Healthcare Workforce Resilience Act

340B Drug Reimbursement Program: to encourage Congress to pass a bill and/or work with the Administration to return the 340B program to its pre-2018 status. S. 773; H.R. 4390; H.R. 3203 (to recalibrate critical access hospitals' revenues due to PRF funds for the purpose of calculating reasonable 340b payments). Kansas Provider Assessment: to encourage CMS to approve the increase in Kansas' Medicaid provider assessment, and to encourage Congress to work with CMS to get it approved. PRF Period 1 reporting: individual hospital needs. S. 2493; H.R. 4735 S. 1893: encouraging Congress to pass this bill that will help add additional physicians in rural areas. S. 1024: encouraging Congress to pass this bill that would encourage physicians to work in rural and out migrating areas. Encouraging Congress to end sequestration and allow PAYGO rules to enact a 4% cut to hospital Medicare reimbursement rates at the end of the year. Encouraging Congress to pass a bill that allows critical access hospitals to also be eligible for telehealth flexibilities afforded to other types of providers.

Client expense: Not reported · Firm income: $16,000

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

Work visas for certain health professionals; S 1024 and HR HR 2255, legislation to enhance the US s nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas. Implementation of COVID Response legislation; Implementation of American Recovery Act of 2021; FY 23 Appropriations.

Client expense: Not reported · Firm income: Not reported

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. Monitoring and outreach on legislative and administrative activity related to infrastructure. Monitoring and outreach on legislative and administrative activity related to reconciliation and the congressional budget resolution. H.R. 4432 - Department of Defense Appropriations Act, FY2022. Senate Draft, Department of Defense Appropriations Act, FY2022 P.L. 116-136, CARES Act P.L. 116-260, FY2021 Omnibus and COVID Relief and Response Act P.L. 117-2, American Rescue Plan Act of 2021 H.R. 3684 - Infrastructure Investment and Jobs Act S. 464 - Safe Step Act H.R. 2163 - Safe Step Act H.R. 1319 - American Rescue Plan Act of 2021 S. 834 - Resident Physician Shortage Reduction Act of 2021 H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 H.R. 1868 - To prevent across-the-board direct spending cuts, and for other purposes H.R. 315 - Medicare Sequester COVID Moratorium Act S. 368 - Telehealth Modernization Act H.R. 1332 - Telehealth Modernization Act H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 S. 1024 - Healthcare Workforce Resilience Act H.R. 2255 - Healthcare Workforce Resilience Act H.R. 1819 - Pharmacy Benefit Manager Accountability Study Act H.R. 3107 - The Improving Seniors Timely Access to Care Act H.R. 3517 - Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act H.R. 315 - The Medicare Sequester COVID Moratorium Act S. 748 - Medicare Sequester Relief Act H.R. 5067 - Preserving Patient Access to Home Infusion Act S. 2652 - Preserving Patient Access to Home Infusion Act H.R. 3541 - Conrad State 30 and Physician Access Reauthorization Act S. 1810 - Conrad State 30 and Physician Access Reauthorization Act H.R. 5376 - Build Back Better Act S. 3314 - Supporting Medicare Providers Act H.R. 6020 - Supporting Medicare Providers Act H.R. 5801 - Help Ensure Lower Patient (HELP) Copays Act S. 4408 Health and Location Data Protection Act of 2022 H.R. 4122 - Resident Education Deferred Interest Act or the REDI Act S. 3658 - Resident Education Deferred Interest Act or the REDI Act H.R.8800 - Supporting Medicare Providers Act of 2022 S.5194 - Protecting Medicare Patients and Physicians Act H.R. 8800 - Protecting Medicare Patients and Physicians Act H.R.9424 - Creating Access to Residency Education Act of 2022 FY2023 Labor Health and Human Services Appropriations content Draft House, Department of Defense Appropriations Act, FY2023 Draft Senate, Department of Defense Appropriations Act, FY2023 Fiscal Year 2023 Omnibus

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. Monitoring and outreach on legislative and administrative activity related to infrastructure. Monitoring and outreach on legislative and administrative activity related to reconciliation and the congressional budget resolution. H.R. 4432 - Department of Defense Appropriations Act, FY2022. Senate Draft, Department of Defense Appropriations Act, FY2022 P.L. 116-136, CARES Act P.L. 116-260, FY2021 Omnibus and COVID Relief and Response Act P.L. 117-2, American Rescue Plan Act of 2021 H.R. 3684 - Infrastructure Investment and Jobs Act S. 464 - Safe Step Act H.R. 2163 - Safe Step Act H.R. 1319 - American Rescue Plan Act of 2021 S. 834 - Resident Physician Shortage Reduction Act of 2021 H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 H.R. 1868 - To prevent across-the-board direct spending cuts, and for other purposes H.R. 315 - Medicare Sequester COVID Moratorium Act S. 368 - Telehealth Modernization Act H.R. 1332 - Telehealth Modernization Act H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 S. 1024 - Healthcare Workforce Resilience Act H.R. 2255 - Healthcare Workforce Resilience Act H.R. 1819 - Pharmacy Benefit Manager Accountability Study Act H.R. 3107 - The Improving Seniors Timely Access to Care Act H.R. 3517 - Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act H.R. 315 - The Medicare Sequester COVID Moratorium Act S. 748 - Medicare Sequester Relief Act H.R. 5067 - Preserving Patient Access to Home Infusion Act S. 2652 - Preserving Patient Access to Home Infusion Act H.R. 3541 - Conrad State 30 and Physician Access Reauthorization Act S. 1810 - Conrad State 30 and Physician Access Reauthorization Act H.R. 5376 - Build Back Better Act S. 3314 - Supporting Medicare Providers Act H.R. 6020 - Supporting Medicare Providers Act H.R. 5801 - Help Ensure Lower Patient (HELP) Copays Act S. 4408 Health and Location Data Protection Act of 2022 H.R. 4122 - Resident Education Deferred Interest Act or the REDI Act S. 3658 - Resident Education Deferred Interest Act or the REDI Act H.R.8800 - Supporting Medicare Providers Act of 2022 S.5194 - Protecting Medicare Patients and Physicians Act H.R. 8800 - Protecting Medicare Patients and Physicians Act H.R.9424 - Creating Access to Residency Education Act of 2022 FY2023 Labor Health and Human Services Appropriations content Draft House, Department of Defense Appropriations Act, FY2023 Draft Senate, Department of Defense Appropriations Act, FY2023 Fiscal Year 2023 Omnibus

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. Monitoring and outreach on legislative and administrative activity related to infrastructure. Monitoring and outreach on legislative and administrative activity related to reconciliation and the congressional budget resolution. H.R. 4432 - Department of Defense Appropriations Act, FY2022. Senate Draft, Department of Defense Appropriations Act, FY2022 P.L. 116-136, CARES Act P.L. 116-260, FY2021 Omnibus and COVID Relief and Response Act P.L. 117-2, American Rescue Plan Act of 2021 H.R. 3684 - Infrastructure Investment and Jobs Act S. 464 - Safe Step Act H.R. 2163 - Safe Step Act H.R. 1319 - American Rescue Plan Act of 2021 S. 834 - Resident Physician Shortage Reduction Act of 2021 H.R. 2256 - Resident Physician Shortage Reduction Act of 2021 H.R. 1868 - To prevent across-the-board direct spending cuts, and for other purposes H.R. 315 - Medicare Sequester COVID Moratorium Act S. 368 - Telehealth Modernization Act H.R. 1332 - Telehealth Modernization Act H.R. 366 - Protecting Access to Post-COVID-19 Telehealth Act of 2021 S. 298 - Pharmacy Benefit Manager Accountability Study Act of 2021 S. 1024 - Healthcare Workforce Resilience Act H.R. 2255 - Healthcare Workforce Resilience Act H.R. 1819 - Pharmacy Benefit Manager Accountability Study Act H.R. 3107 - The Improving Seniors Timely Access to Care Act H.R. 3517 - Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act H.R. 315 - The Medicare Sequester COVID Moratorium Act S. 748 - Medicare Sequester Relief Act H.R. 5067 - Preserving Patient Access to Home Infusion Act S. 2652 - Preserving Patient Access to Home Infusion Act H.R. 3541 - Conrad State 30 and Physician Access Reauthorization Act S. 1810 - Conrad State 30 and Physician Access Reauthorization Act H.R. 5376 - Build Back Better Act S. 3314 - Supporting Medicare Providers Act H.R. 6020 - Supporting Medicare Providers Act H.R. 5801 - Help Ensure Lower Patient (HELP) Copays Act S. 4408 Health and Location Data Protection Act of 2022 H.R. 4122 - Resident Education Deferred Interest Act or the REDI Act S. 3658 - Resident Education Deferred Interest Act or the REDI Act H.R.8800 - Supporting Medicare Providers Act of 2022 S.5194 - Protecting Medicare Patients and Physicians Act H.R. 8800 - Protecting Medicare Patients and Physicians Act H.R.9424 - Creating Access to Residency Education Act of 2022 FY2023 Labor Health and Human Services Appropriations content Draft House, Department of Defense Appropriations Act, FY2023 Draft Senate, Department of Defense Appropriations Act, FY2023 Fiscal Year 2023 Omnibus

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

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

The Elder Justice Reauthorization and Modernization Act of 2021 Nursing Home Workforce Support and Expansion Act H.R. 331, Nurses CARE Act of 2021 H.R. 4288, Workforce for an Expanding Economy Act H.R.5336, Strengthening Knowledge, Improving Learning, and Livelihoods (SKILLS) Act LIFT ACT AHCA/NCAL proposal of Care For Our Seniors Act H.R. 3733 Essential Caregivers Act S. 1024 / H.R. 2255 Healthcare Workforce Resilience Act H.R. 5602 The Bolstering Infectious Outbreaks (BIO) Preparedness Workforce Act Staff Agency Price Gouging -- White House & Federal Trade Commission outreach Immigration Delays - outreach to U.S. Departments of State, Homeland Security & USCIS Advocating for providing temporary nurse aides a reasonable grace period after the public health emergency ends Administration nursing home reform plan FY2023 Appropriations H.R.7744 - Building Americas Health Care Workforce Act Support the formation and creation of the 21st Century Long-Term Care Caucus Outreach to DOL in support of LTC apprenticeship programs Congressional Letters and Outreach around SNF Payment Rule and Administration Staffing Mandate Proposal Outreach on LTC workforce related appropriations matters H.R.7744 - Building America's Health Care Workforce Act Outreach to CMS and the Hill on the TNA waiver issue Outreach to CMS and the Hill on minimum staffing standards S.4381/H.R.8805 - Ensuring Seniors Access to Quality Care Act

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), SENATE, State, Dept of (DOS)

Support H.R. 526, Ensuring Coverage in Public Health Emergencies Act of 2021, a bill to provide for special enrollment periods during public health emergencies; Letter urging Congress to provide additional funds to the Provider Relief Fund and for vaccine distribution and administration, which will allow for continued support of hospitals' COVID-19-related lost revenues, as well as additional expenses incurred due to purchasing supplies and equipment, staffing, establishing emergency testing and vaccination centers and constructing and retrofitting facilities; Support H.R. 708 and S. 168, Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, a bill to provide temporary licensing reciprocity for telehealth and interstate health care treatment; Support H.R. 1306 and S. 412, National Coronavirus Commission Act of 2021, a bill to establish the Commission on the Coronavirus Pandemic in the United States; Support S. 610/ H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act, a bill to address behavioral health and well-being among health care professionals; Support S. 773 a bill to enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program; Support S.834, Resident Physician Shortage Reduction Act of 2021, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions; Oppose H.R. 1195, Workplace Violence Prevention for Health Care and Social Service Workers Act, a bill to direct the Secretary of Labor to issue an occupational safety and health standard that requires covered employers within the health care and social service industries to develop and implement a comprehensive workplace violence prevention plan and urge the Committee on Education and Labor not to report it favorably; Support S.924 and H.R. 2130, Rural America Health Corps Act, a bill to establish a demonstration program to provide payments on eligible loans for individuals who are eligible for the National Health Service Corps Loan Repayment Program; Discussions with ASPR about COVID-19 related medical supply and personnel shortages; Discussions with FEMA about COVID-19 public assistance funding policies; Letter asking Congress to consider an infrastructure proposal that you prioritize hospital and health system needs to ensure our nations health care system is well positioned to meet the opportunities and challenges that lie ahead; Support S.1512/H.R. 2903, CONNECT for Health Act of 2021, a bill to amend title XVIII of the Social Security Act to expand access to telehealth services; Support H.R. 2255/ S 1024, Healthcare Workforce Resilience Act, a bill to enhance our Nations nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas; Support S.1568, Technical Reset to Advance the Instruction of Nurses (TRAIN) Act, a bill to amend title XVIII of the Social Security Act to provide a waiver of the cap on annual payments for nursing and allied health education payments; Support H.R. 3203, a bill to enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program, and for other purposes; Statement to Senate Committee on Homeland Security and Governmental Affairs hearing on "COVID-19 Part II: Evaluating the Medical Supply Chain and Pandemic Response Gaps" urges Congress to take steps to strengthen the nations medical supply chain; Statement to Senate Committee on Finance hearing on COVID-19 Health Care Flexibilities: Perspectives, Experiences, and Lessons Learned stating that these flexibilities can continue to drive significant improvements in patient care long after the public health emergency (PHE) ends and given the beneficial impact of those specific flexibilities urges Congress and the Administration to make them permanent. In addition, a second group of flexibilities will remain critically important for some time following the PHE and will require a carefully crafted phase-out plan to ensure enough time is provided for a necessary transition. Without action from Congress and the Administration prior to the termination of the PHE, we are concerned that much of the progress made because of the implementation of many of these flexibilities may be unnecessarily halted or even lost; Letter urges Senate HELP Committee to consider recommendations and prioritize programs that support the health care workforce needs of the country in the wake of the COVID-19 pandemic and into the future; Support H.R. 769/S. 1491, Rural Maternal and Obstetric Modernization of Services Act or the Rural MOMS Act, a bill to amend the Public Health Service Act to improve obstetric care in rural areas; Support for S.1675/ H.R. 4387, Maternal Health Quality Improvement Act, a bill to improve maternal health; Support 1438, Opioid Workforce Act of 2021, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the opioid crisis; Support HR 3441,Substance Use Disorder Workforce Act, a bill to amend title XVIII of the Social Security Act to provide for the distribution of additional residency positions to help combat the substance use disorder crisis; Support S.1810 / H.R.3541, Conrad State 30 and Physician Access Reauthorization Act, a bill to provide incentives to physicians to practice in rural and medically underserved communities; Statement to the Senate Judiciary Subcommittee on Competition Policy, Antitrust, and Consumer Rights for the hearing on Antitrust Applied: Hospital Consolidation Concerns and Solutions expressing that integration helps to ensure every community, whether rural, urban or suburban, has access to the same high standard of affordable, evidenced based care; discussions to ensure that H.R. 2547s limits on unfair practice under FDCPA for debt collectors does not inappropriately interfere with or restrict the ability of hospitals to be able to obtain payment for care provided; Support for revising/repealing changes to the Rural Health Clinic (RHC) Program that reduced reimbursement for provider-based RHCs; Hill outreach expressing concerns with United Healths retroactive denial of coverage for emergency-level care in facilities; Hill outreach expressing concern about CMS mid-build audit denials; Senate outreach on prior authorization legislation; Urge support for legislation/administrative action to extend the deadline to use PRF money; Urged HRSA to ensure that the drug companies that denied 340B Statute appropriate discounts make the impacted hospitals whole for the benefit of the vulnerable communities they serve; Support S. 2304 Drug-Price Transparency for Competition Act of 2021 (DTC Act of 2021), a bill to amend title XI of the Social Security Act to require that direct-to-consumer advertisements for prescription drugs and biological products include an appropriate disclosure of pricing information; Support S.246/H.R.851 Future Advancement of Academic Nursing Act or the FAAN Act, a bill to amend the Public Health Service Act to authorize grants to support schools of nursing in program enhancement and infrastructure modernization, increasing the number of nursing faculty and students, and for other purposes; Support S. 1568/HR 4407Technical Reset to Advance the Instruction of Nurses Act or the TRAIN Act, a bill to amend title XVIII of the Social Security Act to provide a waiver of the cap on annual payments for nursing and allied health education payments; Comment letter to the Occupational Safety and Health Administration (OSHA) recommending the withdrawal of the COVID-19 Emergency Temporary Standard for occupational exposure to COVID-19; Meeting with Department of Labor staff to discuss our concerns about the OSHA COVID-19 Emergency Temporary Standard for occupational exposure to COVID-19; Discussion with ASPR staff overseeing the Strategic National Stockpile about their intent to procure supplies of surgical masks; Call with Senator Cassidys staff to discuss concerns about impact of FEMA COVID-19 funding of traveling nurse agencies on hospital nursing shortages; Oppose S 2428, False Claims Amendments Act of 2021A bill to amend title 31, United States Code, to modify False Claims Act procedures, and for other purposes; Discussions about Provider Relief Fund - reporting on past disbursements and urging HHS to disburse remaining PRF money; Discussions about the challenges that teaching hospitals have with training the physician workforce, residency caps that limit funding for training programs, a shortage of residents pursuing primary care specialties, a growing patient pool due to the newly insured and aging of the population; Discussions about the hospital and health system priorities for infrastructure and reconciliation bills; Letter urging Congress to maintain the current legal and regulatory framework for evaluating mergers and acquisitions; Hill outreach to discuss the benefits of health care integration; Hill outreach about the negative impact of potentially anticompetitive conduct by nurse-staffing agencies; Support HR 5035/ S 2982 Child Suicide Prevention and Lethal Means Safety Act, a bill to authorize the Secretary of Health and Human Services to award grants to establish or expand programs to implement evidence-aligned practices in health care settings for the purpose of reducing the suicide rates of covered individuals, and for other purposes; Support H.R.5376 Build Back Better Act, this bill provides funding, establishes programs, and otherwise modifies provisions relating to a broad array of areas, including education, labor, child care, health care, taxes, immigration, and the environment; Discussions with members of congress about the implementation of Rural Emergency Hospital payment designation; Discussions on the No Surprises Act Implementation (surprise billing) and urging federal regulators to restore the independence of the independent dispute resolution process in the No Surprises Act Part 2 regulations; Support HR 5699 Student Assisted Vaccination Effort (SAVE) Act, a bill to expand the definition of qualified persons for purposes of the Public Readiness and Emergency Preparedness Act to include health professional students; Support S 2873 Preventing and Addressing Trauma with Health Services Act (PATHS Act), a bill to require the Secretary of Health and Human Services to award grants to establish or expand programs and activities to increase access to high-quality culturally competent trauma support and mental health care; Letter urging HRSA to delay proposals to withdraw certain HPSAs; Support S 3497 and HR 6397, Medical Student Education Authorization Act of 2022, a bill to amend the Public Health Service Act to establish a grant program to award grants to public institutions of higher education located in a covered State; Support HR 6279 and S 3629, Opioid Treatment Access Act of 2022, a bill to authorize a study on certain exemptions for treatment of opioid use disorder through opioid treatment programs during the COVID-19 public health emergency; Support HR 5703 and S 3677, Post-Disaster Mental Health Response Act, a bill to amend the Robert T. Stafford Disaster Relief and Emergency Assistance Act to authorize the President to provide professional counseling services to victims of emergencies declared under such Act; Submitted a statement on the hearing for Pandemic Profiteers: Legislation to Stop Corporate Price Gouging regarding concerns about anticompetitive conduct on the part of health care staffing agencies, some of which have been exploiting the severe shortage of health care providers during the COVID-19 pandemic; Submitted a statement on the hearing for Americas Mental Health Crisis and supports additional approaches to help ensure improved access to needed comprehensive, affordable and quality behavioral health services; Provide comments to the Affordability Subcommittee of the Healthy Future Task Force expressing our shared focus with Congress on providing relief from the pandemic, ensuring a smooth recovery and rebuilding a better health care system for the future, all while continuing to support efforts to promote greater affordability and value to patients and the health care system; Submitted statement on the hearing for Recruiting, Revitalizing & Diversifying: Examining the Health Care Workforce Shortage about the challenges ahead and the need to examine Americas health care workforce shortage. We must work together to solve these issues so that our nations hospitals and health systems can continue to care for the patients and communities they serve; Submitted statement on the hearing for Protecting Youth Mental Health: Part II - Identifying and Addressing Barriers to Care examines ways to protect the mental health of our nations youth; Submitted statement on the hearing for Exploring Pathways to Affordable, Universal Health Coverage Care expressing the need to build upon and improve our existing system to increase access to coverage of comprehensive health benefits; Submitted a letter to provide information regarding the challenges facing Americas health care workforce as the country enters the third year of the COVID-19 pandemic; Provided comments to the Modernization Subcommittee of the Healthy Future Task Force urging Congress to consider how to ensure the telehealth flexibilities could remain in place for patients and health care providers beyond the PHE; Support HR 7053 and S 3792, Hospital Inpatient Services Modernization Act, a bill to amend title XVIII of the Social Security Act to extend acute hospital care at home waiver flexibilities; Support resolution, H. Res. 909, Expressing support for healthcare personnel and condemning assaults on healthcare personnel as the U.S. healthcare system faces unprecedented staffing shortages and increased workplace-related stressors; Letter urges Congress to provide immediate additional support for hospitals and health systems serving their communities during this unprecedented public health crisis. While the support Congress has provided during the last two years of the COVID-19 pandemic has helped hospitals care for their patients and communities, there is still a significant need for financial support and relief as COVID-19 challenges persist; Support S 3904, Healthcare Cybersecurity Act of 2022, a bill to enhance the cybersecurity of the Healthcare and Public Health Sector; Letter urging OSHA to extend the comment deadline for the rule making on the occupational exposure to COVID-19 in healthcare settings by at least an additional 30 days, through May 23; Meeting with the Office of the Assistant Secretary of Health (OASH) at HHS to discuss the widespread blood shortages in the U.S. and next steps; Stakeholder calls with HHS ASPR regarding the distribution/administration of COVID-19 therapeutics; Discussions on S 571, Public Health Funding Prevents Pandemics Act, a bill to fully fund the Prevention and Public Health Fund and reaffirm the importance of prevention in the United States healthcare system; Regular calls with ASPR and other stakeholders participating in the Health Care and Public Health (HPH) Sector Joint Supply Chain Resilience Working Group (Joint SCRWG), a formal Working Group under the authority of the Critical Infrastructure Partnership Advisory Council (CIPAC) to support the Presidents vision for a resilient public health supply chain; Monthly calls with ASPRs Hospital Preparedness Program (HPP) to discuss updates on the hospital association COVID-19 funding program; Call with ASPR Healthcare and Public Health Government Coordinating Council leadership and other hospital associations to provide feedback on the COVID-19 hospital data guidance update; Provide comment letter to OSHA on the re-opening of comments on the Occupational Exposure to COVID-19 Rulemaking in which we urge OSHA not to finalize its rule for occupational exposure to COVID-19. In our comments, we indicate that we continue to oppose establishing new regulations that are not fully aligned with the Centers for Disease Control and Preventions evolving evidence-based guidance. With the constantly evolving, science-based CDC guidance and recommendations, CMS vaccination requirement and existing OSHA general standards, we strongly believe that an inconsistent and overly strict OSHA COVID-19 health care standard is not necessary, would cause confusion and will ultimately lower hospital employees morale and worsen unprecedented personnel shortages in hospitals. It is essential to a well-functioning health care system that only one set of science-based standards be applied to health care providers, and that these standards be aligned across federal agencies; Letter urging Congress to make the expanded tax credits permanent, ensuring millions of low- and middle-income families continue to have access to affordable coverage in 2023 and beyond; Express concerns with the letter to CMS from Congressman Murphy that makes a number of requests for data surrounding the COVID-19 add on payments for hospitals. We are concerned about the questions as they do not take into account the continued needs of the nations hospitals and health systems. Hospitals continue to face numerous challenges, including increased labor and supply costs and workforce shortages. These additional payments have helped to address some but not all of the high costs associated with COVID-19 patient care. The complexity of care is still higher than pre-pandemic levels as measured by length of stay, which further indicates that its still more resource intensive to treat COVID inpatients. In addition, the high costs associated personal protective equipment, isolation measures, and other additional resources are necessary when treating all patients, unless and until it is determined they do not have COVID-19; Submitted a letter to Ways and Means per their request for information on the health care industry and climate change. We support the sustainability efforts while acknowledging that for a variety of reasons, many hospitals and health systems face challenges and barriers to implementing this work, especially while responding to a pandemic; Letter urging HHS to maintain the COVID-19 public health emergency (PHE) until it is clear that the global pandemic has receded and the capabilities authorized by the PHE are no longer necessary. This will help prevent any future surges from threatening the health and safety of patients and the ability of health care professionals to care for them; Long COVID Best Clinical Practices Discussion with the White House Policy Advisor, Office of the COVID-19 Response; Submitted comment letter to the Federal Trade Commission outlining the impact pharmacy benefit managers (PBMs) practices have on the field. Specifically, urging the FTC to increase scrutiny on insured-mandated white bagging policies, as well as the impact of PBM-negotiated rebates and other business practices on the 340B drug discount pricing program and overall drug prices and drug price increases; Submit a comment letter to the Internal Revenue Service for their proposed rule amending how employer coverage affordability would be measured for family members of employees. We advocated for a fix to the current methodology for assessing affordability of employer coverage for family members, often referred to as the family glitch, which is estimated to affect about 5 million individuals. We commend the IRS on proposing to revise the regulation and improve access to health insurance coverage for millions of American families; Concerns S.4348, Food and Drug Administration Safety and Landmark Advancements Act of 2022 or the FDASLA Act of 2022, a bill to amend the Federal Food, Drug, and Cosmetic Act to revise and extend the user-fee programs for prescription drugs, medical devices, generic drugs, and biosimilar biological product; Comment letter on CMS Radiation Oncology (RO) Model proposed rule. We strongly supports CMS efforts to transform the delivery of cancer care. We also support the original intent of the RO Model, which was to protect access to care by ensuring fair, predictable payment for radiation oncologists. However, this important goal of the original RO Model has been marred by the incorporation of significant payment cuts and substantial administrative burdens for those participating in this mandatory model. As such, the AHA supports CMSs proposal to delay the start date of the RO model from Jan. 1, 2023 to a date to be determined through future rulemaking; Support S. 4352,Travel Nursing Agency Transparency Study Act, a bill to require a study on the effects of travel nurse agencies on the health industry during the COVID-19 pandemic; Letter in response to CMS request for guidance on implementing the regulatory requirement for convening providers and facilities exchange information with co-providers and co-facilities to create a comprehensive good faith estimate as part of the implementation of the No Surprises Act. Due to the lack of currently available automated solutions, this process would require a significant manual effort by providers, which would undoubtedly result in the convening provider being unable to meet the short statutory timeframes for delivering good faith estimates to the patients and could also lead to inadvertent errors. AHA has requested an extension in enforcement direction until a technical solution has been identified and implemented; Support HR 7691, Safety From Violence for Healthcare Employees Act or the SAVE Act, a bill to protect hospital personnel from violence, and for other purposes; Letter requesting that HHS, HRSA, and OIG take immediate enforcement action against the now 17 companies that are refusing to honor their obligations under the 340B program; Letter sent to HHS Secretary to discuss how best to ensure prompt repayment to 340B hospitals without penalizing the rest of the hospital field after the U.S. Supreme Court unanimously agreed that HHS outpatient payment cuts to hospitals in the 340B Drug Pricing Program were unlawful. The Courts decision did not determine a remedy for the unlawful payment cuts, instead, it remanded the case to the lower courts to address the proper remedy; Support HR 7084/ S 3983, Protecting and Transforming Cyber Health Care Act of 2022 or the PATCH Act of 2022, a bill to amend the Federal Food, Drug, and Cosmetic Act to require, for purposes of ensuring cybersecurity, the inclusion in any premarket submission for a cyber device of information to demonstrate a reasonable assurance of safety and effectiveness throughout the lifecycle of the cyber device, and for other purposes; Submit Comment letter of support for CMS continued focus on strengthening health insurance coverage and ensuring ease of enrollment and limited gaps in coverage, including proposed updates to Medicare enrollment and eligibility rules; Submit letter for oversight hearing on Medicare Advantage (MA) plans expressing concerns about some MA plans inappropriate restrictions on beneficiary access to medically necessary care, including those highlighted in a recent report issued by the Department of Health and Human Services Office of Inspector General (HHS-OIG), and urge Congress to increase its oversight of these plans; Provided feedback on the Senate Finance Committees discussion draft addressing mental health care and telehealth. AHA supports allowing Medicare beneficiaries who seek treatment for mental health disorders to receive their care through audio-only services, removing the requirement for Medicare patients to receive an in-person visit prior to receiving mental health services through telehealth, and expanding beyond physicians and limited non-physician practitioners the types of providers who can deliver and bill for telehealth services; Support HR 8576/ S 4352 Travel Nursing Agency Transparency Study Act, a bill to require a study on the effects of travel nurse agencies on the health industry during the COVID-19 pandemic; Support HR 8806 Healthcare Cybersecurity Act of 2022, a bill to enhance the cybersecurity of the Healthcare and Public Health Sector; Submitted a statement for the record for the Senate Judiciary Subcommittee hearing on Flatlining Care: Why Immigrants Are Crucial to Bolstering Our Health Care Workforce. This hearing examines the importance of improving the immigration process in order to help alleviate Americas health care workforce shortage. We encourage Congress to help address domestic health care workforce shortage;

Client expense: $6,950,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), Occupational Safety & Health Administration (OSHA), SENATE, White House Office

S. 1024, A bill to enhance our Nation's nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

To enhance our Nation's nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas; S. 1024/H.R. 2255 - Healthcare Workforce Resilience Act

Client expense: $310,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to Medicare and Medicaid coverage and Medicaid disproportionate share program; Financial support for providers for diagnosis and treatment related to COVID-19; coverage of COVID-19 related conditions; access to PPE and other materials and equipment related to the treatment of patients with COVID-19, including funding for the Provider Relief Fund; PL 117-2; Issues related to Bipartisan Infrastructure Framework; Issues related to telehealth; Efforts to extend Medicare sequester delay, including H.R.1868; Issues related to Medicare policy on virtual care; Childrens Health Graduate Medical Education; issues related to drug pricing; Issues related to hospital DSH eligibility; Issues related to Home and Community Based Services (HCBS); Medicaid waiver-related issues; Childrens transplant program issues; S. 346/H.R. 959 - Black Maternal Health Momnibus Act; S.773/H.R. 3203 - legislation to enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program; S. 834/H.R. 2256 - Resident Physician Shortage Reduction Act; S. 1024/H.R. 2255 - Healthcare Workforce Resilience Act; S. 368/H.R. 1332 - Telehealth Modernization Act; S. 1512/H.R. 2903 - CONNECT for Health Act ; S. 1988 - Protecting Rural Telehealth Access Act; H.R. 3 - Elijah E. Cummings Lower Drug Costs Now Act; H.R. 5376 - Build Back Better Act; H.R. 2617 - Consolidated Appropriations Act, 2023; Efforts to delay statutory PAYGO payment reductions; Efforts to offset physician payment reductions; Efforts to improve hospital reimbursement; Issues related to cuts to Medicaid DSH; Issues related to cuts to uncompensated care pools; Issues related to hospital at home programs; H.R. 2471 - Consolidated Appropriations Act (FY 2022 Omnibus); H.R. 7007 - Covid-19 Supplemental Appropriations Act; H.R. 7053/S. 3792 - Hospital Inpatient Services Modernization Act; issues related to the Acute Hospital Care at Home (AHCAH) waiver; S. 3493 - Telehealth Extension and Evaluation Act; H.R. 6202 - Telehealth Extension Act; H.R. 5376 - Inflation Reduction Act (Public Law 117-169); H.R. 6833 - Continuing Resolution; Issues related to adequate financing for hospitals and providers; H.R. 4040 - Advancing Telehealth Beyond COVID-19 Act; Issues related to extending the Medicare Dependent Hospital and Low Volume Hospital programs; Issues related to extending bonus payments for Advanced Alternative Payment models; H.R. 4587 - Value in Health Care Act; Issues related to coding and coverage of spiritual care through chaplain services; Issues related to value-based care programs, including the Bundled Payments for Care Improvement (BPCI) Advanced Model; Issues related to data and quality measure reporting and eligibility for corresponding reimbursements; Issues related to prior authorization; H.R. 3173 - Improving Seniors Timely Access to Care Act; Issues related to Rural Emergency Hospital designation; Issues related to safety net hospital reimbursements.

Client expense: $310,000 · Firm income: Not reported

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

Healthcare Supply Chain - Highlighted the important role played by hospital group purchasing organizations in promoting resiliency and value in healthcare purchasing. Engaged to support policies to ensure greater transparency and mitigate or limit shortages of prescription drugs. Supported policies that would expedite critical cargo, including cargo necessary for medical care, during a public health emergency or disaster. Advocated for greater transparency in the health care supply chain for drugs and medical devices. Supported updating language related to the Unapproved Drugs Initiative, and incorporating the PASTUER Act (S.2076) and the PATCH Act (H.R. 7084) in omnibus legislation (H.R. 2617). Telehealth - Supported efforts to make telehealth flexibilities offered during COVID-19 Public Health Emergency permanent. Supported CONNECT for Health Act (H.R. 2617 S. 1512/H.R. 2903) and the Extending Telehealth Beyond COVID-19 Act (H.R. 4040). Encouraged reimbursement parity for certain telehealth services and support for audio-only telehealth services. Health Care Workforce - Urged passage of the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act (H.R. 708; S. 168); The Health Care Workforce Resilience Act (S. 1024/H.R. 2255). Urged administration to examine practices of health care staffing agencies and supported passage of the Travel Nursing Agency Transparency Study Act (S. 4352). Supported passage of the Safety from Violence for Healthcare Employees Act (H.R. 7961). Prepare for and Respond to Existing Viruses, Emerging New Threats, and (PREVENT) Pandemics Act (S. 3799; H.R 2617) - monitored PREVENT Pandemics Act and supported inclusion of provisions to improve supply chain transparency, enhance cybersecurity of medical devices and extend shelf life of prescription drugs in omnibus legislation. 340B Drug Pricing Program - Urged HHS to enforce guidance that would allow 340B Covered Entities to utilize contract pharmacies. Social Determinants of Health and Health Equity - Shared insights and offered suggestions to CMS regarding health equity measurement, indices and data collection. Supported the Social Determinants Accelerator Act (H.R. 2503; S. 3039); The LINC to Address Social Needs Act (S. 509). Supported passage of Opioid Treatment Access Act (S. 3629/H.R. 6279). Supported passage of Drug Shortages Shelf Life Extension Act (S. 3493). Supported passage of the Biologics Competition Act (H.R. 8877).

Client expense: $250,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Coverage of blood transfusions under Medicare Hospice Benefit Improving Access to Transfusion Care for Hospice Patients Act of 2021 (S. 2566) Issues related to CAR-T/cellular and gene therapies Implementation of the Medicare Access and CHIP Reauthorization Act pf 2015 (P.L. 114-10) Implementation of the Patient Protection and Affordable Care Act (P.L. 111-148) CMS national coverage determinations Medicaid coverage for sickle cell disease Issues impacting opioid access/use for patients with hematologic disease and disorders Issues related to implementation of Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136) Issues related to health equity/disproportionate impact of COVID-19 on minority populations Issues related to telemedicine/telehealth COVID-19 vaccination policies/prioritization Resident Physician Shortage Reduction Act (H.R. 2256/S. 834) Healthcare Workforce Resilience Act (H.R. 2255/S. 1024) Cures 2.0 Act (H.R. 6000) Sickle cell disease/trait issues Sickle Cell Disease Comprehensive Care Act (H.R. 6216 / S.3389) Prior authorization Improving Seniors Timely Access to Care Act (H.R. 3173/S. 3018) Advancing Telehealth Beyond COVID Act (H.R. 4040) Supporting Medicare Providers Act (H.R. 8800) FY2023 Consolidated Appropriations Act (H.R. 2617)

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Resident Physician Shortage Reduction Act (H.R. 2256/S. 834) Healthcare Workforce Resilience Act (H.R. 2255/S. 1024) Implementation of the Patient Protection and Affordable Care Act (P.L. 111-148) Hematology/oncology drug research and approval issues Implementation of the Food and Drug Administration Safety and Innovation Act (FDASIA) (P.L. 112-144) Clinical trials regulations and coverage Issues impacting coverage for hematologic diseases and conditions Issues related to CAR-T/cellular and gene therapies Issues impacting opioid access/use for patients with hematologic disease and disorders Issues impacting blood supply shortages/safety Issues related to convalescent plasma Issues related to health equity/disproportionate impact of COVID-19 on minority populations Issues related to diversity, equity, and inclusion (DEI) in hematology research, practice, and training Cures 2.0 Act (H.R. 6000) Implementation of No Surprises Act (P.L. 116-260) Cancer Patient Equity Act of 2021 (H.R.5377) HELP Copays Act (H.R. 5801) Cancer Drug Parity Act of 2021 (H.R. 4385 / S. 3080) Sickle cell disease/trait issues Sickle Cell Disease Comprehensive Care Act (H.R. 6216 / S.3389) Impact of climate change on health Resolution expressing support for healthcare personnel and condemning assaults on healthcare personnel as the U.S. healthcare system faces unprecedented staffing shortages and increased workplace-related stressors (H.Res. 909) Sickle Cell Care Expansion Act (H.R. 7177/S.4425) Women's Health Protection Act (S. 1975/ H.R. 3755/S. 4132) Newborn Screening Saves Lives Reauthorization Act (H.R. 482/S. 350) Prior authorization Improving Seniors Timely Access to Care Act (H.R. 3173/S. 3018) Health Equity and Accountability Act (H.R. 7585) Issues related to maternal health care and abortion access Verifying Accurate Leading-edge IVCT Development (VALID) Act (H.R. 4128/S. 2209) Food and Drug Administration Safety and Landmark Advancements (FDASLA) Act (S. 4348) Affordability of employer coverage for family members/"family glitch Sickle Cell Disease Treatment Centers Act of 2022 (S. 4866/ H.R. 8855) Advancing Telehealth Beyond COVID Act (H.R. 4040) Resolution supporting the designation of September 2022 as "Sickle Cell Disease Awareness Month" (H.Res.1330/S.Res.868) Let Doctors Provide Reproductive Health Care Act (S. 4723/H.R. 8650) FY2023 Consolidated Appropriations Act (H.R. 2617)

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Natl Institutes of Health (NIH), SENATE

S. 834/ H.R. 2256: Resident Physician Shortage Reduction Act S. 1024/H.R. 2255: Healthcare Workforce Resilience Act S. 1548/H.R. 3085: Equity in Neuroscience and Alzheimers Clinical Trials (ENACT) Act S. 1810/H.R. 3541: Conrad State 30 and Physician Access Reauthorization Act S. 3427: Neuroscience Center of Excellence Act of 2021 S.4348: FDASLA Act of 2022; section 506. S. 4906: National Neurological Conditions Surveillance System Reauthorization Act of 2022 H.R. 2754: COVID-19 Long Haulers Act H.R. 4122: Resident Education Deferred Interest Act of 2021 H.R. 5435: Bringing Regulatory Advances into Neuroscience (BRAIN) Act Urging reforms to proposed surprise billing regulations to align with congressional intent for payment disputes. Support for creating a Neuroscience Center of Excellence at FDA. Supporting policies to address the COVID-19 public health emergency, including maintaining telemedicine coverage and ensuring access to affordable health coverage and medications. Medical research funding related to NIH including the BRAIN Initiative, AHRQ, HEAL Initiative, and the Congressionally Directed Medical Research Programs at the Department of Defense. Support for funding for the Pediatric Subspecialty Loan Repayment Program.

Client expense: $140,000 · Firm income: Not reported

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

Issues related to public health emergency; S. 1024, Healthcare Workforce Resilience Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE, White House Office

Issues related to health care workforce including Healthcare Workforce Resilience Act (H.R. 2255 / S. 1024) and the Provider Training in Palliative Care Act (S. 2890). S. 4260, Palliative Care and Hospice Education & Training Act. and H.R. 8812, the Improving Care and Access to Nurses (ICAN) Act. Issues related to community based palliative care and advanced care illness management. H.R. 9109, The Grief Resilience Investment and Education Fund (GRIEF) Act and issues regarding bereavement care. Issues related to safe opioid disposal and implementing the Support Act (H.R. 2379).

Client expense: $250,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6, American Dream and Promise Act of 2021 H.R. 78, Legal Workforce Act H.R. 206/S. 4813, Paperwork Reduction for Farmers and H-2A Modernization Act H.R. 401, Landscaping Workforce Act of 2021 H.R. 427, Moving H-2A to United States Department of Agriculture Act of 2021 H.R. 865, American Jobs First Act of 2021 H.R. 1037, Better Agriculture Resources Now (BARN) Act H.R. 1177/S. 348, U.S. Citizenship Act H.R. 1571, Dairy H-2A Eligibility Act H.R. 1603, Farm Workforce Modernization Act of 2021 H.R. 2064, TPS and DED Protection Act of 2021 H.R. 2086, Agricultural Guest Worker Reform Initiative Act of 2021 H.R. 2255/S. 1024, Healthcare Workforce Resilience Act H.R. 2298, Accountability Through Electronic Verification Act H.R. 2839/S. 1358, Bipartisan Border Solutions Act of 2021 H.R. 2901/S. 831, EB-5 Reform and Integrity Act of 2021 H.R. 3215, Temporary Family Visitation Act H.R. 3237, Emergency Security Supplemental Appropriations Act, 2021 H.R. 3385/S. 2083, HOPE for Afghan SIVs Act of 2021 H.R. 3513/S. 2032, Afghan Allies Protection Act of 2021 H.R. 3541, Conrad State 30 and Physician Access Reauthorization Act H.R. 3648, Equal Access to Green cards for Legal Employment (EAGLE) Act of 2021 H.R. 3897, H-2B Returning Worker Exception Act of 2021 H.R. 4288, Workforce for an Expanding Economy Act H.R. 4331, Americas Cultivation of Hope and Inclusion for Long-term Dependents Raised and Educated Natively Act of 2021 (Americas CHILDREN Act of 2021) H.R. 4521, America Creating Opportunities for Manufacturing, Pre-Eminence in Technology, and Economic Strength (America COMPETES) Act of 2022 H.R. 4578, Relief for Seasonal Businesses Act of 2021 H.R. 4681, Let Immigrants Kickstart Employment (LIKE) Act of 2021 H.R. 4856, Canadian Snowbird Visa Act H.R. 5498, Preserving Employment Visas Act H.R. 5887/S. 3134, Keep Food Local and Affordable Act of 2021 H.R. 5924, Keep STEM Talent Act of 2021 H.R. 6206, American Tech Workforce Act of 2021 H.R. 6637, Dignity for Immigrants while Guarding our Nation to Ignite and Deliver the American Dream (DIGNIDAD Dignity) Act H.R. 7239, Essential Workers for Economic Advancement Act H.R. 7441, Acute Labor Shortage Solutions Act of 2022 H.R. 7549, Seasonal Worker Solidarity Act of 2022 H.R. 8295, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2023 H.R. 8433, Renewing Immigration Provisions of the Immigration Act of 1929 H.R. 8685/S. 4787, Afghan Adjustment Act H. Res. 901, Expressing the sense of the House of Representatives that BridgeUSA exchange programs are vital to the economy and national interests of the United States, and that Congress should prioritize robust support to ensure equitable opportunities for Americans and people from other countries S. 71, Accountability Through Electronic Verification Act S. 264, Dream Act of 2021 S. 306, Safe Environment from Countries Under Repression and Emergency (SECURE) Act S. 418, E-Verify Act S. 478, Higher Wages for American Workers Act of 2021 S. 495, Prioritizing Help to Businesses Act S. 959, Secure and Protect Act of 2021 S. 970, Backlog Elimination, Legal Immigration, and Employment Visa Enhancement (BELIEVE) Act S. 1810, Conrad State 30 and Physician Access Reauthorization Act S. 1861, Partner with Korea Act S. 2207, A bill to temporarily increase the availability of temporary nonimmigrant nonagricultural workers for the purposes of restoring American forests, and for other purposes S. 2443, A bill to expand the definition of H-2A nonimmigrant for purposes of the Immigration and Nationality Act to include aliens engaged in seafood processing, horticultural commodities, or the care of horses S. 2753, Protecting Children of Long-term Visa Holders Act of 2021 S. 2828, Preserving Employment Visas Act S. 3638, Keep STEM Talent Act of 2022 S. 3720, H-1B and L-1 Visa Reform Act of 2022 S. 3721, Resolving Extended Limbo for Immigrant Employees and Families (RELIEF) Act S. 3850, Securing America's Ports of Entry Act of 2022 S. 3869, A bill to add Ireland to the E-3 nonimmigrant visa program S. 4659, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2023 Draft legislation titled Affordable and Secure Food Act Proposed Rule, U.S. Immigration and Customs Enforcement, Department of Homeland Security; Optional Alternatives to the Physical Document Examination Associated with Employment Eligibility Verification (Form I-9) (87 Fed. Reg. 50,786-50,794, August 18, 2022) Various issues relating to visa waiver program; H-1B Visa Program; H-1B registration rule; H-1B reform; H-2 Visa Program and temporary rule; H-2A Visa Program; H-4 rule; L-1 Visa Program; J-1 BridgeUSA program; EB-5 Visa Program; EB-5 regional center program; E-Verify program; 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; delays in H-4 and L-2 Status Extensions and Employment Authorization Documents (EADs); FY22 funding for Customs and Border Protection staffing; restarting routine visa processing during the COVID-19 pandemic; high-skilled immigration; lesser skilled immigration; temporary agricultural guest workers; temporary non-agricultural guest workers; optional practical training program; size and administration of employment-based immigrant visa categories; size and administration of family-based immigrant visa categories; size and administration of employment-based nonimmigrant visa categories; expansion of the use of the E-Verify system; I-9 employment verification; interior enforcement; increased vetting of visa applicants; unfair immigration related employment practices; international travel; 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; State Department policy extending consular interview waiver eligibility; 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 and extending premium processing capability for the adjudication of various immigration forms; 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; regulatory proposals that will temporarily raise the annual quota for H-2B visas; enhanced COVID-19 testing protocols for international air travel; creation/use of digital passports; reopening and expanding consular operations; fully reinstituting routine visa processing at U.S. embassies and consulates abroad; recapturing unused immigrant visas from prior years; creating exemptions to the current immigrant visa caps; proposals that would expand consular interview waivers for prospective immigrant and nonimmigrant visa applicants abroad; implementation of the EB-5 Reform and Integrity Act of 2022, P.L. 117-103, Division BB; proposals that would provide relief for Afghan refugees; granting temporary protected status and special student relief to Ukrainian nationals; ensuring Ukrainian applicants for refugee/asylee status have access; potential Reinstitution of Stateside Visa Revalidation Services; implementation of electronic visa foils in passports; consular service delays; USCIS processing delays; Visa relief for long term foreign national workers laid off by their employers while waiting for their green cards in the immigrant visa backlogs; improving wait times for CBP Processing at Ports of Entry; expanding and implementing new CBP preclearance facilities abroad

Client expense: $20,990,000 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, State, Dept of (DOS), White House Office

H.R. 6, The American Dream and Promise Act of 2021 S. 264, Dream Act of 2021 Issue: Support policies allowing undocumented students to attend U.S. medical schools and graduate medical education. Support Dreamer eligibility for federal student loans. H.R. 3541/ S. 1810, 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 H.R. 2255/ S. 1024, Healthcare Workforce Resilience Act Issue: Support reduction of green card backlogs for health professionals

Client expense: $876,000 · Firm income: Not reported

Government targets: Bureau of Citizenship & Immigration Services (BCIS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE, State, Dept of (DOS), White House Office

H.R. 3541, Conrad State 30 and Physician Access Reauthorization Act, all provisions S. 1810, Conrad State 30 and Physician Access Reauthorization Act, all provisions H.R. 6, American Dream and Promise Act of 2021, all provisions S. 1024, Healthcare Workforce Resilience Act, all provisions H.R. 2255, Healthcare Workforce Resilience Act, all provisions H.R. 3648, Equal Access to Green cards for Legal Employment (EAGLE) Act of 2022, all provisions H.R. 4521, America COMPETES Act of 2022, provisions relating to Section 80303, Doctoral STEM Programs H.R. 8019, Professionals Access To Health Workforce Integration Act of 2022, all provisions H.R. 8021, Immigrants in Nursing and Allied Health Act of 2022, all provisions H.R. 8022, International Medical Graduates Assistance Act of 2022, all provisions Migrant populations/mental health/safer medical practices and protections

Client expense: $5,060,000 · Firm income: Not reported

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

Area wage index - Save Rural Hospitals Act (S.999, H.R. 4066); behavioral health; Workforce -Resident Physician Shortage Reduction Act of 2021 (S. 834/ H.R. 2256); Healthcare Workforce Resilience Act (S. 1024); Future Advancement of Academic Nursing Act (S. 246/H.R. 851); Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667); rural hospital medical residency and health workforce programs - Rural Health Health Corps Act (S. 924/H.R. 2130); post-acute care/inpatient rehabilitation facilities - IMPACT Act (TRIA) of 2021 (H.R. 2455),IRF CMS Review Choice Demonstration; 340b Eligibility requirements waiver - H.R. 3203 and S.773; Disproportionate Share Hospital and Uncompensated Care funding cuts in the Build Back Better; relief to repay payments received through the Medicare Accelerated and Advance Payments program.

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

HR 432 and S 828 To provide for the coverage of marriage and family therapist services and mental health counselor services under Medicare. HR 708 and S 168 To provide temporary licensing reciprocity for telehealth and interstate health care treatment. HR 1384 and S 445 Loosens restrictions on doctors prescribing buprenorphine for addiction treatment. HR 2503 To direct the HHS Secretary to establish an interagency council on social determinants of health. S 660 Improves access to tele-mental health during the length of the COVID-19 PHE. S 674 To support public health infrastructure (funding up to $4.5 billion). HR 2255/S. 1024 To recapture unused immigrant visas and allocate them to doctors and nurses to help in the fight against COVID-19. HR 2903/S. 1512 Comprehensive bill to expand telehealth access and make permanent telehealth flexibilities available during COVID-19 pandemic. HR 3203/S. 773 To enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program. S. 1162 To expand access to Programs of All-Inclusive Care for the Elderly (PACE). HR 4118 To authorize the HHS Secretary to invest in community-based violence reduction initiatives. S. 2257 To reduce drug and device shortages and costs. HR 5801 To apply additional payments, discounts, and other financial assistance towards the cost-sharing requirements of health insurance plans. Health care workforce shortage concerns. S. 3626 To improve access to the Program of All-Inclusive Care for the Elderly (PACE) HR 7236 To expand the availability of mental, emotional, and behavioral health services under the Medicaid program HR 7353 To treat telehealth services as excepted benefits HR 7961 To protect hospital personnel from violence S 4352 To require a study on the effects of travel nurse agencies on the health industry during the COVID-19 pandemic S 3189 To provide a pathway to health careers through health profession opportunity grants HR 7666 Reauthorizes, expands, and modifies programs, grants, and activities that focus on mental and behavioral health

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), SENATE

H.R. 2255/S. 1024, Healthcare Workforce Resilience Act S. 4381, Ensuring Seniors Access to Quality Care Act Issues related to Skilled Nursing Facilities (SNFs)-Mandatory Staff Mandates

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

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

H.R. 2255/ S.1024-Healthcare Workforce Resilience Act; H.R. 3648, Equal Access to Green cards for Legal Employment Act of 2021 or the EAGLE Act of 2021; H.R. 3541/S. 1810, Conrad State 30 and Physician Access Reauthorization Act; H.R. 4521, America COMPETES Act of 2022; and policies contained in H.R. 5376, Build Back Better Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2255/S.1024, Healthcare Workforce Resilience Act; H.R. 3648, Equal Access to Green cards for Legal Employment Act of 2021 or the EAGLE Act of 2021; H.R. 3541/S. 1810, Conrad State 30 and Physician Access Reauthorization Act; policies contained in H.R. 5376, to provide for reconciliation pursuant to title II of S. Con. Res. 14.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Immigration issues affecting the healthcare industry including foreign visas; S.1024, Healthcare Workforce Resilience Act; H.R.3648, Equal Access to Green cards for Legal Employment (EAGLE) Act of 2021.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Work visas for certain health professionals; S.1024 and HR 2255, legislation to enhance the US nurse and physician workforce during COVID crisis by recapturing unused immigration visas; Implementation of the American Recovery Act; FY 23 Appropriations.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 2255 and S. 1024, legislation to enhance our Nation's nurse and hysician workforce during the COVID crisis by recapturing unused immigration visas. Distribution of COVID relief funds and American Recovery Act funds; FY 23 Appropriations bills;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to health care workforce including H.R. 2255 / S. 1024, Healthcare Workforce Resilience Act and S. 2890, the Provider Training in Palliative Care Act. S. 4260, Palliative Care and Hospice Education & Training Act (PCHETA). H.R. 2617 (P.L. 117-328), the Consolidated Appropriations Act of 2023, as it relates to PCHETA and bereavement care. Issues related to community based palliative care. H.R. 9109, The Grief Resilience Investment and Education Fund (GRIEF) Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Childcare Issues related to childcare - no specific bill General Advocacy on COVID-19 relief, response, and pandemic preparedness, including issues related to: Additional COVID-19 relief funding Assistance for health care providers (Provider Relief Fund) Issues related to personal protective equipment (PPE) and medical supplies Support for resident physicians and medical students Student loan forgiveness/debt relief Federal Medicaid Match State and local funding Demographic data collection Telemedicine/Telehealth Vaccines Testing, contact tracing, and mitigation Hiring additional public health workers to support COVID-19 response Health disparities and protecting vulnerable populations Mental and behavioral health Expanding internet connectivity/broadband Grant program for childcare Food assistance programs Small business loans Reducing health care premiums for low- and middle-income families Incentives and federal funding to expand Medicaid and CHIP eligibility Allowing states to extend Medicaid and CHIP eligibility to women for 12 months postpartum. S.3799 PREVENT Pandemics Act (Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act) Gun Safety S. 2325/H.R.4238 - Making America Safe and Secure (MASS) Act Gun Violence Protection and Safety Act Issues related to gun safety - no specific bill Health Care Issues related to health care/universal access to quality, equitable, affordable coverage - no specific bill Issues related to mental and behavioral health care Health Care Workforce S.3828/ H.R. 2418 - Student Loan Forgiveness for Frontline Health Workers Act S. 54 - Strengthening America's Health Care Readiness Act S. 834/ H.R.2256 - Resident Physician Shortage Reduction Act of 2021 S.610/ H.R.1667 - Dr. Lorna Breen Health Care Provider Protection Act S.3244/ H.R.5602 - BIO Preparedness Workforce Act of 2021 Issues related to health care workforce shortages Issues related to the affordability of medical education and federal loan programs Issues related to scope of practice - no specific bill Issues related to the Department of Veterans Affairs Federal Supremacy Project Immigration Issues related to Immigration - no specific bill S. 1024/H.R. 2255 - Healthcare Workforce Resilience Act Infrastructure Issues related to broadband access Issues related to the Build Back Better framework Interoperability/ONC Issues related to interoperability and information blocking - no specific bill Nutrition H.R.5370 - Medically Tailored Home-Delivered Meals Demonstration Pilot Act of 2021 Issues related to nutrition and food security Racial Justice/Health Equity S. 162/H.R. 666 - Anti-Racism in Public Health Act of 2021 Issues related to racial justice/health care equity Issues related to equitable policies around blood, tissue donations Maternal Health S. 411/ H.R. 3407 - Mothers and Offspring Mortality and Morbidity Awareness (MOMMA's) Act Medical Education Issues related to the affordability of medical education S.3658 /H.R. 4122 - Resident Education Deferred Interest (REDI) Act Medicare/Medicaid Issues related to Medicare physician payment H.R. 1587/ S. 1731 - Medicare Audiologist Access and Services Act of 2021 Issues related to Medicare/Medicaid - no specific bill Issues related to prior authorization and administrative simplification - no specific bill S.3018/ H.R.3173 - Improving Seniors Timely Access to Care Act of 2021 Issues related to Medicare Advantage risk adjustment H.R.5376 - Inflation Reduction Act of 2022 Opioids/ Substance Use Disorder H.R.6311/ S.3418 - Comprehensive Addiction Resources Emergency (CARE) Act S. 2354 - Safer Prescribing of Controlled Substances Act H.R.1026 / S.2353 - LABEL Opioids Act of 2021 Issues related to opioids and substance use disorder - no specific bill Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill Publications Open access to information based on publicly funded research Issues related to scholarly and scientific publishing and public access S.1260 - United States Innovation and Competition Act of 2021 H.R.4521 - America COMPETES Act of 2022 Surprise Billing Issues related to surprise billing - no specific bill Issues related to the implementation of the No Surprises Act Telehealth Issues related to telehealth Issues related to telebehavioral health access Issues related to physician licensing S. 368/H.R. 1332 - Telehealth Modernization Act Vaccines Issues related to vaccines - no specific bill Regulatory Issues related to Medicare physician payment H.R. 8800 - Supporting Medicare Providers Act of 2022 S. 5194 - Protecting Medicare Patients and Physicians Act Issues related to implementation of the No Surprises Act Issues related to telehealth H.R. 4040 - Advancing Telehealth Beyond COVID-19 Act of 2022 Issues related to health equity

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Labor, Dept of (DOL), SENATE, Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

Immigration Issues related to Immigration - no specific bill S. 1024/H.R. 2255 - Healthcare Workforce Resilience Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Childcare Issues related to childcare - no specific bill General Advocacy on COVID-19 relief, response, and pandemic preparedness, including issues related to: Additional COVID-19 relief funding Assistance for health care providers (Provider Relief Fund) Issues related to personal protective equipment (PPE) and medical supplies Support for resident physicians and medical students Student loan forgiveness/debt relief Federal Medicaid Match State and local funding Demographic data collection Telemedicine/Telehealth Vaccines Testing, contact tracing, and mitigation Hiring additional public health workers to support COVID-19 response Health disparities and protecting vulnerable populations Mental and behavioral health Expanding internet connectivity/broadband Grant program for childcare Food assistance programs Small business loans Reducing health care premiums for low- and middle-income families Incentives and federal funding to expand Medicaid and CHIP eligibility Allowing states to extend Medicaid and CHIP eligibility to women for 12 months postpartum. S.3799 PREVENT Pandemics Act (Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act) Gun Safety S. 2325/H.R.4238 - Making America Safe and Secure (MASS) Act Gun Violence Protection and Safety Act Issues related to gun safety - no specific bill Health Care Issues related to health care/universal access to quality, equitable, affordable coverage - no specific bill Issues related to mental and behavioral health care Health Care Workforce S.3828/ H.R. 2418 - Student Loan Forgiveness for Frontline Health Workers Act S. 54 - Strengthening America's Health Care Readiness Act S. 834/ H.R.2256 - Resident Physician Shortage Reduction Act of 2021 S.610/ H.R.1667 - Dr. Lorna Breen Health Care Provider Protection Act S.3244/ H.R.5602 - BIO Preparedness Workforce Act of 2021 Issues related to health care workforce shortages Issues related to the affordability of medical education and federal loan programs Issues related to scope of practice - no specific bill Issues related to the Department of Veterans Affairs Federal Supremacy Project Immigration Issues related to Immigration - no specific bill S. 1024/H.R. 2255 - Healthcare Workforce Resilience Act Infrastructure Issues related to broadband access Issues related to the Build Back Better framework Interoperability/ONC Issues related to interoperability and information blocking - no specific bill Nutrition H.R.5370 - Medically Tailored Home-Delivered Meals Demonstration Pilot Act of 2021 Issues related to nutrition and food security Racial Justice/Health Equity S. 162/H.R. 666 - Anti-Racism in Public Health Act of 2021 Issues related to racial justice/health care equity Issues related to equitable policies around blood, tissue donations Maternal Health S. 411/ H.R. 3407 - Mothers and Offspring Mortality and Morbidity Awareness (MOMMA's) Act Medical Education Issues related to the affordability of medical education S.3658 /H.R. 4122 - Resident Education Deferred Interest (REDI) Act Medicare/Medicaid Issues related to Medicare physician payment H.R. 1587/ S. 1731 - Medicare Audiologist Access and Services Act of 2021 Issues related to Medicare/Medicaid - no specific bill Issues related to prior authorization and administrative simplification - no specific bill S.3018/ H.R.3173 - Improving Seniors Timely Access to Care Act of 2021 Issues related to Medicare Advantage risk adjustment H.R.5376 - Inflation Reduction Act of 2022 Opioids/ Substance Use Disorder H.R.6311/ S.3418 - Comprehensive Addiction Resources Emergency (CARE) Act S. 2354 - Safer Prescribing of Controlled Substances Act H.R.1026 / S.2353 - LABEL Opioids Act of 2021 Issues related to opioids and substance use disorder - no specific bill Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill Publications Open access to information based on publicly funded research Issues related to scholarly and scientific publishing and public access S.1260 - United States Innovation and Competition Act of 2021 H.R.4521 - America COMPETES Act of 2022 Surprise Billing Issues related to surprise billing - no specific bill Issues related to the implementation of the No Surprises Act Telehealth Issues related to telehealth Issues related to telebehavioral health access Issues related to physician licensing S. 368/H.R. 1332 - Telehealth Modernization Act Vaccines Issues related to vaccines - no specific bill Regulatory Issues related to Medicare physician payment H.R. 8800 - Supporting Medicare Providers Act of 2022 S. 5194 - Protecting Medicare Patients and Physicians Act Issues related to implementation of the No Surprises Act Issues related to telehealth H.R. 4040 - Advancing Telehealth Beyond COVID-19 Act of 2022 Issues related to health equity

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Labor, Dept of (DOL), Office of Science & Technology Policy (OSTP), SENATE, Treasury, Dept of, Veterans Affairs, Dept of (VA), White House Office

H.R. 2255/S. 1024, Healthcare Workforce Resilience Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

The Affordable Care Act (P.L. 111-148, P.L. 111-152): Continued advocacy with Congress in support of 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; 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 (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 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. Regarding CMS 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 2024, 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. Urged CMS to discontinue its split/shared visits policy and not move forward with the transition set to take effect in 2023. Urged Congress to support inclusion in must-pass legislation this year provisions to provide financial stability through a baseline positive annual update to the physician fee schedule reflecting inflation in practice costs, and eliminate, revise budget neutrality requirements to allow for appropriate changes in spending growth and prevent a 4.42 percent Medicare payment cut as contained in H.R. 8800, the Supporting Medicare Providers Act of 2022; Extend the moratoriums on sequester and PAYGO cuts that were approved by Congress at the end of last year. Recommended modifications to Medicare law to establish a mechanism for savings to be calculated across all aspects of the program-that is, increased investment in relative and absolute payments for primary care and preventive health care services (Part B) results in savings due to reduced emergency department visits and hospitalizations (Part A)-and to allow these savings to be reinvested back into primary and preventive care, as well as into social and public health services. With regard to Medicares Quality Payment Program, advocated with Congress to provide flexibility to CMS to set performance thresholds, improve the cost performance category, provide scoring flexibility to CMS to allow for multi-category credit, provide CMS flexibility to score and benchmark measures as appropriate and to test and incentivize new measures and MVPs to ensure successful implementation, update the Promoting Interoperability performance category, Extend the $500 million exceptional performance bonus for an additional six years , align comparisons in the MIPS Quality performance category and Physician Compare. FY2023 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Preventions programs in the FY 2023 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as 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 funding for the Health Resources Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Preventions (CDC) Office on Smoking and Health (OSH). 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. 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 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. 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. Urged CMS to support increasing COVID-19 vaccine uptake by ensuring clinicians are appropriately paid for vaccine counseling for beneficiaries of Medicaid and Medicare. Urged that telehealth services should remain in place for at least two years after the end of the PHE to ensure that our physicians are able to continue to use this modality to enhance patient care. Urged Congress to support the concept of a congressionally-mandated bipartisan commission to examine the U.S. preparations for and response to the COVID-19 pandemic, in order to inform future public policy and health systems preparedness. Urged that any uses of technology in the U.S. in the context of the pandemic should be demonstrated to be effective, be temporary, and ensure that safeguards for privacy and confidentiality are in place. Womens Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect 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 and 2022 (H.R. 3755/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. Access to Care: Urged members of Congress to cosponsor and pass 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: Cosponsor and pass H.R. 369, the Health Care Affordability Act of 2021, to permanently expand eligibility for higher premium tax credits under the Affordable Care Act. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2256/S. 834, the Resident Physician Reduction Shortage Act of 2021, to increase the number of GME slots to 14,000 over seven years for specialties facing shortages, including internal medicine; Cosponsor and pass S. 1024, the Healthcare Workforce Resilience Act, to recapture 40,000 unused visas and use them to provide additional green cards to 15,000 physicians and 25,000 professional nurses; Cosponsor and pass H.R. 3541/S. 1810, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R.4122/S.3658, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2023 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Public Health and Pandemic Preparedness: Urged members of Congress to support funding in FY2023 appropriations - $11 billion total for the CDC, $35 million for the CDCs Injury Prevention and Control, Firearm Injury and Mortality Prevention Research; $49 billion in total for the NIH, $25 million for the Office of the Director, Firearm Injury and Mortality Prevention Research; Cosponsor and pass the COVID Supplemental Appropriations Act, 2022, H.R. 7007, or a similar supplemental funding package, to provide $15.6 billion in additional funding for COVID relief; Cosponsor and pass the CONNECT for Health Act (H.R. 2903/S. 1512) and the Telehealth Extension Act of 2021 (H.R. 6202/S. 3593), to remove arbitrary restrictions on where a patient must be located to utilize telehealth services; enable patients to continue to receive telehealth services in their homes; ensure federally-qualified health centers and rural health centers can furnish telehealth services and improve data collection and analysis for at least two years. Prescription Drug Reform: Urged members of Congress to cosponsor and pass 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; Cosponsor and pass 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; Cosponsor and pass 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. Telehealth Services: 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; H.R. 8487, the Improving Seniors Timely Access to Care Act that would help protect patients from unnecessary delays in care and reduce administrative burdens on physicians by standardizing and streamlining the prior authorization approval process in the Medicare Advantage (MA) program. Advocated with Congress for passage of H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act of 2021, to extend coverage for critical telehealth services beyond the public health emergency. Mental and Behavioral Health: Urged members of Congress to cosponsor and pass H.R. 5218, the Collaborate in an Orderly and Cohesive Manner Act, to provide grants through the Department of Health and Human Services to primary care physicians who choose to deliver behavioral health care through the Collaborate Care Model (CoCM); Support enhanced reimbursement for CoCM payment codes under Medicare to more appropriately reflect the value of services provided to patients with mental health and substance use disorder needs. Scope of Practice: Urged Congress to oppose the Improving Care and Access to Nurses Act, or the I CAN Act, H.R. 8812, which allows non-physician clinicians to deliver care that is not commensurate with their training, skills, and demonstrated competencies in accord with national standards

Client expense: $69,651 · 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): Continued advocacy with Congress in support of 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; 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 (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 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. Regarding CMS 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 2024, 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. Urged CMS to discontinue its split/shared visits policy and not move forward with the transition set to take effect in 2023. Urged Congress to support inclusion in must-pass legislation this year provisions to provide financial stability through a baseline positive annual update to the physician fee schedule reflecting inflation in practice costs, and eliminate, revise budget neutrality requirements to allow for appropriate changes in spending growth and prevent a 4.42 percent Medicare payment cut as contained in H.R. 8800, the Supporting Medicare Providers Act of 2022; Extend the moratoriums on sequester and PAYGO cuts that were approved by Congress at the end of last year. Recommended modifications to Medicare law to establish a mechanism for savings to be calculated across all aspects of the program-that is, increased investment in relative and absolute payments for primary care and preventive health care services (Part B) results in savings due to reduced emergency department visits and hospitalizations (Part A)-and to allow these savings to be reinvested back into primary and preventive care, as well as into social and public health services. With regard to Medicares Quality Payment Program, advocated with Congress to provide flexibility to CMS to set performance thresholds, improve the cost performance category, provide scoring flexibility to CMS to allow for multi-category credit, provide CMS flexibility to score and benchmark measures as appropriate and to test and incentivize new measures and MVPs to ensure successful implementation, update the Promoting Interoperability performance category, Extend the $500 million exceptional performance bonus for an additional six years , align comparisons in the MIPS Quality performance category and Physician Compare. FY2023 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Preventions programs in the FY 2023 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as 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 funding for the Health Resources Services Administration (HRSA); Title VII, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Preventions (CDC) Office on Smoking and Health (OSH). 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. 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 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. 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. Urged CMS to support increasing COVID-19 vaccine uptake by ensuring clinicians are appropriately paid for vaccine counseling for beneficiaries of Medicaid and Medicare. Urged that telehealth services should remain in place for at least two years after the end of the PHE to ensure that our physicians are able to continue to use this modality to enhance patient care. Urged Congress to support the concept of a congressionally-mandated bipartisan commission to examine the U.S. preparations for and response to the COVID-19 pandemic, in order to inform future public policy and health systems preparedness. Urged that any uses of technology in the U.S. in the context of the pandemic should be demonstrated to be effective, be temporary, and ensure that safeguards for privacy and confidentiality are in place. Womens Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect 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 and 2022 (H.R. 3755/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. Access to Care: Urged members of Congress to cosponsor and pass 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: Cosponsor and pass H.R. 369, the Health Care Affordability Act of 2021, to permanently expand eligibility for higher premium tax credits under the Affordable Care Act. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2256/S. 834, the Resident Physician Reduction Shortage Act of 2021, to increase the number of GME slots to 14,000 over seven years for specialties facing shortages, including internal medicine; Cosponsor and pass S. 1024, the Healthcare Workforce Resilience Act, to recapture 40,000 unused visas and use them to provide additional green cards to 15,000 physicians and 25,000 professional nurses; Cosponsor and pass H.R. 3541/S. 1810, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R.4122/S.3658, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2023 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Public Health and Pandemic Preparedness: Urged members of Congress to support funding in FY2023 appropriations - $11 billion total for the CDC, $35 million for the CDCs Injury Prevention and Control, Firearm Injury and Mortality Prevention Research; $49 billion in total for the NIH, $25 million for the Office of the Director, Firearm Injury and Mortality Prevention Research; Cosponsor and pass the COVID Supplemental Appropriations Act, 2022, H.R. 7007, or a similar supplemental funding package, to provide $15.6 billion in additional funding for COVID relief; Cosponsor and pass the CONNECT for Health Act (H.R. 2903/S. 1512) and the Telehealth Extension Act of 2021 (H.R. 6202/S. 3593), to remove arbitrary restrictions on where a patient must be located to utilize telehealth services; enable patients to continue to receive telehealth services in their homes; ensure federally-qualified health centers and rural health centers can furnish telehealth services and improve data collection and analysis for at least two years. Prescription Drug Reform: Urged members of Congress to cosponsor and pass 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; Cosponsor and pass 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; Cosponsor and pass 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. Telehealth Services: 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; H.R. 8487, the Improving Seniors Timely Access to Care Act that would help protect patients from unnecessary delays in care and reduce administrative burdens on physicians by standardizing and streamlining the prior authorization approval process in the Medicare Advantage (MA) program. Advocated with Congress for passage of H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act of 2021, to extend coverage for critical telehealth services beyond the public health emergency. Mental and Behavioral Health: Urged members of Congress to cosponsor and pass H.R. 5218, the Collaborate in an Orderly and Cohesive Manner Act, to provide grants through the Department of Health and Human Services to primary care physicians who choose to deliver behavioral health care through the Collaborate Care Model (CoCM); Support enhanced reimbursement for CoCM payment codes under Medicare to more appropriately reflect the value of services provided to patients with mental health and substance use disorder needs. Scope of Practice: Urged Congress to oppose the Improving Care and Access to Nurses Act, or the I CAN Act, H.R. 8812, which allows non-physician clinicians to deliver care that is not commensurate with their training, skills, and demonstrated competencies in accord with national standards.

Client expense: $300,406 · 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)

HR1319; HR2547 (health related debt collection provisions); S1873; S1893; HR3671; S1024/HR2255; 340B general concerns; HR4390; HR5376; SAVE Act of 2022;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Work visas for certain health professionals; S 1024 and HR HR 2255, legislation to enhance the US s nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas. Implementation of COVID Response legislation; Implementation of American Recovery Act of 2021; FY 23 Appropriations.

Client expense: Not reported · Firm income: Not reported

Any COVID-19 stimulus bill(s), package(s), or provision(s) impacting hospitals and health systems, including but not limited to: Additional money and reporting requirements for the Provider Relief Fund; Support for front-line caregivers; Maintaining health benefits for individuals and families and increasing coverage options for the uninsured; Expansion of resources for testing, tracing, and vaccine development; and Expansion of resources for vaccine rollout and administration. Any requirement(s) for hospitals to collect and report infectious disease data. Any bill(s) or provision(s) regarding CMSs hospital transparency rule requiring hospitals to publicly disclose negotiated rates with commercial health plans. Any provision(s) on the CMS hospital inpatient and outpatient prospective payment system/ ambulatory surgical center proposed rule reducing payment rates received by hospitals. Any bill(s) or provision(s) addressing surprise medical billing rule which are harmful to patients and hospitals/health systems. Any bill(s) or provision(s) enabling or making it easier for providers to use telemedicine to increase access for patients. Any provision(s) expanding telehealth services and access. Any issue(s) related to Medicare pass-through funding and other payment technicalities in relation to colleges of nursing and allied health professions. Any bill(s) or provision(s) addressing Medicaid Disproportionate Share Hospital (DSH) cuts, namely having to do with a delay in cuts. Any bill(s) or provision(s) addressing access to mental health care for patients and teammates. RESTORING HOPE FOR MENTAL HEALTH AND WELL-BEING ACT (H.R. 7666). THE BIPARTISAN SAFER COMMUNITIES ACT (S. 2938). Any bill(s) or provision(s) addressing access to rural health care for patients. H.R. 315, S. 748, or any other bill(s) or provision(s) addressing the elimination of Medicare sequester cuts during the COVID-19 public health emergency. Any bill(s) or provision(s) addressing the expansion of Medicaid and increasing the level of Federal matching assistance for states that choose to expand Medicaid coverage. Any bill(s) or provision(s) relating to appropriations funding for the Atrium Health/Wake Forest Baptist Innovation Quarter, The Pearl, and Innovation Corridor. Any bill(s) or provision(s) relating to funding/appropriations for the Atrium Health/Wake Forest Baptist School of Medicine. Any bill(s) or provision(s) related to workforce and continued support for healthcare workers. S.1024 - HEALTHCARE WORKFORCE RESILIENCE ACT; S 834: RESIDENT PHYSICIAN SHORTAGE REDUCTION ACT OF 2021; S. 1024: HEALTHCARE WORKFORCE RESILIENCE ACT. THE SAFETY FROM VIOLENCE FOR HEALTHCARE EMPLOYEES (SAVE) Act (H.R. 7961). Any bill(s) or provision(s) advocating for The Advanced Research Projects Agency for Health (ARPA-H) to be located in North Carolina. Any bill(s) or provision(s) related to laboratory developed tests. S.2209. VALID Act Any bill(s) or provision(s) related to funding for the Wake Forest Institute of Regenerative Medicine (WFIRM). Any bill related to the ending or extension of hospital at home waivers. HR 7053/S. 3792. Hospital @ Home. HR 7667. Prescription Drug User Fee Authorization Any bill(s) or provision(s) related to maternal health and access to care. Any issue(s) related to approval of DPP waivers in Georgia.

Client expense: $68,735 · Firm income: Not reported

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

Any COVID-19 stimulus bill(s), package(s), or provision(s) impacting hospitals and health systems, including but not limited to: Additional money and reporting requirements for the Provider Relief Fund; Support for front-line caregivers; Maintaining health benefits for individuals and families and increasing coverage options for the uninsured; Expansion of resources for testing, tracing, and vaccine development; and Expansion of resources for vaccine rollout and administration. Any bill(s) or provision(s) addressing access to mental health care for patients and teammates. RESTORING HOPE FOR MENTAL HEALTH AND WELL-BEING ACT (H.R. 7666). THE BIPARTISAN SAFER COMMUNITIES ACT (S. 2938). Any bill(s) or provision(s) related to workforce and continued support for healthcare workers. S.1024 - HEALTHCARE WORKFORCE RESILIENCE ACT; S 834: RESIDENT PHYSICIAN SHORTAGE REDUCTION ACT OF 2021; S. 1024: HEALTHCARE WORKFORCE RESILIENCE ACT. THE SAFETY FROM VIOLENCE FOR HEALTHCARE EMPLOYEES (SAVE) Act (H.R. 7961).

Client expense: $68,735 · Firm income: Not reported

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

H.R. 1177 and S. 348: U.S. Citizenship Act A bill to provide an earned path to citizenship, to address the root causes of migration and responsibly manage the southern border, and to reform the immigrant visa system, and for other purposes (provisions relating to legalization for Dreamers and changes to the immigrant and non-immigrant visa systems). H.R. 6: American Dream and Promise Act of 2021 To authorize the cancellation of removal and adjustment of status of certain aliens, and for other purposes (ALL). S. 264: Dream Act of 2021 A bill to authorize the cancellation of removal and adjustment of status of certain individuals who are long-term United States residents and who entered the United States as children, and for other purposes (ALL). H.R. 2255 and S. 1024: Healthcare Workforce Resilience Act To enhance our Nation's nurse and physician workforce during the COVID-19 crisis by recapturing unused immigrant visas (ALL). H.R. 3648 and S. 4567: Equal Access to Green cards for Legal Employment (EAGLE) Act of 2021 To amend the Immigration and Nationality Act to eliminate the per-country numerical limitation for employment-based immigrants, to increase the per-country numerical limitation for family-sponsored immigrants, and for other purposes (ALL). Presidential and executive actions on immigration and international travel.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

340B Drug Reimbursement Program: to encourage Congress to pass a bill and/or work with the Administration to return the 340B program to its pre-2018 status. S. 773; H.R. 4390; H.R. 3203 (to recalibrate critical access hospitals' revenues due to PRF funds for the purpose of calculating reasonable 340b payments). Kansas Provider Assessment: to encourage CMS to approve the increase in Kansas' Medicaid provider assessment, and to encourage Congress to work with CMS to get it approved. PRF Period 1 reporting: individual hospital needs. S. 2493; H.R. 4735 S. 1893: encouraging Congress to pass this bill that will help add additional physicians in rural areas. S. 1024: encouraging Congress to pass this bill that would encourage physicians to work in rural and out migrating areas. Encouraging Congress to end sequestration and allow PAYGO rules to enact a 4% cut to hospital Medicare reimbursement rates at the end of the year. Encouraging Congress to pass a bill that allows critical access hospitals to also be eligible for telehealth flexibilities afforded to other types of providers.

Client expense: Not reported · Firm income: $16,000

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

HR1319; HR2547 (health related debt collection provisions); S1873; S1893; HR3671; S1024/HR2255; 340B general concerns; HR4390; HR5376; SAVE Act of 2022;

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 834/ H.R. 2256: Resident Physician Shortage Reduction Act S. 1024/H.R. 2255: Healthcare Workforce Resilience Act S. 1548/H.R. 3085: Equity in Neuroscience and Alzheimers Clinical Trials (ENACT) Act S. 1810/H.R. 3541: Conrad State 30 and Physician Access Reauthorization Act S. 3427: Neuroscience Center of Excellence Act of 2021 S.4348: FDASLA Act of 2022; section 506. S. 4906: National Neurological Conditions Surveillance System Reauthorization Act of 2022 H.R. 2754: COVID-19 Long Haulers Act H.R. 4122: Resident Education Deferred Interest Act of 2021 H.R. 5435: Bringing Regulatory Advances into Neuroscience (BRAIN) Act H.R. 5376: Inflation Reduction Act of 2022; Subtitle B Urging reforms to proposed surprise billing regulations to align with congressional intent for payment disputes. Support for creating a Neuroscience Center of Excellence at FDA. Supporting policies to address the COVID-19 public health emergency, including maintaining telemedicine coverage and ensuring access to affordable health coverage and medications. Medical research funding related to NIH including the BRAIN Initiative, AHRQ, HEAL Initiative, and the Congressionally Directed Medical Research Programs at the Department of Defense. Support for funding for the Pediatric Subspecialty Loan Repayment Program.

Client expense: $250,000 · Firm income: Not reported

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

Issues related to public health emergency; S. 1024, Healthcare Workforce Resilience Act working with federal counterparts supporting citizens of Ukraine

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

Government targets: HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), SENATE, State, Dept of (DOS), White House Office

H.R. 2255/S. 1024, Healthcare Workforce Resilience Act H.R. 7744, Building Americas Health Care Workforce Act H.R. 8805/S. 4381, Ensuring Seniors Access to Quality Care Act Issues related to Skilled Nursing Facilities (SNFs)-Mandatory Staff Mandates, CMS Rate Reduction Issues related to the Department of Education and the Public Service Loan Forgiveness (PSLF) program

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

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