Protecting Americans with Pre-existing Conditions Act of 2019

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

: Issues related to lung disease treatment, prevention and research; public health; Issues related asthma; COPD; influenza; lung cancer; pneumonia; tuberculosis and other lung diseases; Issues related to tobacco cessation; Issues related to the Affordable Care Act; Issues related to the Childrens Health Insurance Program; Issues related to the President's Budget; Issues related to telehealth; Issues related to changing federal poverty line calculation; Issues related to COVID-19 Response;; H.R.986 Protecting Americans with Preexisting Conditions Act of 2019 H.R.987 Strengthening Health Care and Lowering Prescription Drug Costs Act H.R.1010 To provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect. H.R.1385 SAVE Act H.R.1386 ENROLL Act of 2019 H.R.1425 State Health Care Premium Reduction Act H.R.1499 Protecting Consumer Access to Generic Drugs Act of 2019 H.R.1884 Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019 H.R.2508 Better Respiration through Expanding Access to Tele-Health Act;H.R.2862 VACCINES Act of 2019; H.R.3630 No Surprises Act H.R.4622 Family Asthma Act S.466 Protecting Americans with Pre-existing Conditions Act of 2019 S.946 Henrietta Lacks Enhancing Cancer Research Act of 2019 S.1125 Protect Act S.1895 Lower Health Care Costs Act S.1944 Public Health Funding Restoration Act. HR 3 Elijah E. Cummings Lower Drug Costs Now Act; H.R.4716 I CAN Act; HR 5230 Elijah E. Cummings Family Asthma Act; HR 6201 - Families First Coronavirus Act; HR 6704 - Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020; HR 748 - CARES Act; S. 3548 - CARES Act; S. 1531 - Stopping the Outrageous Practice of Surprise Medical Bills Act of 2019; HR 6408 -- To extend the charitable deduction to all taxpayers regardless of whether a taxpayer itemizes deductions in order to encourage and increase charitable giving, and to provide for loans and loan guarantees to certain public charities; HR 7610 Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2021; HR 7667 Commerce, Justice, Science, and Related Agencies Appropriations Act, 2021; HR 7617 Department of Defense Appropriations Act, 2021; HR 7612 Department of the Interior, Environment, and Related Agencies Appropriations Act, 2021; HR 2468 School-Based Allergies and Asthma Management Program Act; HR 7614 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2021; HR 7609 Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2021; HR 7616 Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, 2021; HR 7608 Department of State, Foreign Operations, and Related Programs Appropriations Act, 2021; H.R.5076 Protecting Seniors Through Immunization Act of 2019; H.R.6561 Improving Social Determinants of Health Act of 2020; HR 6800 HEROES Act; H.R.6935 Protecting the Health of America's Older Adults During COVID-19 and Beyond Act; HR 7286 Quit Because of COVID-19 Act; S. 4775 Delivering Immediate Relief to Americas Families, Schools and Small Businesses Act; S. 4321 The Continuing Small Business Recovery and Paycheck Protection Program Act; S. 4318 The American Workers, Families, and Employers Assistance Act; S. 4317 SAFE TO WORK Act; S. 4322 The Safely Back to School and Back to Work Act; S. 4320 Coronavirus Response Additional Supplemental Appropriations Act, 2020; ;H.R.8061 Community Immunity During COVID-19 Act of 2020;H.R.8406 The Heroes Act; H.R.925 The Heroes Act; S.4557 COVER Act; S.4740 A bill to support public health infrastructure; H.RES.957 Expressing support for the designation of May as "National Asthma and Allergy Awareness Month"; H.R.7011 Pandemic Risk Insurance Act of 2020; H.R.8261 Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2020; S.4572 Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2020; S.4355 Katherine's Lung Cancer Early Detection and Survival Act of 2020; H.RES.1192 Expressing support for the goals of November National Lung Cancer Awareness Month and for the early detection of lung cancer; H.R.8158 To amend title XVIII of the Social Security Act to waive budget neutrality for oxygen under the Medicare program, and for other purposes.;H.R.7481 RESTART Act; S.4737 A bill to amend the Public Health Service Act to direct the Secretary of Health and Human Services to make grants to covered health departments to increase the rate of recommended immunizations, and for other purposes; S.Res.780 A resolution designating November 2020 as "National Lung Cancer Awareness Month" and expressing support for the early detection of lung cancer; H.R.8623 SAVE for Seniors Act; S.4864 HAPI Act; H.R.8725 HAPI Act; H.R.8595 To nullify the effect of Executive Order 13950 relating to combating race and sex stereotyping; Senate Labor HHS Appropriations bill; Senate Defense Appropriations bill; Senate Transportation, Housing and Urban Development and Related Agencies Appropriations bill; Senate Agriculture, Rural Development, FDA, and Related Agencies Appropriations bill; Senate Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2021H.R.133 Consolidated Appropriations Act, 2021; H.J.Res.110 - Extension of Continuing Appropriations Act, 2021

Client expense: $40,000 · 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), Environmental Protection Agency (EPA), Federal Reserve System, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Postal Regulatory Commission, SENATE, Small Business Administration (SBA), Treasury, Dept of, White House Office

Proposed changes to Medicare hospital reimbursement policy Health care policy H.R. 986/S. 466 Protecting Americans with Preexisting Conditions Act of 2019, a bill provide that certain guidance related to waivers for State innovation under the ACA shall have no force or effect H.R. 2113, Prescription Drug Sunshine, Transparency, Accountability and Reporting (STAR) Act" - provisions related to studying rising hospital drug prices and reporting of drug costs H.R. 965/S. 340, "CREATES Act" H.R. 938, Bringing Low-cost Options and Competition while Keeping Incentives for New Generics Act of 2019 or the BLOCKING Act of 2019 - provisions related to eligibility for approval of a subsequent generic drug and 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 H.R. 1499 Protecting Consumer Access to Generic Drugs Act of 2019 - provisions related to prohibiting 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 S. 2543, the Prescription Drug Pricing Reduction Act H.R. 3, "Elijah E. Cummings Lower Drug Costs Now Act" Additional legislative proposals to address rising drug costs H.R. 1559, "340B Protection and Accountability Act" Additional legislative proposals modifying the 340B program S.1895, Lower Health Care Costs Act- provisions related to surprise billing and provider/payer agreements S. 1531, "STOP Surprise Medical Bills Act" H.R. 3630, "No Surprises Act" H.R.5826, "Consumer Protections Against Surprise Medical Bills Act of 2020" Other proposals to address surprise billing Proposals to strengthen the health care system and achieve ACA market stability Legislation aimed at combating COVID-19 - provisions related to healthcare and hospitals H.R. 925, "Health and Economic Recovery Omnibus Emergency Solutions Act (HEROS Act 2.0) H.R. 133, "Consolidated Appropriations Act, 2021" - provisions related to COVID-response and hospitals Legislative proposals aimed at combating coronavirus

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 4840 Ensuring Parity in MA for Audio-Only Telehealth Act of 2020 HR 133 The Consolidated Appropriations Act HR 6800 the HEROES Act re COVID relief S. 4163 re COVID Testing (Gardner) S. 4329 Continuous Health Coverage for Workers Act (McSally) HR 7472 re contract tracing (Speier) S. 4230 Telehealth Expansion Act (Wyden) HR 6395, National Defense Authorization Act S. 4049, National Defense Authorization Act HR 6666, COVID 19 Testing, Reaching and Contacting Everyone Act (TRACE Act) HR 1425, Patient Protection and Affordable Care Enhancement Act HR 6514, Worker Health Coverage Protection Act HR 6568, Coverage for COVID 19 Treatment Act HR 5438, Cox, The End Valley Fever Now Act S. 2897, Warner, regarding the reauthorization of PCORI HR 5201, Matsui, regarding telehealth and behavioral health HR 2328, the No Surprises Act S. 1895, the Lower Health Care Costs Act HR 987 and S. 455, regarding outreach and education activities under the ACA HR 3439, regarding the reauthorization of PCORI House Resolution 271, regarding the Justice Departments position in Texas v. United States HR 2062 & S. 1012, regarding 42 CFR Part 2 and confidentiality of certain health information HR 1884, with provisions to stabilize and strengthen the ACA and the nongroup insurance market. S. 470, regarding a Medicare buy-in option for individuals aged 50-64 S. 489 and HR 1277, regarding a Medicaid buy-in option S. 1129, to establish a single payer system based on Medicare for All. HR 1384, to establish a single payer health care system HR 1425, regarding reinsurance funding under the ACA HR 986 and S. 466, regarding Section 1332 state waiver guidance. HR 1010, regarding Short Term Limited Duration Insurance policies HR 1143, regarding Short Term Limited Duration Insurance policies HR 861, regarding surprise billing

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

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

Legislation pertaining to ocean acidification, harmful algal blooms, hypoxia, red tide/blue-green algae generally, Arctic shipping, red snapper/bluefin/groundfish fishing regulations, fisheries and the Magnuson-Stevens Act generally including fishery disaster assistance, USCG PARS, implementation of EO 13840, maritime shipping, ocean exploration/mapping, climate change and our oceans, marine debris, regional ocean data portals and ocean data legislation generally. NEPA regulations regarding GHG emissions and climate change. Marine Debris: S.1982 - Save Our Seas 2.0 Act S.2660 - Save Our Seas 2.0: Improving Domestic Infrastructure to Prevent Marine Debris Act S.2364 - Save Our Seas 2.0: Enhancing the Domestic Marine Debris Response Act S.2372 - Save Our Seas 2.0: Enhanced Global Engagement to Combat Marine Debris Act H.R.3969 - SOS 2.0 Act H.R.4636 - PLASTIC Seas Act H.R.5845/S.3263/S.3944 - Break Free From Plastic Pollution Act of 2020 S.3281 - Original Recycle Bottle Act of 2020 H.R.5902/S.3306 - MICRO Plastics Act of 2020 S.3306/H.R.5902 - MICRO Plastics Act of 2020 S.4681 - Plastic Pellet Free Waters Act S. 5030 - UNITE for our Oceans Act of 2020 Ocean Acidification/Harmful Algal Blooms/Water Quality: H.R.335/S.10 - South Florida Coastal Waters Act of 2019 H.R.414 - Protecting Local Communities from Harmful Algal Blooms Act H.R.462 - Everglades for the Next Generation Act H.R.988 - NEAR Act of 2019 H.R.1237 - COAST Research Act of 2019 H.R.1716/S.778 - Coastal Communities Ocean Acidification Act of 2019 H.R.1834 - Defending Our National Marine Sanctuaries from Damaging Chemicals Act of 2019 H.R.1921 - Ocean Acidification Innovation Act of 2019 H.R.2448 - Ocean Acidification Research Partnerships Act H.R.2587/S.1375 - Reef Safe Act of 2019 H.R.2588/S.1371 - Oxybenzone and Octinoxate Impact Study of 2019 H.R.3297 - Harmful Algal Bloom Essential Forecasting Act H.R.3324 - Prioritizing Revised Operations to Eliminate Cyanobacteria Toxins in Florida Act H.R.4160/S.2429 - Restoring Resilient Reefs Act of 2019 H.R.6738 - Coral Reef Conservation Reauthorization Act of 2020 H.R.7450 - Prevent Harmful Algal Blooms Act S. 778 - Coastal Communities Ocean Acidification Act of 2019 S.914 - Coordinated Ocean Observations and Research Act of 2019 S.2429 - Restoring Resilient Reefs Act of 2019 S.2699 - OCEAN Research Act of 2019 Marine Wildlife and Fisheries: H.R.1023/S.466 - Great Lakes Fishery Research Authorization Act of 2019 H.R.1568/S.2453 - SAVE Right Whales Act H.R.1747/S.754 - National Fish Habitat Conservation Through Partnerships Act H.R.1979/S.906 - Driftnet Modernization and Bycatch Reduction Act H.R.2236 - Forage Fish Conservation Act H.R.3424 - SEA Act of 2019 H.R.3697 - Strengthening Fishing Communities and Increasing Flexibility in Fisheries Management Act H.R.4679 - Climate Fisheries Act of 2019 H.R.5126/S.2960 - DESCEND Act of 2019 H.R.5548/S.2346 - Fishery Failures: Urgently Needed Disaster Declarations Act H.R.6191/S.4723 - AQUAA Act H.R. 8672/S.4804 - Rhode Island Fishermen's Fairness Act S.908 - Fluke Fairness Act of 2019 S.2802 - Marine Mammal Research and Response Act of 2019 Ocean and Coastal Planning/ Ocean Data/Ocean Climate: H.R.9/S.1743 - Climate Action Now Act H.R.729 - Tribal Coastal Resilience Act S.810 COASTAL Implementation Act of 2019 S.933/H.R.3548 BLUE GLOBE Act H.R.1314 - Integrated Coastal and Ocean Observation System Act Amendments of 2019 H.R.2185 - DC Flood Prevention Act of 2019 H.R.2189/S.1069 - Digital Coast Act H.R.3115/S.1730 - Living Shorelines Act of 2019 H.R.3541 - Coastal State Climate Preparedness Act of 2019 H.R.3596 - Keep America's Waterfronts Working Act H.R.4093 - National Oceans and Coastal Security Improvements Act of 2019 H.R.5221 - 100% Clean Economy Act of 2019 H.R.5390/S.2166 - ROP Act H.R.5589/S.3939 - Blue Carbon for Our Planet Act H.R.7024/S.4046 - Climate Smart Ports Act H.R.7713 - NOPP Revitalization Act H.R.8632 - Ocean Based Climate Solutions Act of 2020 S.5024 - National Ocean Exploration Act Other: H.R.2 - Moving Forward Act S.1177/H.R.3020 - SEAL Act S.2786 - Arctic Shipping Federal Advisory Committee Act H.R.2405/S.910 - National Sea Grant College Program Amendments of 2019 H.R.6636 - NOAA Sexual Harassment and Assault Prevention Improvements Act of 2020 H.R.7387 - Shovel-Ready Restoration Grants for Coastlines and Fisheries Act of 2020 S.Res.537/H.Con.Res.89 - A resolution encouraging the Trump Administration to maintain protections under the National Environmental Policy Act and reverse ongoing administrative actions to weaken this landmark law and its protections for American communities.

Client expense: $141,442 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Council on Environmental Quality (CEQ), HOUSE OF REPRESENTATIVES, Interior, Dept of (DOI), Natl Oceanic & Atmospheric Administration (NOAA), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), U.S. Coast Guard (USCG)

Issues involving attempts to amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D, and for other purposes. HR 448 - Medicare Drug Price Negotiation Act. HR 383, Continuing Coverage for Preexisting Conditions Act of 2019; S. 1556, No Junk Plans Act; S. 466, Protecting Americans with Pre-existing Conditions Act of 2019; S. 1905, ENROLL Act of 2019.

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

Government targets: SENATE

Issues that encompass attempts to amend the Federal Food, Drug, and Cosmetic Act to allow for the importation of affordable and safe drugs by wholesale distributors, pharmacies, and individuals. HR 447 - Affordable and Safe Prescription Drug Importation Act. Issues involving the attempts to amend PL 111-148, The Patient Protection and Affordable Care Act, to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited. HR 383 - Continuing Coverage for Preexisting Conditions Act of 2019; S. 1556, No Junk Plans Act; S. 466, Protecting Americans with Pre-existing Conditions Act of 2019; S. 1905, ENROLL Act of 2019.

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

Government targets: SENATE

Proposed changes to Medicare hospital reimbursement policy Health care policy H.R. 986/S. 466 Protecting Americans with Preexisting Conditions Act of 2019, a bill provide that certain guidance related to waivers for State innovation under the ACA shall have no force or effect H.R. 2113, Prescription Drug Sunshine, Transparency, Accountability and Reporting (STAR) Act" - provisions related to studying rising hospital drug prices and reporting of drug costs H.R. 965/S. 340, "CREATES Act" H.R. 938, Bringing Low-cost Options and Competition while Keeping Incentives for New Generics Act of 2019 or the BLOCKING Act of 2019 - provisions related to eligibility for approval of a subsequent generic drug and 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 H.R. 1499 Protecting Consumer Access to Generic Drugs Act of 2019 - provisions related to prohibiting 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 S. 2543, the Prescription Drug Pricing Reduction Act H.R. 3, "Elijah E. Cummings Lower Drug Costs Now Act" Additional legislative proposals to address rising drug costs H.R. 1559, "340B Protection and Accountability Act" Additional legislative proposals modifying the 340B program S.1895, Lower Health Care Costs Act- provisions related to surprise billing and provider/payer agreements S. 1531, "STOP Surprise Medical Bills Act" H.R. 3630, "No Surprises Act" H.R.5826, "Consumer Protections Against Surprise Medical Bills Act of 2020" Other proposals to address surprise billing Proposals to strengthen the health care system and achieve ACA market stability Legislation aimed at combating COVID-19 - provisions related to healthcare and hospitals H.R. 6201, "Families First Coronavirus Response Act" - provisions related to healthcare, Medicaid and Medicare H.R. 748, "Coronavirus Aid, Relief, and Economic Security Act" (CARES Act) - provisions related to federal financial relief, including funding for healthcare providers Senate Health, Economic Assistance, Liability Protections and Schools (HEALS) Act H.R. 925, Health and Economic Recovery Omnibus Emergency Solutions Act (HEROS Act 2.0) Legislative proposals aimed at combating coronavirus

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

Issues related to lung disease treatment, prevention and research; public health; Issues related asthma; COPD; influenza; lung cancer; pneumonia; tuberculosis and other lung diseases; Issues related to tobacco cessation; Issues related to the Affordable Care Act; Issues related to the Childrens Health Insurance Program; Issues related to the President's Budget; Issues related to telehealth; Issues related to changing federal poverty line calculation; Issues related to COVID-19 Response;; H.R.986 Protecting Americans with Preexisting Conditions Act of 2019 H.R.987 Strengthening Health Care and Lowering Prescription Drug Costs Act H.R.1010 To provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect. H.R.1385 SAVE Act H.R.1386 ENROLL Act of 2019 H.R.1425 State Health Care Premium Reduction Act H.R.1499 Protecting Consumer Access to Generic Drugs Act of 2019 H.R.1884 Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019 H.R.2508 Better Respiration through Expanding Access to Tele-Health Act;H.R.2862 VACCINES Act of 2019; H.R.3630 No Surprises Act H.R.4622 Family Asthma Act S.466 Protecting Americans with Pre-existing Conditions Act of 2019 S.946 Henrietta Lacks Enhancing Cancer Research Act of 2019 S.1125 Protect Act S.1895 Lower Health Care Costs Act S.1944 Public Health Funding Restoration Act. HR 3 Elijah E. Cummings Lower Drug Costs Now Act; H.R.4716 I CAN Act; HR 5230 Elijah E. Cummings Family Asthma Act; HR 6201 - Families First Coronavirus Act; HR 6704 - Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020; HR 748 - CARES Act; S. 3548 - CARES Act; S. 1531 - Stopping the Outrageous Practice of Surprise Medical Bills Act of 2019; HR 6408 -- To extend the charitable deduction to all taxpayers regardless of whether a taxpayer itemizes deductions in order to encourage and increase charitable giving, and to provide for loans and loan guarantees to certain public charities; HR 7610 Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2021; HR 7667 Commerce, Justice, Science, and Related Agencies Appropriations Act, 2021; HR 7617 Department of Defense Appropriations Act, 2021; HR 7612 Department of the Interior, Environment, and Related Agencies Appropriations Act, 2021; HR 2468 School-Based Allergies and Asthma Management Program Act; HR 7614 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2021; HR 7609 Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2021; HR 7616 Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, 2021; HR 7608 Department of State, Foreign Operations, and Related Programs Appropriations Act, 2021; H.R.5076 Protecting Seniors Through Immunization Act of 2019; H.R.6561 Improving Social Determinants of Health Act of 2020; HR 6800 HEROES Act; H.R.6935 Protecting the Health of America's Older Adults During COVID-19 and Beyond Act; HR 7286 Quit Because of COVID-19 Act; S. 4775 Delivering Immediate Relief to Americas Families, Schools and Small Businesses Act; S. 4321 The Continuing Small Business Recovery and Paycheck Protection Program Act; S. 4318 The American Workers, Families, and Employers Assistance Act; S. 4317 SAFE TO WORK Act; S. 4322 The Safely Back to School and Back to Work Act; S. 4320 Coronavirus Response Additional Supplemental Appropriations Act, 2020; ;H.R.8061 Community Immunity During COVID-19 Act of 2020;H.R.8406 The Heroes Act; H.R.925 The Heroes Act; S.4557 COVER Act; S.4740 A bill to support public health infrastructure; H.RES.957 Expressing support for the designation of May as "National Asthma and Allergy Awareness Month"; H.R.7011 Pandemic Risk Insurance Act of 2020; H.R.8261 Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2020; S.4572 Presumptive Benefits for War Fighters Exposed to Burn Pits and Other Toxins Act of 2020; S.4355 Katherine's Lung Cancer Early Detection and Survival Act of 2020; H.RES.1192 Expressing support for the goals of November National Lung Cancer Awareness Month and for the early detection of lung cancer; H.R.8158 To amend title XVIII of the Social Security Act to waive budget neutrality for oxygen under the Medicare program, and for other purposes.;H.R.7481 RESTART Act; S.4737 A bill to amend the Public Health Service Act to direct the Secretary of Health and Human Services to make grants to covered health departments to increase the rate of recommended immunizations, and for other purposes;

Client expense: $40,000 · 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), Environmental Protection Agency (EPA), Federal Reserve System, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Postal Regulatory Commission, SENATE, Small Business Administration (SBA), Treasury, Dept of, White House Office

Legislation pertaining to ocean acidification, harmful algal blooms, hypoxia, red tide/blue-green algae generally, Arctic shipping, red snapper/bluefin/groundfish fishing regulations, fisheries and the Magnuson-Stevens Act generally including fishery disaster assistance, USCG PARS, implementation of EO 13840, maritime shipping, ocean exploration/mapping, climate change and our oceans, marine debris, regional ocean data portals and ocean data legislation generally. NEPA regulations regarding GHG emissions and climate change. Marine Debris: S.1982 - Save Our Seas 2.0 Act S.2660 - Save Our Seas 2.0: Improving Domestic Infrastructure to Prevent Marine Debris Act S.2364 - Save Our Seas 2.0: Enhancing the Domestic Marine Debris Response Act S.2372 - Save Our Seas 2.0: Enhanced Global Engagement to Combat Marine Debris Act H.R.3969 - SOS 2.0 Act H.R.4636 - PLASTIC Seas Act H.R.5845/S.3263/S.3944 - Break Free From Plastic Pollution Act of 2020 S.3281 - Original Recycle Bottle Act of 2020 H.R.5902/S.3306 - MICRO Plastics Act of 2020 S.3306/H.R.5902 - MICRO Plastics Act of 2020 S.4681 - Plastic Pellet Free Waters Act Ocean Acidification/Harmful Algal Blooms/Water Quality: H.R.335/S.10 - South Florida Coastal Waters Act of 2019 H.R.414 - Protecting Local Communities from Harmful Algal Blooms Act H.R.462 - Everglades for the Next Generation Act H.R.988 - NEAR Act of 2019 H.R.1237 - COAST Research Act of 2019 H.R.1716/S.778 - Coastal Communities Ocean Acidification Act of 2019 H.R.1834 - Defending Our National Marine Sanctuaries from Damaging Chemicals Act of 2019 H.R.1921 - Ocean Acidification Innovation Act of 2019 H.R.2448 - Ocean Acidification Research Partnerships Act H.R.2587/S.1375 - Reef Safe Act of 2019 H.R.2588/S.1371 - Oxybenzone and Octinoxate Impact Study of 2019 H.R.3297 - Harmful Algal Bloom Essential Forecasting Act H.R.3324 - Prioritizing Revised Operations to Eliminate Cyanobacteria Toxins in Florida Act H.R.4160/S.2429 - Restoring Resilient Reefs Act of 2019 H.R.6738 - Coral Reef Conservation Reauthorization Act of 2020 H.R.7450 - Prevent Harmful Algal Blooms Act S. 778 - Coastal Communities Ocean Acidification Act of 2019 S.914 - Coordinated Ocean Observations and Research Act of 2019 S.2429 - Restoring Resilient Reefs Act of 2019 S.2699 - OCEAN Research Act of 2019 Marine Wildlife and Fisheries: H.R.1023/S.466 - Great Lakes Fishery Research Authorization Act of 2019 H.R.1568/S.2453 - SAVE Right Whales Act H.R.1747/S.754 - National Fish Habitat Conservation Through Partnerships Act H.R.1979/S.906 - Driftnet Modernization and Bycatch Reduction Act H.R.2236 - Forage Fish Conservation Act H.R.3424 - SEA Act of 2019 H.R.3697 - Strengthening Fishing Communities and Increasing Flexibility in Fisheries Management Act H.R.4679 - Climate Fisheries Act of 2019 H.R.5126/S.2960 - DESCEND Act of 2019 H.R.5548/S.2346 - Fishery Failures: Urgently Needed Disaster Declarations Act H.R.6191 - AQUAA Act S.908 - Fluke Fairness Act of 2019 S.2802 - Marine Mammal Research and Response Act of 2019 S.4723 - A bill to establish a regulatory system for sustainable offshore aquaculture in the United States exclusive economic zone, and for other purposes. Ocean and Coastal Planning/ Ocean Data/Ocean Climate: H.R.9/S.1743 - Climate Action Now Act H.R.729 - Tribal Coastal Resilience Act S.810 COASTAL Implementation Act of 2019 S.933/H.R.3548 BLUE GLOBE Act H.R.1314 - Integrated Coastal and Ocean Observation System Act Amendments of 2019 H.R.2185 - DC Flood Prevention Act of 2019 H.R.2189/S.1069 - Digital Coast Act H.R.3115/S.1730 - Living Shorelines Act of 2019 H.R.3541 - Coastal State Climate Preparedness Act of 2019 H.R.3596 - Keep America's Waterfronts Working Act H.R.4093 - National Oceans and Coastal Security Improvements Act of 2019 H.R.5221 - 100% Clean Economy Act of 2019 H.R.5390/S.2166 - ROP Act H.R.5589/S.3939 - Blue Carbon for Our Planet Act H.R.7024/S.4046 - Climate Smart Ports Act H.R.7713 - NOPP Revitalization Act Other: H.R.2 - Moving Forward Act S.1177/H.R.3020 - SEAL Act S.2786 - Arctic Shipping Federal Advisory Committee Act H.R.2405/S.910 - National Sea Grant College Program Amendments of 2019 H.R.6636 - NOAA Sexual Harassment and Assault Prevention Improvements Act of 2020 H.R.7387 - Shovel-Ready Restoration Grants for Coastlines and Fisheries Act of 2020 S.Res.537/H.Con.Res.89 - A resolution encouraging the Trump Administration to maintain protections under the National Environmental Policy Act and reverse ongoing administrative actions to weaken this landmark law and its protections for American communities.

Client expense: $107,119 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Council on Environmental Quality (CEQ), HOUSE OF REPRESENTATIVES, Interior, Dept of (DOI), Natl Oceanic & Atmospheric Administration (NOAA), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), U.S. Coast Guard (USCG)

Issues involving attempts to amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D, and for other purposes. HR 448 - Medicare Drug Price Negotiation Act. HR 383, Continuing Coverage for Preexisting Conditions Act of 2019; S. 1556, No Junk Plans Act; S. 466, Protecting Americans with Pre-existing Conditions Act of 2019; S. 1905, ENROLL Act of 2019.

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

Government targets: SENATE

Issues that encompass attempts to amend the Federal Food, Drug, and Cosmetic Act to allow for the importation of affordable and safe drugs by wholesale distributors, pharmacies, and individuals. HR 447 - Affordable and Safe Prescription Drug Importation Act. Issues involving the attempts to amend PL 111-148, The Patient Protection and Affordable Care Act, to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited. HR 383 - Continuing Coverage for Preexisting Conditions Act of 2019; S. 1556, No Junk Plans Act; S. 466, Protecting Americans with Pre-existing Conditions Act of 2019; S. 1905, ENROLL Act of 2019.

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

Government targets: SENATE

HR 6800 the HEROES Act re COVID relief S. 4163 re COVID Testing (Gardner) S. 4329 Continuous Health Coverage for Workers Act (McSally) HR 7472 re contract tracing (Speier) S. 4230 Telehealth Expansion Act (Wyden) HR 6395, National Defense Authorization Act S. 4049, National Defense Authorization Act HR 6666, COVID 19 Testing, Reaching and Contacting Everyone Act (TRACE Act) HR 1425, Patient Protection and Affordable Care Enhancement Act HR 6514, Worker Health Coverage Protection Act HR 6568, Coverage for COVID 19 Treatment Act HR 6800, Health and Economic Recovery Omnibus Emergency Solutions Act (HEROES Act) HR 5438, Cox, The End Valley Fever Now Act S. 2897, Warner, regarding the reauthorization of PCORI HR 5201, Matsui, regarding telehealth and behavioral health HR 2328, the No Surprises Act S. 1895, the Lower Health Care Costs Act HR 987 and S. 455, regarding outreach and education activities under the ACA HR 3439, regarding the reauthorization of PCORI House Resolution 271, regarding the Justice Departments position in Texas v. United States HR 2062 & S. 1012, regarding 42 CFR Part 2 and confidentiality of certain health information HR 1884, with provisions to stabilize and strengthen the ACA and the nongroup insurance market. S. 470, regarding a Medicare buy-in option for individuals aged 50-64 S. 489 and HR 1277, regarding a Medicaid buy-in option S. 1129, to establish a single payer system based on Medicare for All. HR 1384, to establish a single payer health care system HR 1425, regarding reinsurance funding under the ACA HR 986 and S. 466, regarding Section 1332 state waiver guidance. HR 1010, regarding Short Term Limited Duration Insurance policies HR 1143, regarding Short Term Limited Duration Insurance policies HR 861, regarding surprise billing

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

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

Proposed changes to Medicare hospital reimbursement policy Health care policy 42 CFR Part 2 alignment with HIPAA H.R. 986/S. 466 Protecting Americans with Preexisting Conditions Act of 2019, a bill provide that certain guidance related to waivers for State innovation under the ACA shall have no force or effect H.R. 2113, Prescription Drug Sunshine, Transparency, Accountability and Reporting (STAR) Act" - provisions related to studying rising hospital drug prices and reporting of drug costs H.R. 965/S. 340, "CREATES Act" H.R. 938, Bringing Low-cost Options and Competition while Keeping Incentives for New Generics Act of 2019 or the BLOCKING Act of 2019 - provisions related to eligibility for approval of a subsequent generic drug and 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 H.R. 1499 Protecting Consumer Access to Generic Drugs Act of 2019 - provisions related to prohibiting 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 S. 2543, the Prescription Drug Pricing Reduction Act H.R. 3, "Elijah E. Cummings Lower Drug Costs Now Act" Additional legislative proposals to address rising drug costs H.R. 1559, "340B Protection and Accountability Act" Additional legislative proposals modifying the 340B program S.1895, Lower Health Care Costs Act- provisions related to surprise billing and provider/payer agreements S. 1531, "STOP Surprise Medical Bills Act" H.R. 3630, "No Surprises Act" H.R.5826, "Consumer Protections Against Surprise Medical Bills Act of 2020" Other proposals to address surprise billing Proposals to strengthen the health care system and achieve ACA market stability Legislation aimed at combating COVID-19 - provisions related to healthcare and hospitals H.R. 6201, "Families First Coronavirus Response Act" - provisions related to healthcare, Medicaid and Medicare H.R. 748, "Coronavirus Aid, Relief, and Economic Security Act" (CARES Act) - provisions related to federal financial relief, including funding for healthcare providers H.R. 6800, HEROES Act Legislative proposals aimed at combating coronavirus

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

Issues related to lung disease treatment, prevention and research; public health; Issues related asthma; COPD; influenza; lung cancer; pneumonia; tuberculosis and other lung diseases; Issues related to tobacco cessation; Issues related to the Affordable Care Act; Issues related to the Childrens Health Insurance Program; Issues related to the President's Budget; Issues related to telehealth; Issues related to changing federal poverty line calculation; Issues related to COVID-19 Response; H.R.965 CREATES Act of 2019; H.R.986 Protecting Americans with Preexisting Conditions Act of 2019 H.R.987 Strengthening Health Care and Lowering Prescription Drug Costs Act H.R.1010 To provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect. H.R.1385 SAVE Act H.R.1386 ENROLL Act of 2019 H.R.1425 State Health Care Premium Reduction Act H.R.1499 Protecting Consumer Access to Generic Drugs Act of 2019 H.R.1884 Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019 H.R.2508 Better Respiration through Expanding Access to Tele-Health Act;H.R.2862 VACCINES Act of 2019; H.R.3630 No Surprises Act H.R.4622 Family Asthma Act S.340 CREATES Act of 2019 S.466 Protecting Americans with Pre-existing Conditions Act of 2019 S.946 Henrietta Lacks Enhancing Cancer Research Act of 2019 S.1125 Protect Act S.1895 Lower Health Care Costs Act S.1944 Public Health Funding Restoration Act. HR 3 Elijah E. Cummings Lower Drug Costs Now Act; H.R.4716 I CAN Act; HR 5230 Elijah E. Cummings Family Asthma Act; HR 6201 - Families First Coronavirus Act; HR 6704 - Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020; HR 748 - CARES Act; S. 3548 - CARES Act; S. 1531 - Stopping the Outrageous Practice of Surprise Medical Bills Act of 2019; HR 6408 -- To extend the charitable deduction to all taxpayers regardless of whether a taxpayer itemizes deductions in order to encourage and increase charitable giving, and to provide for loans and loan guarantees to certain public charities; HR 7610 Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2021; HR 7667 Commerce, Justice, Science, and Related Agencies Appropriations Act, 2021; HR 7617 Department of Defense Appropriations Act, 2021; HR 7612 Department of the Interior, Environment, and Related Agencies Appropriations Act, 2021; HR 2468 School-Based Allergies and Asthma Management Program Act; HR 7614 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2021; HR 7609 Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2021; HR 7616 Transportation, Housing and Urban Development, and Related Agencies Appropriations Act, 2021; HR 7608 Department of State, Foreign Operations, and Related Programs Appropriations Act, 2021; H.R.5076 Protecting Seniors Through Immunization Act of 2019; H.R.6561 Improving Social Determinants of Health Act of 2020; HR 6800 HEROES Act; H.R.6935 Protecting the Health of America's Older Adults During COVID-19 and Beyond Act; HR 7286 Quit Because of COVID-19 Act;

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Environmental Protection Agency (EPA), Federal Reserve System, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Postal Regulatory Commission, SENATE, Small Business Administration (SBA), Treasury, Dept of, White House Office

HR 6395, National Defense Authorization Act S. 4049, National Defense Authorization Act HR 6666, COVID 19 Testing, Reaching and Contacting Everyone Act (TRACE Act) HR 1425, Patient Protection and Affordable Care Enhancement Act HR 6514, Worker Health Coverage Protection Act HR 6568, Coverage for COVID 19 Treatment Act HR 6800, Health and Economic Recovery Omnibus Emergency Solutions Act (HEROES Act) HR 6074, Coronavirus Preparedness and Response Supplemental Appropriations Act (CARES Act) HR 6201, The Families First Coronavirus Response Act HR 5438, Cox, The End Valley Fever Now Act S. 2897, Warner, regarding the reauthorization of PCORI HR 5201, Matsui, regarding telehealth and behavioral health HR 2328, PCORI Reauthorization HR 2328, the No Surprises Act S. 1895, the Lower Health Care Costs Act HR 987 and S. 455, regarding outreach and education activities under the ACA HR 3439, regarding the reauthorization of PCORI House Resolution 271, regarding the Justice Departments position in Texas v. United States HR 2062 & S. 1012, regarding 42 CFR Part 2 and confidentiality of certain health information HR 1884, with provisions to stabilize and strengthen the ACA and the nongroup insurance market. S. 470, regarding a Medicare buy-in option for individuals aged 50-64 S. 489 and HR 1277, regarding a Medicaid buy-in option S. 1129, to establish a single payer system based on Medicare for All. HR 1384, to establish a single payer health care system HR 1425, regarding reinsurance funding under the ACA HR 986 and S. 466, regarding Section 1332 state waiver guidance. HR 1010, regarding Short Term Limited Duration Insurance policies HR 1143, regarding Short Term Limited Duration Insurance policies HR 861, regarding surprise billing

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

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

Legislation pertaining to ocean acidification, harmful algal blooms, hypoxia, red tide/blue-green algae generally, Arctic shipping, red snapper/bluefin/groundfish fishing regulations, fisheries and the Magnuson-Stevens Act generally including fishery disaster assistance, USCG PARS, implementation of EO 13840, maritime shipping, ocean exploration/mapping, climate change and our oceans, marine debris, regional ocean data portals and ocean data legislation generally. NEPA regulations regarding GHG emissions and climate change. Marine Debris: S.1982 - Save Our Seas 2.0 Act S.2660 - Save Our Seas 2.0: Improving Domestic Infrastructure to Prevent Marine Debris Act S.2364 - Save Our Seas 2.0: Enhancing the Domestic Marine Debris Response Act S.2372 - Save Our Seas 2.0: Enhanced Global Engagement to Combat Marine Debris Act H.R.3969 - SOS 2.0 Act H.R.4636 - PLASTIC Seas Act H.R.5845/S.3263/S.3944 - Break Free From Plastic Pollution Act of 2020 S.3281 - Original Recycle Bottle Act of 2020 H.R.5902/S.3306 - MICRO Plastics Act of 2020 S.3306/H.R.5902 - MICRO Plastics Act of 2020 Ocean Acidification/Harmful Algal Blooms/Water Quality: H.R.335/S.10 - South Florida Coastal Waters Act of 2019 H.R.414 - Protecting Local Communities from Harmful Algal Blooms Act H.R.462 - Everglades for the Next Generation Act H.R.988 - NEAR Act of 2019 H.R.1237 - COAST Research Act of 2019 H.R.1716/S.778 - Coastal Communities Ocean Acidification Act of 2019 H.R.1834 - Defending Our National Marine Sanctuaries from Damaging Chemicals Act of 2019 H.R.1921 - Ocean Acidification Innovation Act of 2019 H.R.2448 - Ocean Acidification Research Partnerships Act H.R.2587/S.1375 - Reef Safe Act of 2019 H.R.2588/S.1371 - Oxybenzone and Octinoxate Impact Study of 2019 H.R.3297 - Harmful Algal Bloom Essential Forecasting Act H.R.3324 - Prioritizing Revised Operations to Eliminate Cyanobacteria Toxins in Florida Act H.R.4160/S.2429 - Restoring Resilient Reefs Act of 2019 H.R.6738 - Coral Reef Conservation Reauthorization Act of 2020 S. 778 - Coastal Communities Ocean Acidification Act of 2019 S.914 - Coordinated Ocean Observations and Research Act of 2019 S.2429 - Restoring Resilient Reefs Act of 2019 S.2699 - OCEAN Research Act of 2019 Marine Wildlife and Fisheries: H.R.1023/S.466 - Great Lakes Fishery Research Authorization Act of 2019 H.R.1568/S.2453 - SAVE Right Whales Act H.R.1747/S.754 - National Fish Habitat Conservation Through Partnerships Act H.R.1979/S.906 - Driftnet Modernization and Bycatch Reduction Act H.R.2236 - Forage Fish Conservation Act H.R.3424 - SEA Act of 2019 H.R.3697 - Strengthening Fishing Communities and Increasing Flexibility in Fisheries Management Act H.R.4679 - Climate Fisheries Act of 2019 H.R.5126/S.2960 - DESCEND Act of 2019 H.R.5548/S.2346 - Fishery Failures: Urgently Needed Disaster Declarations Act H.R.6191 - AQUAA Act S.908 - Fluke Fairness Act of 2019 S.2802 - Marine Mammal Research and Response Act of 2019 Ocean and Coastal Planning/ Ocean Data/Ocean Climate: H.R.9/S.1743 - Climate Action Now Act H.R.729 - Tribal Coastal Resilience Act S.810 COASTAL Implementation Act of 2019 S.933/H.R.3548 BLUE GLOBE Act H.R.1314 - Integrated Coastal and Ocean Observation System Act Amendments of 2019 H.R.2185 - DC Flood Prevention Act of 2019 H.R.2189/S.1069 - Digital Coast Act H.R.3115/S.1730 - Living Shorelines Act of 2019 H.R.3541 - Coastal State Climate Preparedness Act of 2019 H.R.3596 - Keep America's Waterfronts Working Act H.R.4093 - National Oceans and Coastal Security Improvements Act of 2019 H.R.5221 - 100% Clean Economy Act of 2019 H.R.5390/S.2166 - ROP Act H.R.5589/S.3939 - Blue Carbon for Our Planet Act H.R.7024/S.4046 - Climate Smart Ports Act Other: S.1177/H.R.3020 - SEAL Act S.2786 - Arctic Shipping Federal Advisory Committee Act H.R.2405/S.910 - National Sea Grant College Program Amendments of 2019 H.R.6636 - NOAA Sexual Harassment and Assault Prevention Improvements Act of 2020 H.R.7387 - To require the Secretary of Commerce to establish a grant program to benefit coastal habitats, resiliency, and the economy, and for other purposes. S.Res.537/H.Con.Res.89 - A resolution encouraging the Trump Administration to maintain protections under the National Environmental Policy Act and reverse ongoing administrative actions to weaken this landmark law and its protections for American communities.

Client expense: $146,044 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Council on Environmental Quality (CEQ), HOUSE OF REPRESENTATIVES, Interior, Dept of (DOI), Natl Oceanic & Atmospheric Administration (NOAA), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), U.S. Coast Guard (USCG)

Legislation pertaining to ocean acidification, harmful algal blooms, hypoxia, red tide/blue-green algae generally, Arctic shipping, red snapper/bluefin/groundfish fishing regulations, fisheries and the Magnuson-Stevens Act generally including fishery disaster assistance, USCG PARS, implementation of EO 13840, maritime shipping, ocean exploration/mapping, climate change and our oceans, marine debris, regional ocean data portals and ocean data legislation generally. NEPA regulations regarding GHG emissions and climate change. Marine Debris: S.1982 - Save Our Seas 2.0 Act S.2660 - Save Our Seas 2.0: Improving Domestic Infrastructure to Prevent Marine Debris Act S.2364 - Save Our Seas 2.0: Enhancing the Domestic Marine Debris Response Act S.2372 - Save Our Seas 2.0: Enhanced Global Engagement to Combat Marine Debris Act H.R.3969 - SOS 2.0 Act H.R.4636 - PLASTIC Seas Act H.R.5845/S.3263/S.3944 - Break Free From Plastic Pollution Act of 2020 S.3281 - Original Recycle Bottle Act of 2020 H.R.5902/S.3306 - MICRO Plastics Act of 2020 S.3306/H.R.5902 - MICRO Plastics Act of 2020 Ocean Acidification/Harmful Algal Blooms/Water Quality: H.R.335/S.10 - South Florida Coastal Waters Act of 2019 H.R.414 - Protecting Local Communities from Harmful Algal Blooms Act H.R.462 - Everglades for the Next Generation Act H.R.988 - NEAR Act of 2019 H.R.1237 - COAST Research Act of 2019 H.R.1716/S.778 - Coastal Communities Ocean Acidification Act of 2019 H.R.1834 - Defending Our National Marine Sanctuaries from Damaging Chemicals Act of 2019 H.R.1921 - Ocean Acidification Innovation Act of 2019 H.R.2448 - Ocean Acidification Research Partnerships Act H.R.2587/S.1375 - Reef Safe Act of 2019 H.R.2588/S.1371 - Oxybenzone and Octinoxate Impact Study of 2019 H.R.3297 - Harmful Algal Bloom Essential Forecasting Act H.R.3324 - Prioritizing Revised Operations to Eliminate Cyanobacteria Toxins in Florida Act H.R.4160/S.2429 - Restoring Resilient Reefs Act of 2019 H.R.6738 - Coral Reef Conservation Reauthorization Act of 2020 S. 778 - Coastal Communities Ocean Acidification Act of 2019 S.914 - Coordinated Ocean Observations and Research Act of 2019 S.2429 - Restoring Resilient Reefs Act of 2019 S.2699 - OCEAN Research Act of 2019 Marine Wildlife and Fisheries: H.R.1023/S.466 - Great Lakes Fishery Research Authorization Act of 2019 H.R.1568/S.2453 - SAVE Right Whales Act H.R.1747/S.754 - National Fish Habitat Conservation Through Partnerships Act H.R.1979/S.906 - Driftnet Modernization and Bycatch Reduction Act H.R.2236 - Forage Fish Conservation Act H.R.3424 - SEA Act of 2019 H.R.3697 - Strengthening Fishing Communities and Increasing Flexibility in Fisheries Management Act H.R.4679 - Climate Fisheries Act of 2019 H.R.5126/S.2960 - DESCEND Act of 2019 H.R.5548/S.2346 - Fishery Failures: Urgently Needed Disaster Declarations Act H.R.6191 - AQUAA Act S.908 - Fluke Fairness Act of 2019 S.2802 - Marine Mammal Research and Response Act of 2019 Ocean and Coastal Planning/ Ocean Data/Ocean Climate: H.R.9/S.1743 - Climate Action Now Act H.R.729 - Tribal Coastal Resilience Act S.810 COASTAL Implementation Act of 2019 S.933/H.R.3548 BLUE GLOBE Act H.R.1314 - Integrated Coastal and Ocean Observation System Act Amendments of 2019 H.R.2185 - DC Flood Prevention Act of 2019 H.R.2189/S.1069 - Digital Coast Act H.R.3115/S.1730 - Living Shorelines Act of 2019 H.R.3541 - Coastal State Climate Preparedness Act of 2019 H.R.3596 - Keep America's Waterfronts Working Act H.R.4093 - National Oceans and Coastal Security Improvements Act of 2019 H.R.5221 - 100% Clean Economy Act of 2019 H.R.5390/S.2166 - ROP Act H.R.5589/S.3939 - Blue Carbon for Our Planet Act H.R.7024/S.4046 - Climate Smart Ports Act Other: S.1177/H.R.3020 - SEAL Act S.2786 - Arctic Shipping Federal Advisory Committee Act H.R.2405/S.910 - National Sea Grant College Program Amendments of 2019 H.R.6636 - NOAA Sexual Harassment and Assault Prevention Improvements Act of 2020 H.R.7387 - To require the Secretary of Commerce to establish a grant program to benefit coastal habitats, resiliency, and the economy, and for other purposes. S.Res.537/H.Con.Res.89 - A resolution encouraging the Trump Administration to maintain protections under the National Environmental Policy Act and reverse ongoing administrative actions to weaken this landmark law and its protections for American communities.

Client expense: $146,044 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Council on Environmental Quality (CEQ), HOUSE OF REPRESENTATIVES, Interior, Dept of (DOI), Natl Oceanic & Atmospheric Administration (NOAA), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), U.S. Coast Guard (USCG)

Issues involving attempts to amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D, and for other purposes. HR 448 - Medicare Drug Price Negotiation Act. HR 383, Continuing Coverage for Preexisting Conditions Act of 2019; S. 1556, No Junk Plans Act; S. 466, Protecting Americans with Pre-existing Conditions Act of 2019; S. 1905, ENROLL Act of 2019.

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

Government targets: SENATE

Issues that encompass attempts to amend the Federal Food, Drug, and Cosmetic Act to allow for the importation of affordable and safe drugs by wholesale distributors, pharmacies, and individuals. HR 447 - Affordable and Safe Prescription Drug Importation Act. Issues involving the attempts to amend PL 111-148, The Patient Protection and Affordable Care Act, to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited. HR 383 - Continuing Coverage for Preexisting Conditions Act of 2019; S. 1556, No Junk Plans Act; S. 466, Protecting Americans with Pre-existing Conditions Act of 2019; S. 1905, ENROLL Act of 2019.

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

Government targets: SENATE

Support HR 1763/ S 348, Resident Physician Shortage Reduction Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose HR 506,Hospital Competition Act of 2019, a bill to amend title XVIII of the Social Security Act to increase hospital competition; Statement submitted to the House Judiciary on the hearing "Diagnosing the Problem: Exploring the Effects of Consolidation and Anticompetitive Conduct in Health Care Markets";Letter of support for the Senate Workgroups efforts to ensure consumer protections by addressing surprise medical bills and comments on the development of legislation to protect patients from surprise medical bills; Letter urging Congress and the Administration to take further action to help reduce input and administrative costs, as well as maximize the number of insured patients; Comment letter urged CMS to extend the comment period for the proposed rules related to interoperability provisions of the 21st Century Cures Act by at least 30 days; Comment letter on the Food and Drug Administrations (FDA) draft guidance on blood glucose monitoring test systems (BGMS) for prescription point-of-care (POC) use and urge FDA to consider compiling a finite list of universally acceptable disinfectant products that would apply to all medical devices or classes of device; Comment letter that urged CMS to address the substantial flaws in the star ratings methodology since the ratings inception in 2016 and to suspend the display of overall star ratings on Hospital Compare while the agency continues its important work of enhancing the validity and meaningfulness of star ratings; Comment letter to FDA on the public meeting, Identifying the Root Causes of Drug Shortages and Finding Enduring Solutions with the following legislative recommendations: Strengthen manufacturers drug shortage disclosure requirements, Incentivize manufacturing contingency plans and/or redundancies, Enhance production transparency requirements, Enact shortage disclosure notification requirements for certain medical devices needed to administer drugs, Assess drug shortages as a national security threat, Include potential risk for drug shortages as a factor in the Federal Trade Commission (FTC) reviews of drug company merger proposals, and regulatory recommendations: Establish incentives to encourage manufacturers to produce drugs in shortage, Prevent manufacturing shutdowns, Establish a quality manufacturing initiative, Enhance information on the quality of outsourcing facilities compounding, Expand and improve the FDAs drug shortages list, Develop a list of critical drugs, Consider how reducing the number of unapproved drugs1 on the market might impact shortages, Reduce drug waste, Create an Office of Clinical Affairs within the Drug Enforcement Administration (DEA); Comment letter urging the CMS to use its upcoming proposed rules for Inpatient Rehabilitation Facility (IRF) and other post-acute care providers to address several issues related to the implementation of the revised case-mix grouping (CMG) policies; 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; Support letter for the adoption of a unique patient identifier (UPI, by removing the prohibition on the use of federal funds to promulgate or adopt a national UPI would provide HHS the ability to explore solutions that link patients with their correct medical records; 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; 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 today 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.

Client expense: $5,940,000 · Firm income: Not reported

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

Issues related to lung disease treatment, prevention and research; public health; Issues related asthma; COPD; influenza; lung cancer; pneumonia; tuberculosis and other lung diseases; Issues related to tobacco cessation; Issues related to the Affordable Care Act; Issues related to the Childrens Health Insurance Program; Issues related to the President's Budget; Issues related to telehealth; Issues related to changing federal poverty line calculation; Issues related to COVID-19 Response; Issues related to FY21 appropriations including Labor, Health and Human Services, Education and Related Agencies; H.R.965 CREATES Act of 2019; H.R.986 Protecting Americans with Preexisting Conditions Act of 2019 H.R.987 Strengthening Health Care and Lowering Prescription Drug Costs Act H.R.1010 To provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect. H.R.1385 SAVE Act H.R.1386 ENROLL Act of 2019 H.R.1425 State Health Care Premium Reduction Act H.R.1499 Protecting Consumer Access to Generic Drugs Act of 2019 H.R.1884 Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019 H.R.2508 Better Respiration through Expanding Access to Tele-Health Act;H.R.2862 VACCINES Act of 2019; H.R.3630 No Surprises Act H.R.4622 Family Asthma Act S.340 CREATES Act of 2019 S.466 Protecting Americans with Pre-existing Conditions Act of 2019 S.946 Henrietta Lacks Enhancing Cancer Research Act of 2019 S.1125 Protect Act S.1895 Lower Health Care Costs Act S.1944 Public Health Funding Restoration Act. HR 3 Elijah E. Cummings Lower Drug Costs Now Act; H.R.4716 I CAN Act; HR 5230 Elijah E. Cummings Family Asthma Act; HR 6201 - Families First Coronavirus Act; HR 6704 - Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020; HR 748 - CARES Act; S. 3548 - CARES Act; S. 1531 - Stopping the Outrageous Practice of Surprise Medical Bills Act of 2019; HR 6408 -- To extend the charitable deduction to all taxpayers regardless of whether a taxpayer itemizes deductions in order to encourage and increase charitable giving, and to provide for loans and loan guarantees to certain public charities;

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Postal Regulatory Commission, SENATE, Treasury, Dept of, White House Office

Issues involving attempts to amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D, and for other purposes. HR 448 - Medicare Drug Price Negotiation Act. HR 383, Continuing Coverage for Preexisting Conditions Act of 2019; S. 1556, No Junk Plans Act; S. 466, Protecting Americans with Pre-existing Conditions Act of 2019; S. 1905, ENROLL Act of 2019.

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

Government targets: SENATE

Issues that encompass attempts to amend the Federal Food, Drug, and Cosmetic Act to allow for the importation of affordable and safe drugs by wholesale distributors, pharmacies, and individuals. HR 447 - Affordable and Safe Prescription Drug Importation Act. Issues involving the attempts to amend PL 111-148, The Patient Protection and Affordable Care Act, to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited. HR 383 - Continuing Coverage for Preexisting Conditions Act of 2019; S. 1556, No Junk Plans Act; S. 466, Protecting Americans with Pre-existing Conditions Act of 2019; S. 1905, ENROLL Act of 2019.

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

Government targets: SENATE

Proposed changes to Medicare hospital reimbursement policy Health care policy 42 CFR Part 2 alignment with HIPAA H.R. 986/S. 466 Protecting Americans with Preexisting Conditions Act of 2019, a bill provide that certain guidance related to waivers for State innovation under the ACA shall have no force or effect H.R. 2113, Prescription Drug Sunshine, Transparency, Accountability and Reporting (STAR) Act" - provisions related to studying rising hospital drug prices and reporting of drug costs H.R. 965/S. 340, "CREATES Act" H.R. 938, Bringing Low-cost Options and Competition while Keeping Incentives for New Generics Act of 2019 or the BLOCKING Act of 2019 - provisions related to eligibility for approval of a subsequent generic drug and 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 H.R. 1499 Protecting Consumer Access to Generic Drugs Act of 2019 - provisions related to prohibiting 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 S. 2543, the Prescription Drug Pricing Reduction Act H.R. 3, "Elijah E. Cummings Lower Drug Costs Now Act" Additional legislative proposals to address rising drug costs H.R. 1559, "340B Protection and Accountability Act" Additional legislative proposals modifying the 340B program S.1895, Lower Health Care Costs Act- provisions related to surprise billing and provider/payer agreements S. 1531, "STOP Surprise Medical Bills Act" H.R. 3630, "No Surprises Act" House Ways and Means Committee proposal to address surprise medical bills Other proposals to address surprise billing Proposals to strengthen the health care system and achieve ACA market stability Legislation aimed at combating COVID-19 - provisions related to healthcare and hospitals. H.R. 6201, "Families First Coronavirus Response Act" - provisions related to healthcare, Medicaid and Medicare H.R. 748, "Coronavirus Aid, Relief, and Economic Security Act" (CARES Act) - provisions related to federal financial relief, including funding for healthcare providers Legislative proposals aimed at combating coronavirus

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 6074 Coronavirus Preparedness and Response Supplemental Appropriations Act HR 6074 CARES Act HR 6201 The Families First Coronavirus Response Act HR 5438 Cox, The End Valley Fever Now Act S. 2897, Warner, regarding the reauthorization of PCORI HR 5201 Matsui, regarding telehealth and behavioral health HR 2328, PCORI Reauthorization HR 2328, the No Surprises Act S. 1895, the Lower Health Care Costs Act HR 987 and S. 455, regarding outreach and education activities under the ACA HR 3439, regarding the reauthorization of PCORI House Resolution 271, regarding the Justice Departments position in Texas v. United States HR 2062 & S. 1012, regarding 42 CFR Part 2 and confidentiality of certain health information HR 1884, with provisions to stabilize and strengthen the ACA and the nongroup insurance market. S. 470, regarding a Medicare buy-in option for individuals aged 50-64 S. 489 and HR 1277, regarding a Medicaid buy-in option S. 1129, to establish a single payer system based on Medicare for All. HR 1384, to establish a single payer health care system HR 1425, regarding reinsurance funding under the ACA HR 986 and S. 466, regarding Section 1332 state waiver guidance. HR 1010, regarding Short Term Limited Duration Insurance policies HR 1143, regarding Short Term Limited Duration Insurance policies HR 861, regarding surprise billing

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

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

Legislation pertaining to ocean acidification, harmful algal blooms, hypoxia, red tide/blue-green algae generally, Arctic shipping, red snapper/bluefin/groundfish fishing regulations, fisheries and the Magnuson-Stevens Act generally including fishery disaster assistance, USCG PARS, implementation of EO 13840, maritime shipping, ocean exploration/mapping, climate change and our oceans, marine debris, regional ocean data portals and ocean data legislation generally. NEPA regulations regarding GHG emissions and climate change. Marine Debris: S.1982 - Save Our Seas 2.0 Act S.2660 - Save Our Seas 2.0: Improving Domestic Infrastructure to Prevent Marine Debris Act S.2364 - Save Our Seas 2.0: Enhancing the Domestic Marine Debris Response Act S.2372 - Save Our Seas 2.0: Enhanced Global Engagement to Combat Marine Debris Act H.R.3969 - SOS 2.0 Act H.R.4636 - PLASTIC Seas Act H.R.5845/S.3263 - Break Free From Plastic Pollution Act of 2020 S.3281 - Original Recycle Bottle Act of 2020 H.R.5902/S.3306 - MICRO Plastics Act of 2020 Ocean Acidification/Harmful Algal Blooms/Water Quality: H.R.335/S.10 - South Florida Coastal Waters Act of 2019 H.R.414 - Protecting Local Communities from Harmful Algal Blooms Act H.R.462 - Everglades for the Next Generation Act H.R.988 - NEAR Act of 2019 H.R.1237 - COAST Research Act of 2019 H.R.1716/S.778 - Coastal Communities Ocean Acidification Act of 2019 H.R.1834 - Defending Our National Marine Sanctuaries from Damaging Chemicals Act of 2019 H.R.1921 - Ocean Acidification Innovation Act of 2019 H.R.2448 - Ocean Acidification Research Partnerships Act H.R.2587/S.1375 - Reef Safe Act of 2019 H.R.2588/S.1371 - Oxybenzone and Octinoxate Impact Study of 2019 H.R.3297 - Harmful Algal Bloom Essential Forecasting Act H.R.3324 - Prioritizing Revised Operations to Eliminate Cyanobacteria Toxins in Florida Act H.R.4160/S.2429 - Restoring Resilient Reefs Act of 2019 S. 778 - Coastal Communities Ocean Acidification Act of 2019 S.914 - Coordinated Ocean Observations and Research Act of 2019 S.2429 - Restoring Resilient Reefs Act of 2019 S.2699 - OCEAN Research Act of 2019 Marine Wildlife and Fisheries: H.R.1023/S.466 - Great Lakes Fishery Research Authorization Act of 2019 H.R.1568/S.2453 - SAVE Right Whales Act H.R.1747/S.754 - National Fish Habitat Conservation Through Partnerships Act H.R.1979/S.906 - Driftnet Modernization and Bycatch Reduction Act H.R.2236 - Forage Fish Conservation Act H.R.3424 - SEA Act of 2019 H.R.3697 - Strengthening Fishing Communities and Increasing Flexibility in Fisheries Management Act H.R.4679 - Climate Fisheries Act of 2019 H.R.5126/S.2960 - Direct Enhancement of Snapper Conservation and the Economy through Novel Devices Act of 2019 H.R.5548/S.2346 - Fishery Failures: Urgently Needed Disaster Declarations Act S.908 - Fluke Fairness Act of 2019 Ocean and Coastal Planning/ Ocean Data/Ocean Climate: H.R.9/S.1743 - Climate Action Now Act H.R.729 - Tribal Coastal Resilience Act S.810 COASTAL Implementation Act of 2019 S.933/H.R.3548 BLUE GLOBE Act H.R.1314 - Integrated Coastal and Ocean Observation System Act Amendments of 2019 H.R.2185 - DC Flood Prevention Act of 2019 H.R.2189/S.1069 - Digital Coast Act H.R.3115/S.1730 - Living Shorelines Act of 2019 H.R.3541 - Coastal State Climate Preparedness Act of 2019 H.R.3596 - Keep America's Waterfronts Working Act H.R.4093 - National Oceans and Coastal Security Improvements Act of 2019 H.R.5221 - 100% Clean Economy Act of 2019 H.R.5390/S.2166 - ROP Act H.R.5589 - Blue Carbon for Our Planet Act Other: S.1177/H.R.3020 - SEAL Act S.2786 - Arctic Shipping Federal Advisory Committee Act H.R.2405/S.910 - National Sea Grant College Program Amendments of 2019

Client expense: $221,213 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Council on Environmental Quality (CEQ), HOUSE OF REPRESENTATIVES, Interior, Dept of (DOI), Natl Oceanic & Atmospheric Administration (NOAA), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), U.S. Coast Guard (USCG)

Health Insurance Coverage (general); Health Disparities (general); Breastfeeding (general); Assisted Reproductive Technology (general); Smoking Cessation (general); Substance Use Disorder (general); Gynecologic Cancer (general); Gynecologic Devices (general); Reproductive Health (general); Intimate Partner Violence (general); Gun Violence (general); Immunization (general); Breast Cancer (general); E-Cigarettes (general); Medical Liability Reform (general); Health IT (general); Patient-Physician Relationship (general); Conscience Refusals (general); Child Welfare (general); Prematurity (general); Maternal Mortality and Morbidity (general); Graduate Medical Education (general); Contraception (general); Abortion (general); Indian Health (general); Teaching Health Centers (general); Sexuality Education (general); Teen Pregnancy Prevention Program (general); Personal Responsibility Education Program (general); Research in Pregnant and Breastfeeding Women (general); Health Care Reform (general); Title X Family Planning Program (general); Womens Preventive Services (general); Drug Pricing (general); Administrative Burden (general); Surprise Billing (general); Pediatric Loan Repayment Program (general); H.R. 1551/S.1960, Quality Care for Moms and Babies Act; H.R. 1897/S. 916, MOMMAs Act; H.R. 1763/S. 348, Resident Physician Shortage Reduction Act of 2019; H.R. 1554, Resident Education Deferred Interest Act; H.R.___/S. 116, MOMS Act; S.___, Rural MOMS Act; H.R. 2778/S. 1481, Healthy MOM Act; H.R. 2902/S. 1600, Maternal CARE Act; H.R. 2602/S. 1343, MOMMIES Act; H.R. 1585/S.___, Violence Against Women Reauthorization Act of 2019; S. 130/S. 311, Born-Alive Abortion Survivors Protection Act; H.R. 784/S. 160, Pain-Capable Unborn Child Protection Act; H.R. 2975/S. 1645, Womens Health Protection Act; H.R. 986/S. 466, Protecting Americans with Preexisting Conditions Act; H.R. 1010, To provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect; H.R. 1143, Educating Consumers on the Risks of Short-Term Plans Act of 2019; S.Res. 29, A resolution expressing support for the designation of a Womens Health Research Day; H.R. 2815/S. 304/S. 1191, Training the Next Generation of Primary Care Doctors Act of 2019; H.R.__/S.__, Wise Investment in our Children Act; H.Res. 317/S.Res. 154, A resolution recognizing Black Maternal Health Week; H.R. 2689/S. 1438, Breast Cancer Research Stamp Reauthorization Act; S. 1895, Lower Health Care Costs Act; H.R. 2862/S. 1619, VACCINES Act; H.R. 3296/S. 1847, Affordability is Access Act; H.R. 2777/S. 1936, Protecting Access to Lifesaving Screenings Act; H.R. 3109, GEDI Act; H.R. 2803/S. 1461, Access to Infertility Treatment and Care Act; H.R. 2411/S. 1258, Tobacco to 21 Act; implementation of P.L. 115-344, Preventing Maternal Deaths Act; implementation of P.L. 115-320, Improving Access to Maternity Care Act

Client expense: $420,234 · 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), Defense, Dept of (DOD), Environmental Protection Agency (EPA), 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), Indian Health Service, Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), U.S. Agency for International Development (USAID), Veterans Affairs, Dept of (VA), White House Office

House Resolution 271, regarding the Justice Departments position in Texas v. United States HR 2062 & S. 1012, regarding 42 CFR Part 2 and confidentiality of certain health information HR 1884, with provisions to stabilize and strengthen the ACA and the nongroup insurance market. S. 470 regarding a Medicare buy-in option for individuals aged 50-64 S. 489 and HR 1277, regarding a Medicaid buy-in option S. 1129 to establish a single payer system based on Medicare for All. HR 1384 to establish a single payer health care system HR 1425 regarding reinsurance funding under the ACA HR 986 and S. 466 regarding Section 1332 state waiver guidance. HR 1010 regarding Short Term Limited Duration Insurance policies HR 1143 regarding Short Term Limited Duration Insurance policies HR 861 regarding surprise billing

Client expense: $660,000 · Firm income: Not reported

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

HR 1730/S 741, the Cancer Drug Parity Act; HR 1010, to provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect; HR 986/S 466, the Protecting Americans with Pre-existing Conditions Act; HR 647, the Palliative Care and Hospice Education and Treatment Act (PCHETA); S 1895, the Lower Health Care Costs Act of 2019; HR 965, the CREATES Act; potential regulatory activity to reform the anti-kickback statute and Stark self-referral regulations; LLS plans for a clinical trial for pediatric patients diagnosed with acute myeloid leukemia (AML); Texas v US lawsuit implications for protections for people with pre-existing conditions; prescription drug shortages,

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

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

HR 2328, PCORI Reauthorization HR 2328, the No Surprises Act S. 1895, the Lower Health Care Costs Act HR 987 and S. 455, regarding outreach and education activities under the ACA HR 3439, regarding the reauthorization of PCORI House Resolution 271, regarding the Justice Departments position in Texas v. United States HR 2062 & S. 1012, regarding 42 CFR Part 2 and confidentiality of certain health information HR 1884, with provisions to stabilize and strengthen the ACA and the nongroup insurance market. S. 470, regarding a Medicare buy-in option for individuals aged 50-64 S. 489 and HR 1277, regarding a Medicaid buy-in option S. 1129, to establish a single payer system based on Medicare for All. HR 1384, to establish a single payer health care system HR 1425, regarding reinsurance funding under the ACA HR 986 and S. 466, regarding Section 1332 state waiver guidance. HR 1010, regarding Short Term Limited Duration Insurance policies HR 1143, regarding Short Term Limited Duration Insurance policies HR 861, regarding surprise billing

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

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

S. 350, Competitive Health Insurance Reform Act (Daines) - McCarran-Ferguson Act S. 455, Marketing and Outreach Restoration to Empower Health Education Act (Shaheen) - funding for outreach and education on ACA Exchanges S. 466, Protecting Americans with Preexisting Conditions Act (Warner) - blocking updated Section 1332 guidance S. 560, Ensuring Lasting Smiles Act (Baldwin) - coverage mandate for treatment of congenital anomaly or birth defect S. 741, Cancer Drug Parity Act (Smith) -- cost sharing for oral anticancer drugs S. 913, Disclosure of Price Information to Enrollees (Braun) S. 961, Improving Health Insurance Affordability Act (Shaheen) - premium tax credits S. 964, Marketplace Certainty Act (Shaheen) - cost-sharing subsidies S. 967, Reducing Costs for Out-of-Network Services Act (Shaheen) - caps on out-of-network charges S. 981, Medicare-X Choice Act (Bennet) - public option S. 1033, CHOICE Act (Whitehouse) - public option S. 1125, Protect Act (Tillis) - pre-existing condition protections S. 1129, Medicare for All Act (Sanders) - government health insurance system S. 1170, Association Health Plans Act (Enzi) - codifying final rule for expanding AHPs S. 1266, Protecting Patients from Surprise Medical Bills Act (Scott) - surprise medical billing S. 1531, STOP Surprise Medical Bills Act (Cassidy-Bennet) - surprise medical billing S. 1576, Behavioral Health Coverage Transparency Act (Warren) - mental health parity S. 1577, Know the Price Act (Cassidy-Bennet) - restrictions on provider contracts S. 1737, Mental Health Parity Compliance Act (Murphy) - mental health parity S. 1948, Chronic Disease Management Act (Thune) - pre-deductible coverage of chronic disease prevention services S. 2546, Safe Step Act (Murkowski)-Step therapy exceptions H.R. 692, Pre-existing Conditions Protection Act (Walden) - pre-existing condition protections H.R. 986, Protecting Americans with Preexisting Conditions Act (Kuster) - blocking updated Section 1332 guidance H.R. 987, Marketing and Outreach Restoration to Empower Health Education Act (Blunt Rochester) - funding for outreach and education on ACA Exchanges, Navigator program, and establishment of state-based Health Insurance Exchanges; drug pricing proposals H.R. 1010, Short-Term Plans (Castor) - blocking final rule that expands short-term plans H.R. 1143, Educating Consumers on the Risks of Short-Term Plans Act (Eshoo) - standardized disclosures for short-term plans H.R. 1379, Ensuring Lasting Smiles Act (Peterson) - coverage mandate for treatment of congenital anomaly or birth defect H.R. 1384, Medicare for All Act (Jayapal) - government health insurance system H.R. 1385, State Allowance for a Variety of Exchanges Act (Kim) - funding for establishment of state-based Health Insurance Exchanges H.R. 1386, Expand Navigators Resources for Outreach, Learning, and Longevity Act (Castor) - funding for Navigator Program H.R. 1418, Competitive Health Insurance Reform Act (DeFazio) - McCarran-Ferguson Act H.R. 1425, State Health Care Premium Reduction Act (Craig) - funding for state reinsurance programs H.R. 1510, Premium Relief Act (Burgess) -- Patient and State Stability Fund H.R. 1730, Cancer Drug Parity Act (Higgins) -- cost sharing for oral anticancer drugs H.R. 1884, Protecting Pre-Existing Conditions and Making Health Care More Affordable Act (Pallone) - reinsurance funding, stabilization and affordability proposals H.R. 2000, Medicare-X Choice Act (Delgado) - public option H.R. 2061, Pathway to Universal Coverage Act (Bera) - auto-enrollment H.R. 2085, CHOICE Act (Schakowsky) - public option H.R. 2183, State Flexibility and Patient Choice Act (Marshall) - flexibility in state innovation waivers H.R. 2848, Parity Enforcement Act (Norcross) - mental health parity H.R. 2874, Behavioral Health Coverage Transparency Act (Kennedy) - mental health parity H.R. 3165, Mental Health Parity Compliance Act (Porter) - mental health parity H.R. 3502, Protecting People From Surprise Medical Bills Act (Ruiz) - surprise medical billing H.R. 3630, No Surprises Act (Pallone)-surprise medical billing H.R. 3784, Air Ambulance Affordability Act of 2019 (Neguse)- air ambulances H.R. 4223, Protecting Patients from Surprise Medical Bills Act (Spano)-surprise medical billing H.R. 4379, Under Performing Directories that Affect Treating Emergencies Act (Axne)-provider directories H.R. 4457, Chronic Condition Copay Elimination Act (Underwood)- Eliminating copays for services/drugs for chronic conditions H.R. 4484, Flexibility Through Lower Expenses Health Care Act (Budd)-STLDI plans H.R. 4530, Native American Health Savings Improvement Act (Moolenaar)-HSAs H.R. 4575, Improving Provider Directories Act (Schrier)-provider directories H.R. 5010, State-Based Universal Health Care Act of 2019 (Khanna) - universal health care systems H.R. 5121, Healthcare Cost Transparency Act (Beyer) - provider price comparison tool H.R. 5144, Insurance Accountability and Transparency Act (Davids) - insurance have publicly accessible self-audit information H.R. 5239 Prescription Drug Price Reporting Act (Joyce) - reporting on drug expenditures and price changes under group health plans H. Res. 271 (Allred) - resolution urging DOJ to reverse position in Texas v. United States litigation Regulatory Issues: Insurance regulatory reform; issues related to the coordination of private and public disability income benefits; disability risk management; disability income insurance enrollment and awareness; issues related to encouraging impaired workers to stay in/return to the workforce; issues related to expanding long-term care insurance coverage; issues relating to the coordination of benefits between private health insurance plans and Medicaid; Medigap claims processing and crossover fees; Medigap cross-over claim issues, Medigap coverage, implementation of Medigap standardized plan offerings; Medigap carrier recoveries related to CMS fraud and abuse enforcement activities, and issues related to Medigap educational materials, and other Medigap issues; fraud and abuse issues affecting public and private insurance coverage; issues relating to antitrust; implementation of the Mental Health Parity Act requirements; implementation of the 21st Century Cures Act requirements; summary of benefits and coverage disclosures; prior authorization; accountable care organizations; coverage of preventive services; preexisting condition exclusions; lifetime and annual dollar limits on benefits; patient protections; grandfathered health plan provisions; health reimbursement accounts; dependent coverage; treatment of expatriate plans; issues related to surprise medical bills; issues related to all payor claims databases; issues related to association health plans; issues related to substance abuse and provider treatment records (42 CFR Part 2); issues related to medical management; issues related to fraud, waste, abuse, Stark/Anti-Kickback laws and regulations, non-discriminatory wellness programs; issues related to supplemental products; issues relating to dental coverage; issues relating to proposals for single-payer and Medicare/Medicaid buy-in options; issues related to implementation of the Telephone Consumer Protection Act; issues relating to third party payment of premiums; issues related to cost-sharing reductions (CSRs); issues related to interoperability and price transparency; issues related to the employer market; issues relating to the individual market; and other issues relating to health care reform implementation.

Client expense: $2,340,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office

Proposed changes to Medicare hospital reimbursement policy Health care policy 42 CFR Part 2 alignment with HIPAA H.R. 986/S. 466 Protecting Americans with Preexisting Conditions Act of 2019, a bill provide that certain guidance related to waivers for State innovation under the ACA shall have no force or effect H.R. 2113, Prescription Drug Sunshine, Transparency, Accountability and Reporting (STAR) Act" - provisions related to studying rising hospital drug prices and reporting of drug costs H.R. 965/S. 340, "CREATES Act" H.R. 938, Bringing Low-cost Options and Competition while Keeping Incentives for New Generics Act of 2019 or the BLOCKING Act of 2019 - provisions related to eligibility for approval of a subsequent generic drug and 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 H.R. 1499 Protecting Consumer Access to Generic Drugs Act of 2019 - provisions related to prohibiting 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 S. 2543, the Prescription Drug Pricing Reduction Act H.R. 3, "Elijah E. Cummings Lower Drug Costs Now Act" Additional legislative proposals to address rising drug costs H.R. 1559, "340B Protection and Accountability Act" Additional legislative proposals modifying the 340B program S.1895, Lower Health Care Costs Act- provisions related to surprise billing and provider/payer agreements S. 1531, "STOP Surprise Medical Bills Act" H.R. 3630, "No Surprises Act" House Ways and Means Committee proposal to address surprise medical bills Other proposals to address surprise billing Proposals to strengthen the health care system and achieve ACA market stability

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.J. Res. 74: Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury and the Secretary of Health and Human Services relating to "State Relief and Empowerment Waivers"; all provisions H.R. 986: Protecting Americans with Preexisting Conditions Act of 2019; all provisions H.R. 987: Strengthening Health Care and Lowering Prescription Drug Costs Act; all provisions H.R. 1010: To provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect; all provisions H.R. 1425: State Health Care Premium Reduction Act; all provisions H.R. 1868: Health Care Affordability Act of 2019; all provisions H.R. 1870: Family Health Care Affordability Act of 2019; all provisions H.R. 3630: No Surprises Act; all provisions Ways & Means and Energy & Commerce discussion draft on capping Medicare Part D out-of-pocket costs; all provisions S.J. Res. 52: A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury and the Secretary of Health and Human Services relating to "State Relief and Empowerment Waivers"; all provisions S. 466: Protecting Americans with Pre-existing Conditions Act of 2019; all provisions S. 475: Reducing Existing Costs Associated with Pharmaceuticals for Seniors (RxCAP) Act of 2019; all provisions S. 961: Improving Health Insurance Affordability Act of 2019; all provisions S. 1531: Stopping the Outrageous Practice of Surprise Medical Bills Act of 2019; all provisions S. 1556: No Junk Plans Act; all provisions S. 1712: Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act of 2019; all provisions S. 1895: Lower Health Care Costs Act; all provisions S. 1935: Family Coverage Act; all provisions

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

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

H.J. Res. 74: Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury and the Secretary of Health and Human Services relating to "State Relief and Empowerment Waivers"; all provisions H.R. 3: Elijah E. Cummings Lower Drug Costs Now Act; all provisions H.R. 19: Lower Costs, More Cures Act of 2019; all provisions H.R. 986: Protecting Americans with Preexisting Conditions Act of 2019; all provisions H.R. 987: Strengthening Health Care and Lowering Prescription Drug Costs Act; all provisions H.R. 1010: To provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force or effect; all provisions H.R. 1425: State Health Care Premium Reduction Act; all provisions H.R. 1868: Health Care Affordability Act of 2019; all provisions H.R. 1870: Family Health Care Affordability Act of 2019; all provisions H.R. 2296: More Efficient Tools to Realize Information for Consumers Act; all provisions H.R. 2507: Newborn Screening Saves Lives Reauthorization Act of 2019; all provisions H.R. 3630: No Surprises Act; all provisions H.R. 4698: Medical Records Access Fairness Act; all provisions Ways & Means and Energy & Commerce discussion draft on capping Medicare Part D out-of-pocket costs; all provisions Draft Legislation related to 21st Century Cures Act 2.0; all provisions Antibiotic Development Incentives discussions; all provisions S.J. Res. 52: A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury and the Secretary of Health and Human Services relating to "State Relief and Empowerment Waivers"; all provisions S. 110:Medical Expense Savings Act; all provisions S. 466: Protecting Americans with Pre-existing Conditions Act of 2019; all provisions S. 475: Reducing Existing Costs Associated with Pharmaceuticals for Seniors (RxCAP) Act of 2019; all provisions S. 961: Improving Health Insurance Affordability Act of 2019; all provisions S. 1531: Stopping the Outrageous Practice of Surprise Medical Bills Act of 2019; all provisions S. 1556: No Junk Plans Act; all provisions S. 1712: Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act of 2019; all provisions S. 1895: Lower Health Care Costs Act; all provisions S. 1935: Family Coverage Act; all provisions S. 2158: Newborn Screening Saves Lives Reauthorization Act of 2019; all provisions S. 2543: Prescription Drug Pricing Reduction Act of 2019; all provisions Antibiotic Development Incentives discussions; all provisions

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

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

Issues related to lung disease treatment, prevention and research; public health; Issues related asthma; COPD; influenza; lung cancer; pneumonia; tuberculosis and other lung diseases; Issues related to tobacco cessation; Issues related to the Affordable Care Act; Issues related to the Childrens Health Insurance Program; Issues related to the President's Budget; H.R.965 CREATES Act of 2019 H.R.986 Protecting Americans with Preexisting Conditions Act of 2019 H.R.987 Strengthening Health Care and Lowering Prescription Drug Costs Act H.R.1010 To provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect. H.R.1385 SAVE Act H.R.1386 ENROLL Act of 2019 H.R.1425 State Health Care Premium Reduction Act H.R.1499 Protecting Consumer Access to Generic Drugs Act of 2019 H.R.1884 Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019 H.R.2508 Better Respiration through Expanding Access to Tele-Health Act H.R.2839 Department of State, Foreign Operations, and Related Programs Appropriations Act, 2020 H.R.2862 VACCINES Act of 2019 H.R.3055 Commerce, Justice, Science, Agriculture, Rural Development, Food and Drug Administration, Interior, Environment, Military Construction, Veterans Affairs, Transportation, and Housing and Urban Development Appropriations Act, 2020; S.2580, Department of the Interior, Environment, and Related Agencies Appropriations Act H.R.3630 No Surprises Act H.R.4622 Family Asthma Act S.340 CREATES Act of 2019 S.466 Protecting Americans with Pre-existing Conditions Act of 2019 S.946 Henrietta Lacks Enhancing Cancer Research Act of 2019 S.1125 Protect Act S.1895 Lower Health Care Costs Act S.1944 Public Health Funding Restoration Act. HR 3 Elijah E. Cummings Lower Drug Costs Now Act; H.R.4716 I CAN Act; HR 5230 Elijah E. Cummings Family Asthma Act

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Environmental Protection Agency (EPA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), SENATE, 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";Letter of support for the Senate Workgroups efforts to ensure consumer protections by addressing surprise medical bills and comments on the development of legislation to protect patients from surprise medical bills; Letter urging Congress and the Administration to take further action to help reduce input and administrative costs, as well as maximize the number of insured patients; Comment letter urged CMS to extend the comment period for the proposed rules related to interoperability provisions of the 21st Century Cures Act by at least 30 days; Comment letter on the Food and Drug Administrations (FDA) draft guidance on blood glucose monitoring test systems (BGMS) for prescription point-of-care (POC) use and urge FDA to consider compiling a finite list of universally acceptable disinfectant products that would apply to all medical devices or classes of device; Comment letter that urged CMS to address the substantial flaws in the star ratings methodology since the ratings inception in 2016 and to suspend the display of overall star ratings on Hospital Compare while the agency continues its important work of enhancing the validity and meaningfulness of star ratings; Comment letter to FDA on the public meeting, Identifying the Root Causes of Drug Shortages and Finding Enduring Solutions with the following legislative recommendations: Strengthen manufacturers drug shortage disclosure requirements, Incentivize manufacturing contingency plans and/or redundancies, Enhance production transparency requirements, Enact shortage disclosure notification requirements for certain medical devices needed to administer drugs, Assess drug shortages as a national security threat, Include potential risk for drug shortages as a factor in the Federal Trade Commission (FTC) reviews of drug company merger proposals, and regulatory recommendations: Establish incentives to encourage manufacturers to produce drugs in shortage, Prevent manufacturing shutdowns, Establish a quality manufacturing initiative, Enhance information on the quality of outsourcing facilities compounding, Expand and improve the FDAs drug shortages list, Develop a list of critical drugs, Consider how reducing the number of unapproved drugs1 on the market might impact shortages, Reduce drug waste, Create an Office of Clinical Affairs within the Drug Enforcement Administration (DEA); Comment letter urging the CMS to use its upcoming proposed rules for Inpatient Rehabilitation Facility (IRF) and other post-acute care providers to address several issues related to the implementation of the revised case-mix grouping (CMG) policies; 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; Support letter for the adoption of a unique patient identifier (UPI, by removing the prohibition on the use of federal funds to promulgate or adopt a national UPI would provide HHS the ability to explore solutions that link patients with their correct medical records; 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 H.R. 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; 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.

Client expense: $6,610,000 · Firm income: Not reported

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

Health Insurance Coverage (general); Health Disparities (general); Breastfeeding (general); Assisted Reproductive Technology (general); Smoking Cessation (general); Substance Use Disorder (general); Gynecologic Cancer (general); Gynecologic Devices (general); Reproductive Health (general); Intimate Partner Violence (general); Gun Violence (general); Immunization (general); Breast Cancer (general); E-Cigarettes (general); Medical Liability Reform (general); Health IT (general); Patient-Physician Relationship (general); Conscience Refusals (general); Child Welfare (general); Prematurity (general); Maternal Mortality and Morbidity (general); Graduate Medical Education (general); Contraception (general); Abortion (general); Indian Health (general); Teaching Health Centers (general); Sexuality Education (general); Teen Pregnancy Prevention Program (general); Personal Responsibility Education Program (general); Research in Pregnant and Breastfeeding Women (general); Health Care Reform (general); Title X Family Planning Program (general); Womens Preventive Services (general); Drug Pricing (general); Administrative Burden (general); Surprise Billing (general); Pediatric Loan Repayment Program (general); H.R. 1551/S.1960, Quality Care for Moms and Babies Act; H.R. 1897/S. 916, MOMMAs Act; H.R. 1763/S. 348, Resident Physician Shortage Reduction Act of 2019; H.R. 1554, Resident Education Deferred Interest Act; H.R.___/S. 116, MOMS Act; S. 2373/H.R. 4243, Rural MOMS Act; H.R. 2778/S. 1481, Healthy MOM Act; H.R. 2902/S. 1600, Maternal CARE Act; H.R. 2602/S. 1343, MOMMIES Act; H.R. 1585/S.___, Violence Against Women Reauthorization Act of 2019; S. 130/S. 311, Born-Alive Abortion Survivors Protection Act; H.R. 2975/S. 1645, Womens Health Protection Act; H.R. 986/S. 466, Protecting Americans with Preexisting Conditions Act; H.R. 1010, To provide that the rule entitled "Short-Term, Limited Duration Insurance" shall have no force or effect; H.R. 1143, Educating Consumers on the Risks of Short-Term Plans Act of 2019; S.Res. 29, A resolution expressing support for the designation of a Womens Health Research Day; H.R. 2815/S. 304/S. 1191, Training the Next Generation of Primary Care Doctors Act of 2019; H.R.__/S.__, Wise Investment in our Children Act; H.Res. 317/S.Res. 154, A resolution recognizing Black Maternal Health Week; H.R. 2689/S. 1438, Breast Cancer Research Stamp Reauthorization Act; S. 1895, Lower Health Care Costs Act; H.R. 2862/S. 1619, VACCINES Act; H.R. 3296/S. 1847, Affordability is Access Act; H.R. 2777/S. 1936, Protecting Access to Lifesaving Screenings Act; H.R. 3109, GEDI Act; H.R. 2803/S. 1461, Access to Infertility Treatment and Care Act; H.R. 2411/S. 1258, Tobacco to 21 Act; implementation of P.L. 115-344, Preventing Maternal Deaths Act; implementation of P.L. 115-320, Improving Access to Maternity Care Act; S. 2586, Maternal Outcomes Matter Act; HR 3630, No Surprises Act; HR 3502, Protecting People From Surprise Medical Bills Act; Cures 2.0; S. 227/H.R. 2733, Savannas Act; S. 336/H.R. 2029, the Studying the Missing and Murdered Indian Crisis Act; H.R. 4495, Maternal Health Quality Improvement Act of 2019; H.R. 4996, Helping MOMS Act; Ways and Means Rural and Underserved Communities Health Task Force; H.R. 5640/S. 3152, the Data Mapping to Save Moms Lives Act;

Client expense: $192,376 · 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), Defense, Dept of (DOD), Environmental Protection Agency (EPA), 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), Indian Health Service, Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), U.S. Agency for International Development (USAID), Veterans Affairs, Dept of (VA), White House Office

HR 5438 Cox, The End Valley Fever Now Act S. 2897, Warner, regarding the reauthorization of PCORI HR 5201 Matsui, regarding telehealth and behavioral health HR 2328, PCORI Reauthorization HR 2328, the No Surprises Act S. 1895, the Lower Health Care Costs Act HR 987 and S. 455, regarding outreach and education activities under the ACA HR 3439, regarding the reauthorization of PCORI House Resolution 271, regarding the Justice Departments position in Texas v. United States HR 2062 & S. 1012, regarding 42 CFR Part 2 and confidentiality of certain health information HR 1884, with provisions to stabilize and strengthen the ACA and the nongroup insurance market. S. 470, regarding a Medicare buy-in option for individuals aged 50-64 S. 489 and HR 1277, regarding a Medicaid buy-in option S. 1129, to establish a single payer system based on Medicare for All. HR 1384, to establish a single payer health care system HR 1425, regarding reinsurance funding under the ACA HR 986 and S. 466, regarding Section 1332 state waiver guidance. HR 1010, regarding Short Term Limited Duration Insurance policies HR 1143, regarding Short Term Limited Duration Insurance policies HR 861, regarding surprise billing

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

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

Legislation pertaining to ocean acidification, harmful algal blooms, hypoxia, red tide/blue-green algae generally, Arctic shipping, red snapper/bluefin/groundfish fishing regulations, fisheries and the Magnuson-Stevens Act generally including fishery disaster assistance, USCG PARS, implementation of EO 13840, climate change and our oceans, marine debris, regional ocean data portals and ocean data legislation generally. NEPA regulations regarding GHG emissions and climate change. Marine Debris: S.1982 - Save Our Seas 2.0 Act S.2660 - Save Our Seas 2.0: Improving Domestic Infrastructure to Prevent Marine Debris Act S.2364 - Save Our Seas 2.0: Enhancing the Domestic Marine Debris Response Act S.2372 - Save Our Seas 2.0: Enhanced Global Engagement to Combat Marine Debris Act H.R.3969 - SOS 2.0 Act H.R.4636 - PLASTIC Seas Act Ocean Acidification/Harmful Algal Blooms/Water Quality: H.R.335/S.10 - South Florida Coastal Waters Act of 2019 H.R.414 - Protecting Local Communities from Harmful Algal Blooms Act H.R.462 - Everglades for the Next Generation Act H.R.988 - NEAR Act of 2019 H.R.1237 - COAST Research Act of 2019 H.R.1716/S.778 - Coastal Communities Ocean Acidification Act of 2019 H.R.1834 - Defending Our National Marine Sanctuaries from Damaging Chemicals Act of 2019 H.R.1921 - Ocean Acidification Innovation Act of 2019 H.R.2448 - Ocean Acidification Research Partnerships Act H.R.2587/S.1375 - Reef Safe Act of 2019 H.R.2588/S.1371 - Oxybenzone and Octinoxate Impact Study of 2019 H.R.3297 - Harmful Algal Bloom Essential Forecasting Act H.R.3324 - Prioritizing Revised Operations to Eliminate Cyanobacteria Toxins in Florida Act H.R.4160/S.2429 - Restoring Resilient Reefs Act of 2019 S. 778 - Coastal Communities Ocean Acidification Act of 2019 S.914 - Coordinated Ocean Observations and Research Act of 2019 S.2429 - Restoring Resilient Reefs Act of 2019 S.2699 - OCEAN Research Act of 2019 Marine Wildlife and Fisheries: H.R.1023/S.466 - Great Lakes Fishery Research Authorization Act of 2019 H.R.1568/S.2453 - SAVE Right Whales Act H.R.1747/S.754 - National Fish Habitat Conservation Through Partnerships Act H.R.1979/S.906 - Driftnet Modernization and Bycatch Reduction Act H.R.2236 - Forage Fish Conservation Act H.R.3424 - SEA Act of 2019 H.R.3697 - Strengthening Fishing Communities and Increasing Flexibility in Fisheries Management Act H.R.4679 - Climate Fisheries Act of 2019 H.R.5126/S.2960 - Direct Enhancement of Snapper Conservation and the Economy through Novel Devices Act of 2019 H.R.5548/S.2346 - Fishery Failures: Urgently Needed Disaster Declarations Act S.908 - Fluke Fairness Act of 2019 Ocean and Coastal Planning/ Ocean Data/Ocean Climate: H.R.9/S.1743 - Climate Action Now Act H.R.729 - Tribal Coastal Resilience Act S.810 COASTAL Implementation Act of 2019 S.933/H.R.3548 BLUE GLOBE Act H.R.1314 - Integrated Coastal and Ocean Observation System Act Amendments of 2019 H.R.2185 - DC Flood Prevention Act of 2019 H.R.2189/S.1069 - Digital Coast Act H.R.3115/S.1730 - Living Shorelines Act of 2019 H.R.3541 - Coastal State Climate Preparedness Act of 2019 H.R.3596 - Keep America's Waterfronts Working Act H.R.4093 - National Oceans and Coastal Security Improvements Act of 2019 H.R.5221 - 100% Clean Economy Act of 2019 H.R.5390/S.2166 - ROP Act Other: S.1177/H.R.3020 - SEAL Act S.2786 - Arctic Shipping Federal Advisory Committee Act H.R.2405/S.910 - National Sea Grant College Program Amendments of 2019

Client expense: $198,293 · Firm income: Not reported

Government targets: Commerce, Dept of (DOC), Council on Environmental Quality (CEQ), HOUSE OF REPRESENTATIVES, Interior, Dept of (DOI), Natl Oceanic & Atmospheric Administration (NOAA), Office of Management & Budget (OMB), Office of Science & Technology Policy (OSTP), SENATE, State, Dept of (DOS), U.S. Coast Guard (USCG)

Issues involving attempts to amend title XVIII of the Social Security Act to provide for the negotiation of lower covered part D drug prices on behalf of Medicare beneficiaries and the establishment and application of a formulary by the Secretary of Health and Human Services under Medicare part D, and for other purposes. HR 448 - Medicare Drug Price Negotiation Act. HR 383, Continuing Coverage for Preexisting Conditions Act of 2019; S. 1556, No Junk Plans Act; S. 466, Protecting Americans with Pre-existing Conditions Act of 2019; S. 1905, ENROLL Act of 2019.

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

Government targets: SENATE

Issues that encompass attempts to amend the Federal Food, Drug, and Cosmetic Act to allow for the importation of affordable and safe drugs by wholesale distributors, pharmacies, and individuals. HR 447 - Affordable and Safe Prescription Drug Importation Act. Issues involving the attempts to amend PL 111-148, The Patient Protection and Affordable Care Act, to ensure that preexisting condition exclusions with respect to enrollment in health insurance coverage and group health plans continue to be prohibited. HR 383 - Continuing Coverage for Preexisting Conditions Act of 2019; S. 1556, No Junk Plans Act; S. 466, Protecting Americans with Pre-existing Conditions Act of 2019; S. 1905, ENROLL Act of 2019.

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

Government targets: SENATE

H.J. Res. 74: Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury and the Secretary of Health and Human Services relating to "State Relief and Empowerment Waivers"; all provisions H.R. 3 - Lower Drug Costs Now Act of 2019; all provisions H.R. 986: Protecting Americans with Preexisting Conditions Act of 2019; all provisions H.R. 987: Strengthening Health Care and Lowering Prescription Drug Costs Act; all provisions H.R. 1010: To provide that the rule entitled Short-Term, Limited Duration Insurance shall have no force or effect; all provisions H.R. 1425: State Health Care Premium Reduction Act; all provisions H.R. 1868: Health Care Affordability Act of 2019; all provisions H.R. 1870: Family Health Care Affordability Act of 2019; all provisions H.R. 2296: FAIR Drug Pricing Act of 2019; all provisions H.R. 2507: Newborn Screening Saves Lives Reauthorization Act of 2019; all provisions Ways & Means and Energy & Commerce discussion draft on capping Medicare Part D out-of-pocket costs; all provisions S.J. Res. 52: A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury and the Secretary of Health and Human Services relating to "State Relief and Empowerment Waivers"; all provisions S. 466: Protecting Americans with Pre-existing Conditions Act of 2019; all provisions S. 475: Reducing Existing Costs Associated with Pharmaceuticals for Seniors (RxCAP) Act of 2019; all provisions S. 961: Improving Health Insurance Affordability Act of 2019; all provisions S. 1556: No Junk Plans Act; all provisions S. 1712: Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act of 2019; all provisions S. 1895: Lower Health Care Costs Act; all provisions S. 1935: Family Coverage Act; all provisions S. 2158: Newborn Screening Saves Lives Reauthorization Act of 2019; all provisions S. 2543 - Prescription Drug Pricing Reduction Act of 2019; all provisions The Medical Records Access Fairness Act draft; all provisions

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE