Conrad State 30 and Physician Access Reauthorization Act

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

Client expense: $102,561 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA)

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

Client expense: $248,306 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS)

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

Client expense: $98,181 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS)

H.R. 2255/ S.1024 - A bill to enhance our Nation's nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas. Policies contained in H.R. 1044/S. 386, the Fairness for High-Skilled Immigrants Act of 2019 and H.R. 2895/S. 948, the Conrad State 30 and Physician Access Reauthorization Act (116th Congress).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

Supported maintaining the current definition of Public Charge to ensure continued access to Medicaid and other federal assistance programs; Conrad 30 and the Physician Access Reauthorization Act, S 948

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), Vice President of the U.S.

Affordable prescription drugs, 340B Program; HR985 FAST Generics Act of 2019; Appropriate and accurate payment for healthcare; Site Neutral payment policies; S. 1895 - Lower Health Care Costs Act; S. 340 - CREATES Act, H.R. 987 - Strengthening Health Care and Lowering Prescription Drug Costs Act; S. 1391 - Fair Accountability and Innovative Research Drug Pricing Act of 2019; Surprise billing: S. 1531 - Stop the Outrageous Practice of Surprise Medical Bills Act of 2019; HR 3, the Lower Drug Costs Now Act; H.R.2149 - Exposing the Financing of Human Trafficking Act; H.R.508 - Trafficking Victims Housing Act of 2019; H.R. 1520 - Purple Book Continuity At of 2019; H.R. 1503 - Orange Book Transparency Act of 2019; S.2543 - Prescription Drug Pricing Reduction Act of 2019; Health care privacy; patient privacy; H.R. 647, S.2080 - Palliative Care and Hospice Education and Training Act; Conrad 30 and the Physician Access Reauthorization Act, S 948; Issues related to the Medicaid Fiscal Accountability Regulation (MFAR); HR 6074 - Coronavirus Preparedness and Response Supplemental Appropriations Act; HR 6201 - Families First Coronavirus Response Act - Public Law No: 116-127; HR 748 - Coronavirus Aid, Relief, and Economic Security (CARES) Act; response to the COVID-19 public health emergency; S. 178 - HEALS Act; H.R. 1425, Patient Protection and Affordable Care Enhancement Act; H.R. 6800 - HEROES Act; H.R. 266, Paycheck Protection Program and Health Care Enhancement Act; issues related to coverage of virtual car; Financial support for providers for diagnosis and treatment related to COVID-19, coverage of COVID-19 related conditions, and access to PPE and other materials and equipment related to the treatment of patients with COVID-19; H.R. 133 - Consolidated Appropriations Act; Issues related to social determinants of health; H.R. 6561 - Improving Social Determinants of Health Act ; S. 4421- Temporary Reciprocity to Ensure Access to Treatment Act; liability relief for health care providers

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), Vice President of the U.S.

Discussions on drug pricing, 340b, and price transparency policies, as well as the International Pricing Index ANPRM; Discussions about the work of Aligning for Health to address social determinants of health; Support HR 1041 / S 586,Critical Access Hospital Relief Act of 2019, a bill to amend title XVIII of the Social Security Act to remove the 96-hour physician certification requirement for inpatient critical access hospital services; Support S 895, Rural Hospital Regulatory Relief Act of 2019, a bill to provide for a permanent extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals; Support S 948,Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities, and for other purposes; Discussions in support of the Rural Emergency Medical Center Act (REACH) Act; Support for extension of the Rural Community Hospital Demonstration Program; Support for extension of the Frontier Community Health Integration Project Demonstration program; Discuss changes with House and Senate committees to Section 8122 of the SUPPORT for Patients and Communities Act; Letter of support to Energy and Commerce Committee for the hearing on legislation to strengthen our health care system and ACA market stability; Support HR 1781/ S 801, Payment Commission Data Act of 2019, a bill to amend titles XVIII and XIX of the Social Security Act to provide the Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission with access to certain drug payment information, including certain rebate information; Support S 551 Recovering Excessive Funds for Unused and Needless Drugs Act of 2019 or the REFUND Act of 2019, a bill to amend title XVIII of the Social Security Act to require manufacturers of certain single-dose vial drugs payable under part B of the Medicare program to provide rebates with respect to amounts of such drugs discarded, and for other purposes; Support S 824/ HR 1767, Excellence in Mental Health and Addiction Treatment Expansion Act, a bill to increase the number of States that may conduct Medicaid demonstration programs to improve access to community mental health services; Statement submitted to Senate Finance Committee on the implementation of the Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Support HR 2552Protecting Local Access to Care for Everyone Act of 2019 or the PLACE Act of 2019, a bill to direct the Secretary of Health and Human Services to prevent certain payment reductions for clinic visit services furnished at excepted off-campus outpatient departments of a provider under the Medicare program; Support HR 3022, Patient Access Protection Act, a bill to amend title XIX of the Social Security Act to repeal the reductions in Medicaid DSH allotments, and for other purposes; Letter of support to the Ways and Means Committee in support of legislation to improve the quality of an access to services for Medicare beneficiaries, help train the physician workforce and reduce administrative burden on rural hospitals; Support HR 3431, HEARTS and Rural Relief Act, a bill to provide for the extension of the enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals through 2021; Support HR 3417,Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 or the BETTER Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program; Oppose HR 1384, Medicare for All Act of 2019, a bill to establish an improved Medicare for All national health insurance program; Oppose S 1129, Medicare for All Act of 2019, a bill to establish a Medicare-for-all national health insurance program; Letter to House Committee on Ways and Means for the hearing on Pathways to Universal Health Coverage addressing concerns with Medicare for All and believe that the variety of proposals that often are used interchangeably under that name are not the solution; Oppose HR 2452, Medicare for America Act of 2019, a bill to amend the Social Security Act to establish a Medicare for America health program to provide for comprehensive health coverage for all Americans; Letter to House Committee on Budget for the hearing on the Congressional Budget Offices (CBO) Key Design Components and Considerations for Establishing a Single-Payer Health Care System addressing concerns with Medicare for All; Oppose S 1261/ HR 2463, Choose Medicare Act, a bill to provide for the establishment of Medicare part E public health plans, and for other purposes; Oppose S 981/ HR 2000Medicare-X Choice Act of 2019A bill to establish a public health plan; Oppose S 1033/ HR 2085, CHOICE Act, a bill to amend the Public Health Service Act to establish a public health insurance option, and for other purposes; Oppose S 470, Medicare at 50 Act, a bill to amend title XVIII of the Social Security Act to provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare; Oppose HR 1346, Medicare Buy-In and Health Care Stabilization Act of 2019, a bill to amend title XVIII of the Social Security Act to provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes; Submitted Statement to the House Committee on Rules for the Hearing Medicare for All Act of 2019; Comment on provisions of HR 2328,Reauthorizing and Extending Americas Community Health (REACH) Act, support for the Medicaid disproportionate share hospital(DSH) program provisions included in Title III; comments on Title IV, which contains provisions of the No Surprises Act and concern with the legislations approach to determining reimbursement for out-of-network providers; Support HR 3107 Seniors Timely Access to Care Act of 2019, this legislation would establish requirements for the use of prior authorization under Medicare Advantage plans; Meeting with the Senate finance committee to discuss changes to drug bill; Meeting with CMS to discuss changes to prior authorization; Meeting with Department of Labor to discuss issues with ERISA health plans; Met with CMS staff on rural hospital issues; Regulatory burden related to new CMS guidance on documenting Crossover bad debt; Sent a Comment letter to CMS on a final rule on program integrity enhancements to the provider enrollment process for Medicare, Medicaid and Children's Health Insurance Programs; Oppose S. 2860 Patient Access to Higher Quality Health Care Act of 2019, a bill to repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals, and for other purposes; Support HR 4996, Helping MOMS Act of 2019, a bill amend title XIX of the Social Security Act to provide for a State option under the Medicaid program to provide for and extend continuous coverage for certain individuals, and for other purposes; Addressing hospital concerns about HR 3 Lower Drug Costs Now Act, a bill to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes; Sent comment letter requesting that CMS withdraw the proposed regulation related to Medicaid Program: Medicaid Fiscal Accountability Regulation ( MFAR) financing and supplemental payments. Given that the proposal would severely curtail the availability of health care services to millions of individuals and because many of its provisions are not legally permissible; Discussion with CMS for rural hospitals and critical access hospitals about the Medicare accelerated payment program, which is intended to provide necessary funds to providers, including rural hospitals and critical access hospitals, when there is a disruption in claims submission and/or claims processing; Submitted comments on CMSs proposed rule on Medicare Advantage and Part D prescription drug program for Contract Years 2021 and 2022. The letter focuses on several proposals addressing network adequacy; Letter sent to HHS, CDC, CMS, and SAMHSA requesting specialized guidance and assistance for providers who care for patients with behavioral health disorders; Support resetting the Improving Medicare Post- Acute Care Transformation (IMPACT) Act of 2014 in the next COVID-19 relief package. The IMPACT Acts implementation is behind schedule and does not take into account extensive payment reforms already underway in each post-acute care setting; Letter urging HHS to release substantial additional emergency funds to all hospitals in an expedited manner. This second wave of funding to all hospitals, targeted relief is necessary for hospitals in hot spots, hospitals with a high percentage of payments under Medicare Advantage, hospitals caring for high numbers of Medicaid patients, and rural hospitals; Support HR 6693 Critical Access Hospital Expansion Act of 2020, a bill to amend title XVIII of the Social Security Act to allow States to certify certain hospitals as necessary providers for purposes of designating such hospitals as critical access hospitals under the Medicare program; Support HR 6753/ S 3615 Rural Community Hospital Demonstration Extension Act of 2020, a bill to amend the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to extend the rural community hospital demonstration program; Letter urging CMS to use its authority to extend to LTCHs the existing 20% hospital add-on payment for Medicare beneficiaries diagnosed with COVID-19; Letter to CMS urging the agency to temporarily extend certain waivers and make others permanent beyond the COVID-19 public health emergency to allow hospitals to provide better and more cost effective care to their patients and communities; Sent comment letter to CMS about our concerns with the timeline proposed for implementation as well as the potential for penalties for noncompliance within this timeline on the Medicare Program: Electronic Prescribing of Controlled Substances; Sent comment letter on the FY 2021 Inpatient PPS proposed rule addressing CMS proposals related to payer-specific negotiated rate data collection, Medicare DSH payments, CAR T, bad debt, MS-DRG classifications, and quality programs, among other topics. Letter requesting that the CMS delay the implementation of the Appropriate Use Criteria for Advanced Diagnostic Imaging Services program to allow providers the opportunity to implement and test operational changes and acquire the education necessary to achieve compliance with the program; Sent comments to the CMS on the agencys long-term care hospital prospective payment system proposed policy changes and fiscal year 2021 rates; Letter to CMS asking for a delay in the start of repayments associated with the Medicare Accelerated and Advance Payment (AAP) Programs; Letter urging the CMS to continue its suspension of medical review activities throughout the ongoing COVID-19 public health emergency; Letter urging CMS to allow periodic interim payment (PIP) hospitals to carry out their accelerated payment repayment at cost settlement, as was initially communicated by the agency and also request that the agency make alternative repayment approaches available, such as direct payments to the Medicare Administrative Contractor (MAC), for all hospitals; Comment letter on CY 2021 Home Health Prospective Payment System Rate Update proposed rule. While we continue to support the PDGM objective of increasing HH PPS payment accuracy, we remain concerned that CY 2020s large behavioral offset, 4.36%, was implemented on a prospective basis; Letter urging the CMS to withdraw the condition of participation (CoP) that hospitals report daily COVID-19 data and request that CMS immediately release detailed interpretive guidance so hospitals can take the necessary steps to come into compliance; Urged CMS to withdraw its Medicaid fiscal accountability proposed rule from its regulatory agenda because it would "severely curtail the availability of health care services to millions of individuals" and "many of its provisions are not legally permissible;" Submitted comment letter that disagree with CMS interim APC assignments of COVID-19 vaccine administration services to these New Technology APCs because they are inconsistent with longstanding CMS policy; Submitted comments responding to a CMS request for information on regulatory relief to support economic recovery urging the agency to take additional action to remove certain regulatory barriers standing in the way of efficiency and innovation, thus allowing hospitals to provide better and more cost-effective care to our patients and communities. In order to achieve these objectives, we ask the agency to temporarily extend certain waivers and make others permanent beyond the duration of the COVID-19 public health emergency; Urged a delay implementation of CMS price transparency rule and also asked the Biden Transition team for enforcement discretion with the rule; Letter urging Congress to include in the year-end legislation an extension of the congressionally-enacted moratorium on the application of the Medicare sequester cuts into 2021 and through the duration of the public health emergency (PHE); Letter urging Congress to continue to support the movement to value by ensuring that clinicians in advanced alternative payment models (APMs) continue to receive incentives established under the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); Support S 5044, The Improving Seniors Timely Access to Care Act of 2020, a bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans; Submitted a comment letter, urging CMS not to finalize proposals that would allow states to create a new type of direct enrollment marketplace in lieu of Healthcare.gov or a state-based marketplace. In addition, we do not support the codification in regulation of previous Section 1332 guidance that could allow states to pursue alternative approaches to coverage that would result in coverage losses; Support efforts to protect patients from surprise medical bills by including the No Surprises Act as part of the year-end legislative package; Submitted COVID-19 snapshot report for Congress to better understand the needs of hospitals and health systems during the public health emergency, which combines important data points with news articles and testimonials from the field to reiterate the dire circumstances hospitals and health systems face, and highlight why additional relief is necessary; Submitted comments in response to HRSAs proposal to include additional counties as eligible to receive Federal Office of Rural Health Policy (FORHP) grants, encouraged the agency to use a definition of rural that is inclusive and flexible, in order to broaden opportunities for providers in rural communities and urged HRSA to increase rural grant opportunities.

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

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

H.R. 6, The American Dream and Promise Act of 2019 S. 874, The Dream Act of 2019 Issue: Support policies allowing undocumented students to attend U.S. medical schools and graduate medical education. Oppose rescission of Deferred Action for Childhood Arrivals (DACA) executive action without permanent replacement. Support Dreamer eligibility for federal student loans. Issue: Oppose repeal of DACA Executive Action S. 948 / H.R. 2895, Conrad State 30 and Physician Access Reauthorization Act Issue: Support reauthorization and expansion of the Conrad 30 program, and improvements to physician immigration Issue: Support policies to ensure timely and predictable processing for immigration of academic medicine community Issue: Support extending duration of stay for physicians on visas during the COVID pandemic, expediting change of status and visa renewals, and expedite visa approvals for medical residents entering the country. Issue: Oppose travel ban indefinitely bars individuals from certain countries from entering the United States based on their nationality. Issue: Oppose Duration of Status rule which provides a specific end date for certain nonimmigrant visa categories, including F-1 student and J-1 exchange visitor visas. Issue: Support the rescission of H-1B Prevailing Wage rules. Issue: Oppose policies limiting entry of medical students, residents, researchers, and health professionals to the U.S. on the F-1, J-1, and H-1B visas.

Client expense: $1,035,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Natl Science Foundation (NSF), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), Office of the Vice President of the United States, SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

HR 133 Consolidate Appropriations Act of 2020:Oppose Medicare financial relief that excludes certain primary care service. HR 2815/S 1119 - Teaching Health Centers GME; Community Health Centers; National Health Service Corps; Special Diabetes Program; Special Diabetes Program for Indians: Increased funding, five-year reauthorization. HR 2895/S. 948 - Conrad State 30 & Physician Access Act: Expand program, streamline eligibility. HR 8337 - Continuing Appropriations Act 2021 and Other Extensions Act: Extension of THCGMEs, Medicare Accelerated Payments. No Bill No. - Congressional Primary Care Caucus: 116th Congress Membership in the bipartisan CPCC. No Bill No. - Teaching Health Centers GME; Community Health Centers; National Health Service Corps; Special Diabetes Program; Special Diabetes Program for Indians: Increased funding, five-year reauthorization. No Bill No. - 501(c)(6) Non-Profits Relief: include emergency financial relief for 501(c)(6) organizations in COVID response legislation.

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

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

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

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

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

Health care workforce issues - S. 1399, Title VII Nursing Workforce Reauthorization Act - S.948 Conrad 30 reauthorization 340B drug pricing Appropriations telehealth - S. 2741 the Connect Act surprise medical billing - HR 3630, No surprises Act - S, 1895 Lower Health Care Costs Act rural health delivery system reform COVID-19 Provider Relief Fund

Client expense: $15,000 · Firm income: Not reported

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

Monitor S. 948 and H.R. 2895 - Conrad State 30 and Physician Access Reauthorization Act, generally

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

Government targets: SENATE

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

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

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

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

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

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

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

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

Safe Step Act HR 2279/S. 2546 Telehealth Expansion HR 6644 COVID Relief for Physicians: HR 6720, HR 7059, HR 2895/S. 948, HR 6788/S. 3599, HR 7077/S. 3877

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Safe Step Act HR 2279/S. 2546 Telehealth Expansion HR 6644 COVID Relief for Physicians: HR 6720, HR 7059, HR 2895/S. 948, HR 6788/S. 3599, HR 7077/S. 3877

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

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

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

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Navy, Dept of, SENATE

H.R. 6, The American Dream and Promise Act of 2019 S. 874, The Dream Act of 2019 Issue: Support policies allowing undocumented students to attend U.S. medical schools and graduate medical education. Oppose rescission of Deferred Action for Childhood Arrivals (DACA) executive action without permanent replacement. Support Dreamer eligibility for federal student loans. S. 948, H.R. 2895, Conrad State 30 and Physician Access Reauthorization Act Issue: Support reauthorization and expansion of the Conrad 30 program, and improvements to physician immigration Issue: Support policies to ensure timely and predictable processing for immigration of academic medicine community Issue: Support extending duration of stay for physicians on visas during the COVID pandemic, expediting change of status and visa renewals, and expedite visa approvals for medical residents entering the country. Issue: Oppose policies limiting entry of medical students, residents, researchers, and health professionals to the U.S. on the F-1, J-1, and H-1B visas.

Client expense: $1,095,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Bureau of Citizenship & Immigration Services (BCIS), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Internal Revenue Service (IRS), Medicare Payment Advisory Commission (MedPAC), Natl Institutes of Health (NIH), Natl Science Foundation (NSF), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), Office of the Vice President of the United States, SENATE, State, Dept of (DOS), Substance Abuse & Mental Health Services Administration (SAMHSA), Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

Affordable prescription drugs, 340B Program, HR985 FAST Generics Act of 2019, Appropriate and accurate payment for healthcare, Site Neutral payment policies, S. 1895 - Lower Health Care Costs Act, S. 340 - CREATES Act, H.R. 987 - Strengthening Health Care and Lowering Prescription Drug Costs Act, S. 1391 - Fair Accountability and Innovative Research Drug Pricing Act of 2019, Surprise billing: S. 1531 - Stop the Outrageous Practice of Surprise Medical Bills Act of 2019; HR 3, the Lower Drug Costs Now Act; H.R.2149 - Exposing the Financing of Human Trafficking Act; H.R.508 - Trafficking Victims Housing Act of 2019; H.R. 1520 - Purple Book Continuity At of 2019; H.R. 1503 - Orange Book Transparency Act of 2019; S.2543 - Prescription Drug Pricing Reduction Act of 2019; Health care privacy; H.R. 647, S.2080 - Palliative Care and Hospice Education and Training Act; Conrad 30 and the Physician Access Reauthorization Act, S 948; Issues related to the Medicaid Fiscal Accountability Regulation (MFAR); HR 6074 - Coronavirus Preparedness and Response Supplemental Appropriations Act; HR 6201 - Families First Coronavirus Response Act; HR 748 - Coronavirus Aid, Relief, and Economic Security (CARES) Act; response to the COVID-19 public health emergency; S. 178 - HEALS Act; H.R. 1425, Patient Protection and Affordable Care Enhancement Act; H.R. 6800 - HEROES Act; H.R. 266, Paycheck Protection Program and Health Care Enhancement Act; issues related to coverage of virtual care

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), Vice President of the U.S.

Supported maintaining the current definition of Public Charge to ensure continued access to Medicaid and other federal assistance programs; Conrad 30 and the Physician Access Reauthorization Act, S 948

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), Vice President of the U.S.

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

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

Health care workforce issues - S. 1399, Title VII Nursing Workforce Reauthorization Act - S.948 Conrad 30 reauthorization 340B drug pricing Appropriations telehealth - S. 2741 the Connect Act surprise medical billing - HR 3630, No surprises Act - S, 1895 Lower Health Care Costs Act rural health delivery system reform HEROS Act HR 6800 COVID-19 Provider Relief Fund

Client expense: $15,000 · Firm income: Not reported

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

H.R. 2895, Conrad State 30 and Physician Access Reauthorization Act, all provisions S. 948, Conrad State 30 and Physician Access Reauthorization Act, all provisions H.R. 6788, Healthcare Workforce Resilience Act, all provisions S. 3599, Healthcare Workforce Resilience Act, all provisions Executive Orders related to immigration and international medical graduates J-1 Visa duration of status regulations H-1B Physician/dependent Visas F-1 Visa/medical students ICE-run Family residential centers/children/parents/caregivers U.S. Customs and Border Protection (CBP)/expiring contract for medical services Detained immigrants/living conditions/health care/informed consent practices

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Education, Dept of, Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), Natl Institutes of Health (NIH), Office of Natl Drug Control Policy (NDCP), President of the U.S., SENATE, State, Dept of (DOS), U.S. Immigration & Customs Enforcement (ICE), Veterans Affairs, Dept of (VA), White House Office

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

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

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

P.L. 116-123 - CORONAVIRUS PREPAREDNESS AND RESPONSE SUPPLEMENTAL APPROPRIATIONS ACT, 2020 (P.L. 116-123): Ensure primary care physicians have adequate supplies, finances to serve their patients, are eligible for loans, payment for telehealth services. P.L. 116-127 - The Families First Coronavirus Response Act: Support for small business and non-profits during COVID crisis. P.L. 116-136 - CARES Act: Ensure primary care physicians have adequate supplies, finances to serve their patients, are eligible for Small Business loans, payment for telehealth services. HR 2774; S 2783 - Primary Care Patient Protection Act: Create a primary care benefit in high deductible health plans. HR 2895/S. 948 - Conrad State 30 & Physician Access Act: Expand program, streamline eligibility. HR 6149/S. 4088 - Kids Access to Primary Care Act/Ensuing Access to Primary Care for Women and Children Act: Increase Medicaid payment rates for primary care. HR 6788/S. 3599 Healthcare workforce Resilience Act: recapture 15,000 unused employment-based physician immigrant visas from prior fiscal years to bolster physician workforce during COVID pandemic. HR 6837/S 3750: Medicare Accelerated and Advance Payments Improvement Act of 2020: Advanced payments to Medicare Part B providers. HR 7059 Coronavirus Provider Protection Act: targeted and limited liability protections for health care providers responding to COVID pandemic. HR 7663/S 4230 - Expansion of telehealth; Protecting Access to Post-COVID-19 Telehealth Act: Expansion of telehealth services for primary care; coverage and payment parity during PHE. H.R. 8061- Community Immunity During COVID-19 Act: Support grants to increase the rates of recommended immunizations. HR 8337 - Continuing Appropriations Act 2021 and Other Extensions Act: Extension of THCGMEs, Medicare Accelerated Payments. S. 4349 - Dr. Lorna Breen Provider Protection Act: Support the wellbeing of frontline physicians during COVID-19. No Bill No. - Congressional Primary Care Caucus: 116th Congress Membership in the bipartisan CPCC. No Bill No. - Teaching Health Centers GME; Community Health Centers; National Health Service Corps; Special Diabetes Program; Special Diabetes Program for Indians: Increased funding, five-year reauthorization. No Bill No. - 501(c)(6) Non-Profits Relief: include emergency financial relief for 501(c)(6) organizations in COVID response legislation. No Bill No. - Emergency financial relief for primary care physicians: additional financial support for primary care clinicians to stabilize our nations primary care infrastructure. No Bill No. - Issues related to increase immunization utilization/distribution: Efforts to support children and adults securing needed immunizations.

Client expense: $1,257,804 · Firm income: Not reported

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

H.R. 2895/S. 948 - Conrad State 30 & Physician Access Act: Expand program, streamline eligibility. HR 6149/S. 4088 - Kids Access to Primary Care Act/Ensuing Access to Primary Care for Women and Children Act: Increase Medicaid payment rates for primary care. HR 8337 - Continuing Appropriations Act 2021 and Other Extensions Act: Extension of THCGMEs, Medicare Accelerated Payments. No Bill No. - Congressional Primary Care Caucus: 116th Congress Membership in the bipartisan CPCC. No Bill No. - Teaching Health Centers GME; Community Health Centers; National Health Service Corps; Special Diabetes Program; Special Diabetes Program for Indians: Increased funding, five-year reauthorization. No Bill No. - 501(c)(6) Non-Profits Relief: include emergency financial relief for 501(c)(6) organizations in COVID response legislation.

Client expense: $1,257,804 · Firm income: Not reported

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

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

Client expense: $1,257,804 · Firm income: Not reported

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

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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

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

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

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

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

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

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

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

H.R. 1044/S. 386, the Fairness for High-Skilled Immigrants Act of 2019; H.R. 2895/S. 948, the Conrad State 30 and Physician Access Reauthorization Act; H.R. 6788/S. 3599, the Healthcare Workforce Resilience Act; and issues relating to the Presidents Proclamation Suspending Entry of Aliens Who Present a Risk to the U.S. Labor Market Following the Coronavirus Outbreak (dated June 22, 2020).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitor S. 948 and H.R. 2895 - Conrad State 30 and Physician Access Reauthorization Act, generally

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

Client expense: $144,000 · Firm income: Not reported

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