioids 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records: appropriate access to patient information essential for providing whole-person care H.R.3928, Truth in Healthcare Marketing Act of 2017 H.R. 1554, REDI Act: student loan debt repayment for residents 21st Century Cures Initiative Drug Shortages - FDA, DEA, HHS, CMS, GAO, House Energy and Commerce Committee, Senate HELP Committee DEA Scheduling Propofol Comparative Effectiveness Research - PCORI HITECH Implementation, Electronic Health Records, Final and Proposed Rules, HIT Meaningful Use HHS/OIG Anesthesia Practice Arrangements, Company Model FDA Safe Use Initiative Pain Management FTC Letters to States re: Interventional Pain Medicine & Advanced Practice Nurses & Competition in Healthcare Anesthesia Research Funding (Pediatric and others) Scope of Practice FDA Operating Room Fires Naloxone FDA Opioids Prescription Drug Abuse FDA Network of Experts NIH Interagency Pain Research Coordinating Committee FDA SMART TOTS - pediatric anesthesia research USP - US Pharmacopeia National Pain Strategy Nondiscrimination Compounding FDA Nominations to Advisory Committees (Anesthesia Drugs, Anesthesia Devices, Compounding) Agency for Healthcare Research and Quality (AHRQ) funding Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Sequestration Opioids and opioid abuse; Brain health Certified Anesthesiologist Assistants Blood management COVID-19: Increased supply of PPE and ventilators, Funding for physician practices impacted by the cancellation of elective surgeries, unique role of anesthesiologists in responding to COVID-19 pandemic, medical liability, Scope of Practice (Waiver of federal supervision requirement under the Emergency Declaration), insurance moratorium; COVID Update Memorandum 4/21/20 Centre for Clinical and Applied Services Provision Research

Client expense: $410,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

H.R. 1044/S. 386, the Fairness for High-Skilled Immigrants Act of 2019; H.R. 2895/S. 948, the Conrad State 30 and Physician Access Reauthorization Act; H.R. 6788/S. 3599, the Healthcare Workforce Resilience Act; issues relating to the Presidents Proclamation Suspending Entry of Aliens Who Present a Risk to the U.S. Labor Market Following the Coronavirus Outbreak (dated June 22, 2020); and issues pertaining to add issues pertaining to Establishing a Fixed Time Period of Admission and an Extension of Stay Procedure for Nonimmigrant Academic Students, Exchange Visitors, and Representatives of Foreign Information Media (DHS Docket No. ICEB-2019-0006).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6, American Dream and Promise Act of 2019 H.R. 60, Better Agriculture Resources Now (BARN) Act H.R. 250, Legal Workforce Act H.R. 549, Venezuela TPS Act of 2019 H.R. 641/S. 175, Agricultural Worker Program Act of 2019 H.R. 648, Consolidated Appropriations Act, 2019 H.R. 748/S. 3548, Coronavirus Aid, Relief, and Economic Security (CARES) Act H.R. 773, To Terminate the EB-5 program H.R. 1044/S. 386, Fairness for High-Skilled Immigrants Act of 2019 H.R. 1158, Consolidated Appropriations Act, 2020 H.R. 1399/S.556, Accountability Through Electronic Verification Act H.R. 1740, Workforce for an Expanding Economy Act H.R. 1778, Dairy and Sheep H-2A Visa Enhancement Act H.R. 1865, Further Consolidated Appropriations Act, 2020 H.R. 1996, Secure Travel Partnership Act of 2019 H.R. 2187, Jobs Originated through Launching Travel (JOLT) Act of 2019 H.R. 2278/S. 1103, Reforming American Immigration for a Strong Economy (RAISE) Act H.R. 2413, Nicaragua TPS Act of 2019 H.R. 2418/H.R. 2877/S. 3134, To add Ireland to the E-3 nonimmigrant visa program H.R. 2658, Commercial Fishing and Seafood Business Act of 2019 H.R. 2783, TPS and DED Protection Act of 2019 H.R. 2813, Asylum Seeker Work Authorization Act of 2019 H.R. 2820, Dream Act of 2019 H.R. 2821, American Promise Act of 2019 H.R. 2895/S. 948, Conrad State 30 and Physician Access Reauthorization Act H.R. 3033, H-4 Employment Protection Act of 2019 H.R. 3055, Further Continuing Appropriations Act, 2020, and Further Health Extenders Act of 2019 H.R. 3319, Paperwork Reduction for Farmers and H-2A Modernization Act H.R. 3401/S. 1900, Emergency Supplemental Appropriations for Humanitarian Assistance and Security at the Southern Border Act, 2019 H.R. 3564, Fairness for High-Skilled Americans Act of 2019 H.R. 3740, AGRI Act of 2019 H.R. 4218, Poland Visa Waiver Act of 2019 H.R. 4482, Protecting America's Food and Agriculture Act of 2019 H.R. 4498, Promoting Tourism to Enhance our Economy Act of 2019 H.R. 5038, Farm Workforce Modernization Act of 2019 H.R. 5174, State Sponsored Visa Pilot Program Act of 2019 H.R. 6312, COVID-19 Relief for Small Businesses Act of 2020 H.R. 6379, Take Responsibility for Workers and Families Act H.R. 6395/S. 4049, National Defense Authorization Act for Fiscal Year 2021 H.R. 6404, To extend the deadline for States to meet the requirements of the REAL ID Act of 2005 due to COVID-19 H.R. 6507, COVID-19 Employment Authorization Document Extension Act H.R. 6717, Health Care Workforce Protection Act of 2020 H.R. 6788/S. 3599, Healthcare Workforce Resilience Act H.R. 6800, The Heroes Act H.R. 6870, Landscaping Workforce Act of 2020 H.R. 6905, FIRST COVID-19 Care Delivery Act of 2020 H.R. 6993/S. 3770, H-1B and L-1 Visa Reform Act of 2020 H.R. 7508, To provide supplemental appropriations to U.S. Citizenship and Immigration Services, and for other purposes. H.R. 7669, Department of Homeland Security Appropriations Act, 2021 H.R. 8046, Improving Opportunities for New Americans Act of 2020 H.R. 8078, Emergency Stopgap USCIS Stabilization Act H.R. 8089, Emergency Stopgap USCIS Stabilization Act H.R. 8337, Continuing Appropriations Act, 2021 and Other Extensions Act S. 135, Prioritizing Help to Businesses Act S. 301, E-Verify Act of 2019 S. 328, Startup Act S. 599, Singh's Law S. 636, Venezuela Temporary Protected Status Act of 2019 S. 874, Dream Act of 2019 S. 1004, Securing America's Ports of Entry Act of 2019 S. 1744, Keep STEM Talent Act of 2019 S. 1806, Permanent E-Verify Act S. 1887, Paperwork Reduction for Farmers and H-2A Modernization Act S. 2091, Backlog Elimination, Legal Immigration, and Employment Visa Enhancement Act S. 2540, EB-5 Reform and Integrity Act of 2019 S. 2778, Immigrant Investor Program Reform Act S. 2863, E Visa Integrity Act of 2019 S. 2926, Advancing Mutual Interests and Growing Our Success (AMIGOS) Act S. 3470, New Deal for New Americans Act of 2020 S. 3504, A bill to require the Secretary of Homeland Security to extend, until not earlier than September 30, 2021, the requirement that State-issued identification must be compliant with the REAL ID Act of 2005 to be accepted by Federal agencies for certain purposes H.J.Res. 31, Consolidated Appropriations Act, 2019 Potential legislation updating The Heroes Act (116th Cong.) Potential legislation similar to H.R. 6794/S. 2344, Immigration Innovation Act of 2018 Proposed rule regarding registration requirement for petitioners seeking to file H-1B petitions on behalf of cap-subject aliens (83 Fed. Reg. 62,406-62,447, December 3, 2018) Various issues relating to visa waiver program; H-1B Visa Program; H-1B registration rule; H-2 Visa Program and temporary rule; H-4 rule; L-1 Visa Program; EB-5 Visa Program; EB-5 rule; EB-5 regional center program; H-2A Visa Program; E-Verify program; I-129 form delay request; private-public partnerships with the Department of Homeland Security at land border ports of entry; STEM visa reform; nonimmigrant workers in temporary or seasonal nonagricultural employment; Customs and Border Protection staffing at U.S. ports of entry; border security; immigration policy and reforms; guest worker programs; legalization concepts; visa reform; customs trade facilitation and enforcement; Deferred Action for Childhood Arrivals (DACA) program; extension of temporary protected status (TPS) designations for El Salvador, Honduras, and Haiti; administrative-regulatory efforts related to public charge, notice to appear, H-4 & OPT; supplemental funding for additional Customs and Border Protection (CBP) officers at ports-of-entry; United States Citizenship and Immigration Services (USCIS) decision on electronic registration for the fiscal year (FY) 2021 H-1B cap filing season and stakeholder engagement for the H-1B registration tool; United States Citizenship and Immigration Services (USCIS) fee schedule; United States Citizenship and Immigration Services (USCIS) funding; Presidential Proclamation 9996, suspension of entry as immigrants and nonimmigrants of certain additional persons who pose a risk of transmitting 2019 Novel Coronavirus, March 14, 2020; Presidential Proclamation 10014, suspending entry of immigrants who present risk to the U.S. labor market during the economic recovery following the COVID-19 outbreak, April 22, 2020; Presidential Proclamation 10052, suspending entry of aliens who present a risk to the U.S. labor market following the Coronavirus outbreak, June 22, 2020; Potential recision of the Deferred Action for Childhood Arrivals (DACA) program; high-skilled immigration; lesser skilled immigration; temporary agriculture guest worker; temporary non-agriculture guest worker; optional practical training program; size and administration of employment-based immigrant visa categories; size and administration of family-based immigrant visa categories; expansion of the use of the E-Verify system; employment verification; interior enforcement; family separations; family reunification; temporary suspension of entry of nationals from certain countries; increased vetting of visa applicants; unfair immigration related employment practices; travel issues; trusted traveler programs; biometric entry-exit; increasing the number of ICE officers, border patrol agents and Customs and Border Protection officers; aerial security enhancements; temporary DHS guidance for the I-9 employment verification process in the wake of COVID-19; Department of Labor Guidance on Labor Condition Application requirements in the wake of COVID-19; temporary Department of Labor procedural changes regarding the Permanent Labor Certification process in the wake of COVID-19; State Department policy accommodations regarding the use of interview waivers for H-2 nonimmigrant workers in the wake of COVID-19; temporary United States Citizenship and Immigration Services (USCIS) procedures to provide flexibility with regard to filing deadlines, and temporary USCIS guidelines providing flexibility to wet-ink signatures on USCIS forms and documents; United States Citizenship and Immigration Services (USCIS) funding shortfalls; Customs and Border Protection (CBP) funding shortfalls; clarification of the criteria that makes one eligible for a waiver from the entry restrictions for various employment-based immigrants and nonimmigrants; forthcoming regulatory proposals that would restrict applicant eligibility for the H-1B program; forthcoming regulatory proposals that would drastically change how prevailing wage levels are determined for the purposes of obtaining certain employment nonimmigrant and immigrant visas; forthcoming proposals that would significantly change how cap-subject H-1B petitions will be chosen in the future

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

Government targets: Agriculture, Dept of (USDA), Army, Dept of (Corps of Engineers), Bureau of Citizenship & Immigration Services (BCIS), Bureau of Industry and Security (BIS), Bureau of Reclamation, Commerce, Dept of (DOC), Commodity Futures Trading Commission (CFTC), Consumer Financial Protection Bureau (CFPB), Council on Environmental Quality (CEQ), Defense, Dept of (DOD), Education, Dept of, Energy, Dept of, Environmental Protection Agency (EPA), Equal Employment Opportunity Commission (EEOC), Executive Office of the President (EOP), Federal Aviation Administration (FAA), Federal Communications Commission (FCC), Federal Deposit Insurance Corporation (FDIC), Federal Emergency Management Agency (FEMA), Federal Energy Regulatory Commission (FERC), Federal Motor Carrier Safety Administration, Federal Reserve System, Federal Trade Commission (FTC), General Services Administration (GSA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Interior, Dept of (DOI), Internal Revenue Service (IRS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Natl Economic Council (NEC), Natl Institute of Standards & Technology (NIST), Natl Labor Relations Board (NLRB), Natl Security Council (NSC), Natl Telecommunications & Information Administration (NTIA), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), Office of the Comptroller of the Currency (OCC), Patent & Trademark Office (PTO), Pension Benefit Guaranty Corporation (PBGC), SENATE, Securities & Exchange Commission (SEC), Small Business Administration (SBA), State, Dept of (DOS), Transportation Security Administration (TSA), Transportation, Dept of (DOT), Treasury, Dept of, U.S. Copyright Office, U.S. Customs & Border Protection, U.S. Trade Representative (USTR), White House Office