Protecting Rural Seniors’ Access to Care Act

S. 495/H.R. 1815 Expanding Veterans Options for Long Term Care Act - Seeking expanded flexibility and access to Assisted Living for Veterans; H.R. 6835 Caring Across Generations Act - Seeking additional support for funding of multigenerational programs in Long-Term care; S. 3410/H.R. 5796 Protecting Rural Seniors' Access to Care Act - establishing an advisory panel to support the nursing home workforce; H.R. 6025/S. 3211 Healthcare Workforce Resilience Act - Carrying forward unused visas from prior fiscal years for health care providers. S. 2853 Train More Nurses Act - Requiring the Secretary of HHS and Secretary of Labor to conduct a study and issue a report on grant programs to support the nursing workforce. H.R. 6586 Bipartisan Workforce Pell Act - Expanding Pell Grant coverage for healthcare workforce needs.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

(H.R.6033) - Supporting Patient Education and Knowledge (SPEAK) Act - Expressed support for the Supporting Patient Education and Knowledge. This legislation authorizes the Department of Health and Human Services to identify best practices and ways to improve telehealth access for patients with limited English proficiency and create new resources for telehealth providers. The bill outlines participation by health information technology providers, physicians, hospitals, insurance companies and language services providers in the process. Urged Congress to provide adequate resources including increased training and development programs to bolster the workforce, as well as to provide more flexibility in meeting staffing requirements and standards, including telehealth options. (H.R. 7623) Telehealth Modernization Act: Expressed support for the Telehealth Modernization Act - This legislation ensures that seniors and rural patients who may not have internet connectivity can receive the care they need through audio-only telehealth services, in addition to allowing health centers and rural health clinics to provide telehealth services. (H.R. 3305/S. 1606) Black Maternal Health Momnibus Act - Expressed support for the Black Maternal Health Momnibus Act. This legislation would make critical investments in the social determinants of health, address behavioral health needs, cultural competency, and gaps in the perinatal workforce, and bolster the collection of data to address every driver of maternal mortality, morbidity, and disparities in the United States. (H.R. 8245) Rural Hospital Stabilization Act: Expressed support for the Rural Hospital Stabilization Act. This legislation would ensure that healthcare providers in rural areas continue to provide services and meet their communities' needs. (H.R. 8244) Ensuring Seniors' Access to Care Act: Expressed support for the Ensuring Seniors' Access to Care Act. This legislation would allow nursing home providers, who have been prohibited from training staff to be certified nurse aids (CNA) because of compliance penalties, to begin training staff once they have demonstrated their return to compliance, rather than having to wait a full two years. Urged Congress to make essential telehealth flexibilities permanent well before the statutory deadline of Dec. 31, 2024. (S. 3410/H.R. 5796) The Protecting Rural Seniors' Access to Care Act - Expressed support for the Protecting Rural Seniors' Access to Care Act. This legislation would prohibit HHS from finalizing a proposed nursing home staffing requirement rule and establish an advisory panel on nursing home staffing. (H.R. 3226/S.1573) The PREMIE Reauthorization Act - Expressed support for the PREMIE Reauthorization Act. This legislation would reauthorize essential maternal and infant health programs and research at a time when maternal and infant death rates, especially in communities of color, have increased dramatically. (2584/S.2768) The Safety from Violence for Healthcare Employees Act - Expressed support for the Safety from Violence for Healthcare Employees Act. This legislation would address rising incidents of violence in healthcare settings by establishing stronger legal penalties for people who knowingly and intentionally assault or intimidate hospital employees. (H.R. 5568) The Care for Moms Act - Expressed support for the Care for Moms Act. This legislation supports the maternal health workforce, promotes access to prenatal and postpartum care, and provides essential resources to providers in rural areas. Urged Congress to support legislation on Proposed Nursing Home Staffing Requirements that prohibits the HHS Secretary from finalizing a proposed nursing home staffing rule. (H.R. 4771) - Children's Health Insurance Program Permanency (CHIPP) Act - Expressed support for the Children's Health Insurance Program Permanency (CHIPP) Act. This legislation would make the Children's Health Insurance Program (CHIP) permanent and place it on par with other federal public health insurance programs rather than needing periodic reauthorization. (S. 2415/H.R. 3838) - Preventing Maternal Deaths Reauthorization Act of 2023 - Expressed support for Preventing Maternal Deaths Reauthorization Act of 2023. This legislation continues crucial federal support for the state-based maternal mortality review committees (MMRCs) that review pregnancy-related deaths to identify causes and make recommendations for the prevention of future mortalities. Provided the Senate with information regarding the 340B program and expressed strong support for continuing to strengthen and protect this vital program. Urged Congress to provide a $1 billion increase for the Title V Maternal and Child Health (MCH) Services Block Grant in the FY2025 Labor, Health and Human Services, Education & Related Agencies Appropriations bill. Urged Congress to provide $100 million for the Surveillance for Emerging Threats to Mothers and Babies (SET-NET) at the Centers for Disease Control and Prevention (CDC). Urged Congress to bolster existing federal programs to build a strong health workforce and improve primary care to assist health providers in hiring and retaining workers. (H.R. 2389) - Resident Physician Shortage Reduction Act - Expressed support for the Resident Physician Shortage Reduction Act. (H.R. 3290) - To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program-Expressed opposition. (H.R. 3561) Section 302 - Expressed opposition to Section 302. This legislative provision would reduce payments for the drug administration services furnished in off-campus provider-based departments. Urged Congress to support access to quality palliative care and appropriate effective pain management by prioritizing a Palliative Care, Trans-Institute Strategy by the National Institute of Aging (NIA) in the Labor, Health and Human Services, Education, and Related Agencies appropriations bill. Urged Congress to increase funding for federally qualified health centers (FQHCs) as part of the Community Health Center Fund reauthorization. (S.2243) - Palliative Care and Hospice Education and Training Act (PCHETA). Urged Congress to support the Palliative Care and Hospice Education and Training Act. This legislation would address the palliative care workforce shortage and help respond to pressing issues including appropriate pain management and pandemic preparedness.

Client expense: $166,785 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Meetings, Letters, and Briefings in House and Senate on CMS Nursing Home Staffing Rule, and sharing SEIU strong Opposition to HR 5796, H.R. 7513, S. 3410, H.J. Res. 139 and S.J. Res. 91 that would prohibit the rule. Sent letter and held meetings with several House and Senate individual officers and Committee Staff of House Energy and Commerce, House Ways and Means and Senate Finance in Opposition to HR 6860/S.5018, the Restore Protections for Dialysis Patients Act (RPDPA).

Client expense: $220,000 · Firm income: Not reported

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

MMM [House, Senate, HHS, CMS, FDA, Administration on Aging, EOP, DOC] Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2023 (H.R. 5138 and S. 4137): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Medicare Drug Prices (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act; to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer; to block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. Medicare Drug Costs. The Pharmaceutical Research Transparency Act of 2023 (S. 1476 and H.R. 3160): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Medicare Drug Savings. The Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 2893): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. (No bills): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and to raise the income threshold for the Low-Income Subsidy program offering assistance in paying for drugs. Medicare Prescription Drugs. The Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2023 (H.R. 3093): Proposals to require companies that receive federal funding for research (or a license of the rights to a patent or regulatory test data) for a biomedical product or service to agree to set reasonable prices for the resulting biomedical product or service and authorize to determine a reasonable price based on a formula that ensures the U.S. price for the product or service is not more than the median price for the product or service in Canada and six other reference countries. Medicare Prescription Drugs. (No bill): A regulatory proposal encouraging the Secretaries of the Departments of Health and Human Services (HHS) and Commerce to exercise march in rights that would aim to better control the pricing of prescription drugs. Medicare Prescription Drugs. (No bill): An HHS regulatory proposal to ensure robust negotiation rules and processes that aim to curtail the cost of certain prescription drugs, as authorized by the Inflation Reduction Act (Public Law No: 117-169). Medicare and Medicaid Prescription Drugs. (No bill): Joined comments with 19 other organizations urging HHS to use its existing authority to license competition in order to lower consumer and taxpayer costs for semaglutide drugs treating diabetes and weight management (e.g., Ozempic and Wegovy). Medicare Prescription Drugs. The PACE Part D Choice Act (H.R. 3549 and S. 1703): Proposal to increase the affordability of the Program of All-Inclusive Care for the Elderly (PACE) for Medicare beneficiaries by lowering the cost of Part D premiums substantially for Medicare-only enrollees, thus opening up the PACE program to this population. Medicare Low-Income Subsidy (LIS) Program. (No bill): Proposal to increase funding for LIS outreach and enrollment, so that low-income beneficiaries can more readily access needed medications at prices they can afford. Medicare Reform. The Assuring Medicares Promise Act (H.R. 34) and The Medicare and Social Security Fair Share Act (S. 1174 and H.R. 4535): Proposals to close the loophole for wealthy individuals who bypass paying net investment income tax (NIIT) and directing the revenue to the Hospital Insurance Trust Fund, which pays for Medicare Part A that covers inpatient care in hospitals, and to the Social Security Trust Funds. Medicare Trustees Report (No bill). Review of the findings on economic, legislative and other developments affecting the actuarial soundness of the Medicare Part A (Hospital Insurance) Trust Fund and the Trust Funds for Parts B and D coverage. Medicare Dental Coverage. The Medicare Dental Benefit Act (S. 2012 and H.R. 4146): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Help Extend Auditory Relief Act of 2024 (H.R. 8064): Proposal to expand Medicare coverage to include hearing examinations and diagnoses, fittings and hearing aids. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with the Department of Health and Humans Services/Center for Medicare and Medicaid Services) HHS/CMS. Public Health Emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage (MA). (No bill): Proposals to create transparency around Medicare Advantage plans using prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Advantage. (No bill): Proposals to apply a higher coding adjustment factor to fully account for intensive upcoding by MA plans and to exclude certain information for MA risk adjustment scores and payments; to use two years of traditional Medicare and MA diagnostic data for calculating MA risk-adjusted payments; and to promulgate more fundamental changes to the Hierarchical Condition Category (HCC) risk adjustment model. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid Home and Community-Based Services. The HCBS Access Act (H.R. 1493 and S. 762): Proposals to make home and community-based services (HCBS) a mandatory benefit within Medicaid, and to ensure eligible older adults and people with disabilities have the option to choose between home care and institutional care. Caregiving. The Alleviating Barriers to Caregiving Act (H.R. 8018 and S. 3109): Proposal to require the Secretaries of HHS and SSA to review and streamline enrollment in coverage and benefits for family caregivers in Medicare, Medicaid, CHIP and Social Security. Medicare and Medicaid Nursing Homes. The Nursing Home Disclosure Act (H.R. 177): Proposal to direct HHS to establish a national registry of medical directors. Medicare, Medicaid Nursing Homes. The Protecting Americas Seniors Access to Care Act (H.R. 7513 and S. 3410): Proposal to prohibit the HHS Secretary from promulgating national staffing standards in nursing homes. Medicare, Medicaid Nursing Homes. (H.J. Res. 139 and S.J. Res. 91): Proposal to use the Congressional Review Act to disapprove the HHS Secretarys final rule promulgating national staffing standards in nursing homes Medicare, Medicaid Nursing Homes. The Building Americas Health Care Workforce Act (H.R. 9067): Proposal to allow time spent working in a nursing home (prior to any formal training, and permitted during the COVID-19 pandemic) to count toward a 75-hour minimum federal training standard that is required for certified nursing assistants. Medicare, Medicaid Nursing Homes. The Ensuring Seniors Access to Quality Care Act (H.R. 3227): Proposal to repeal regulations that prohibit certified nursing assistant training and competency evaluation programs in skilled nursing facilities that have a record of health and safety deficiencies and have incurred penalties (e.g., civil monetary penalties for substandard quality of care). Medicare, Medicaid Nursing Homes, Assisted Living and Other Long Term Care Services and Supports (LTSS) Settings. The Long-Term Care Workforce Support Act (H.R. 7994 and S. 4120): Proposals to increase the number of direct care professionals, including in rural communities; pathways to enter and be supported in the workforce for women, people of color, and people with disabilities; and to improve compensation for direct care professionals to reduce vacancies and turnover. Medicare and Medicaid Nursing Home Ownership. (No bill): A final HHS regulation for comprehensive ownership disclosure in the nursing home sector issued on November 17th, 2023. Rule calls for strengthened cost reporting requirements, together with ongoing national analyses and monitoring of the performance of the nursing home sector that uses ownership, staffing, cost report data and inspection data. Medicare and Medicaid Nursing Home Staffing. (No bill): Final regulations establishing national staffing standards in nursing homes that would safeguard the health and safety of all elderly and disabled residents. Medicaid Long-Term Services and Supports (LTSS). (No bill): Proposals to request that CMS collect standardized LTSS expenditure data annually from every state and across all LTSS programs and for disaggregation of expenditure data by the delivery system and demographic characteristics in order to identify disparities in access and use of LTSS and help states and CMS deploy targeted strategies to meet the needs of older adults and people with disabilities. Oversight of Health Care Industry Owned by Private Equity Firms. (No bill): Joined with other organizations in submitting comments (April 2024) to HHS, the Federal Trade Commission and the Department of Justice urging sustained, stepped up and rigorous oversight be extended to health care industry transactions that are financed by private equity company companies and other types of private investors. Medicaid Eligibility and Beneficiary Assets. Medicaid Estate Recovery Act (H.R. 7573): Proposals to provide financial protection to the families of Medicaid beneficiaries, including ending Medicaid estate claims and Medicaid liens, except in cases when benefits had been incorrectly paid, as determined by a court.

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

1. S. 762, The HCBS Access Act, entire bill 2. H.R. 1493, The HCBS Access Act, entire bill 3. S. 842, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 4. H.R. 33, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 5. Proposals regarding the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost-sharing subsidies under part D of the Medicare program 6. Medicare ACO Realizing Equity, Access, and Community Health (REACH) program 7. Proposals to reduce Medicaid funding 8. H.R. 3069, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 9. S. 1296, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 10. Implementation of provisions of the Inflation Reduction Act of 2022 regarding drug prices under the Medicare program 11. Proposals regarding revisions to Medicare rules regarding inpatient hospital stays 12. Proposed CMS rule: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting 13. H.R. 1638, Improving Access to Mental Health Act of 2023, entire bill 14. S. 838,Improving Access to Mental Health Act of 2023, entire bill 15. Proposals regarding the Medicare Low Income Subsidy program 16. H.R. 7513, Protecting Americas Seniors Access to Care Act, entire 17. S. 3410, Protecting Rural Seniors Access to Care Act, entire bill 18. H.R. 8106, To amend title XIX of the Social Security Act to increase transparency and expand coverage options with respect to home and community-based services under a Medicaid waiver, entire bill 19. H.R. 8107, Ensuring Access to Medicaid Buy-in Programs Act of 2024, entire bill 20. H.R. 8109, Money Follows the Person Permanency Act of 2024, entire bill 21. H.R. 8110, Protecting Married Seniors from Impoverishment Act of 2024, entire bill 22. H.R. 8018, Alleviating Barriers for Caregivers Act, entire bill 23. S. 3109, Alleviating Barriers for Caregivers Act, entire bill 24. H.R. 7573, Stop Unfair Medicaid Recoveries Act, entire bill 25. Proposals for $2 per month generic drug prescription co-pays under Medicare

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

HR 5796/S 3410 Protecting Rural Seniors Access to Care Act S.1749/HR 3227 Ensuring Seniors' Access to Quality Care Act S100/HR4131 Better Care Better Jobs Act HR 2713/S2418 Improving Care and Access to Nurses Act S 2137/HR5159 Preserving Access to Home Health Care Act S 3118 HCBS Relief Act H.R.7513 s 3307: encounter data enhancement act hr 9803 hospice care, accountability, reform, and enforcement act hr 8107 Ensuring Access to Medicaid Buy-in Programs Act of 2024 H.R. 8261, the Preserving Telehealth, Hospital, and Ambulance Access Act Home Health Payment Adult Day Reimbursement Congressional Review Act -- Nursing home staffing mandate

Client expense: $11,995 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

1. S. 762, The HCBS Access Act, entire bill 2. H.R. 1493, The HCBS Access Act, entire bill 3. S. 842, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 4. H.R. 33, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 5. Proposals regarding the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost-sharing subsidies under part D of the Medicare program 6. Medicare ACO Realizing Equity, Access, and Community Health (REACH) program 7. Proposals to reduce Medicaid funding 8. H.R. 3069, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 9. S. 1296, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 10. Implementation of provisions of the Inflation Reduction Act of 2022 regarding drug prices under the Medicare program 11. Proposals regarding revisions to Medicare rules regarding inpatient hospital stays 12. Proposed CMS rule: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting 13. H.R. Improving Access to Mental Health Act of 2023, entire bill 14. S. 838,Improving Access to Mental Health Act of 2023, entire bill 15. Proposals regarding the Medicare Low Income Subsidy program 16. H.R. 7513, Protecting Americas Seniors Access to Care Act, entire 17. S. 3410, Protecting Rural Seniors Access to Care Act, entire bill 18. H.J.Res. 139, providing for Congressional disapproval of the CMS rule Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting," entire resolution 19. H.R. 8106, To amend title XIX of the Social Security Act to increase transparency and expand coverage options with respect to home and community-based services under a Medicaid waiver, entire bill 20. H.R. 8107, Ensuring Access to Medicaid Buy-in Programs Act of 2024, entire bill 21. H.R. 8109, Money Follows the Person Permanency Act of 2024, entire bill 22. H.R. 8110, Protecting Married Seniors from Impoverishment Act of 2024, entire bill 23. H.R. 8018, Alleviating Barriers for Caregivers Act, entire bill 24. S. 3109, Alleviating Barriers for Caregivers Act, entire bill

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

(H.R.6033) - Supporting Patient Education and Knowledge (SPEAK) Act - Expressed support for the Supporting Patient Education and Knowledge. This legislation authorizes the Department of Health and Human Services to identify best practices and ways to improve telehealth access for patients with limited English proficiency and create new resources for telehealth providers. The bill outlines participation by health information technology providers, physicians, hospitals, insurance companies and language services providers in the process. Urged Congress to provide adequate resources including increased training and development programs to bolster the workforce, as well as to provide more flexibility in meeting staffing requirements and standards, including telehealth options. (H.R. 7623) Telehealth Modernization Act: Expressed support for the Telehealth Modernization Act - This legislation ensures that seniors and rural patients who may not have internet connectivity can receive the care they need through audio-only telehealth services, in addition to allowing health centers and rural health clinics to provide telehealth services. (H.R. 3305/S. 1606) Black Maternal Health Momnibus Act - Expressed support for the Black Maternal Health Momnibus Act. This legislation would make critical investments in the social determinants of health, address behavioral health needs, cultural competency, and gaps in the perinatal workforce, and bolster the collection of data to address every driver of maternal mortality, morbidity, and disparities in the United States. (H.R. 8245) Rural Hospital Stabilization Act: Expressed support for the Rural Hospital Stabilization Act. This legislation would ensure that healthcare providers in rural areas continue to provide services and meet their communities' needs. (H.R. 8244) Ensuring Seniors' Access to Care Act: Expressed support for the Ensuring Seniors' Access to Care Act. This legislation would allow nursing home providers, who have been prohibited from training staff to be certified nurse aids (CNA) because of compliance penalties, to begin training staff once they have demonstrated their return to compliance, rather than having to wait a full two years. Urged Congress to make essential telehealth flexibilities permanent well before the statutory deadline of Dec. 31, 2024. (S. 3410/H.R. 5796) The Protecting Rural Seniors' Access to Care Act - Expressed support for the Protecting Rural Seniors' Access to Care Act. This legislation would prohibit HHS from finalizing a proposed nursing home staffing requirement rule and establish an advisory panel on nursing home staffing. (H.R. 3226/S.1573) The PREMIE Reauthorization Act - Expressed support for the PREMIE Reauthorization Act. This legislation would reauthorize essential maternal and infant health programs and research at a time when maternal and infant death rates, especially in communities of color, have increased dramatically. (2584/S.2768) The Safety from Violence for Healthcare Employees Act - Expressed support for the Safety from Violence for Healthcare Employees Act. This legislation would address rising incidents of violence in healthcare settings by establishing stronger legal penalties for people who knowingly and intentionally assault or intimidate hospital employees. (H.R. 5568) The Care for Moms Act - Expressed support for the Care for Moms Act. This legislation supports the maternal health workforce, promotes access to prenatal and postpartum care, and provides essential resources to providers in rural areas. Urged Congress to support legislation on Proposed Nursing Home Staffing Requirements that prohibits the HHS Secretary from finalizing a proposed nursing home staffing rule. (H.R. 4771) - Children's Health Insurance Program Permanency (CHIPP) Act - Expressed support for the Children's Health Insurance Program Permanency (CHIPP) Act. This legislation would make the Children's Health Insurance Program (CHIP) permanent and place it on par with other federal public health insurance programs rather than needing periodic reauthorization. (S. 2415/H.R. 3838) - Preventing Maternal Deaths Reauthorization Act of 2023 - Expressed support for Preventing Maternal Deaths Reauthorization Act of 2023. This legislation continues crucial federal support for the state-based maternal mortality review committees (MMRCs) that review pregnancy-related deaths to identify causes and make recommendations for the prevention of future mortalities. Provided the Senate with information regarding the 340B program and expressed strong support for continuing to strengthen and protect this vital program. Urged Congress to provide a $1 billion increase for the Title V Maternal and Child Health (MCH) Services Block Grant in the FY2025 Labor, Health and Human Services, Education & Related Agencies Appropriations bill. Urged Congress to provide $100 million for the Surveillance for Emerging Threats to Mothers and Babies (SET-NET) at the Centers for Disease Control and Prevention (CDC). Urged Congress to bolster existing federal programs to build a strong health workforce and improve primary care to assist health providers in hiring and retaining workers. (H.R. 2389) - Resident Physician Shortage Reduction Act - Expressed support for the Resident Physician Shortage Reduction Act. (H.R. 3290) - To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program-Expressed opposition. (H.R. 3561) Section 302 - Expressed opposition to Section 302. This legislative provision would reduce payments for the drug administration services furnished in off-campus provider-based departments. Urged Congress to support access to quality palliative care and appropriate effective pain management by prioritizing a Palliative Care, Trans-Institute Strategy by the National Institute of Aging (NIA) in the Labor, Health and Human Services, Education, and Related Agencies appropriations bill. Urged Congress to increase funding for federally qualified health centers (FQHCs) as part of the Community Health Center Fund reauthorization. (S.2243) - Palliative Care and Hospice Education and Training Act (PCHETA). Urged Congress to support the Palliative Care and Hospice Education and Training Act. This legislation would address the palliative care workforce shortage and help respond to pressing issues including appropriate pain management and pandemic preparedness.

Client expense: $165,062 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Observation Stays and 3 Day Stay Issue Outreach to HHS/CMS/Administration Survey Relief/Civil Monetary Penalties CMS on Public Health Waiver and other waivers SNF Payment Rule OSHA Emergency Temporary Standards Care For Our Seniors Act Medicare Advantage H.R. 177 - To amend title XI of the Social Security Act to ensure nursing facilities report information on medical directors of such facilities. CDC/COVID Safety Guidance Outreach to hill, HHS and ONC on LTPAC health information technology needs (zoom meetings and letters) Outreach to hill on needed Physician Fee Schedule reforms (sign on letters only) Improve Access to Mental Access Act S838/HR1638 (sign on letters) Improving Access to Medicare Coverage Act of 2023 s.4137/H.R.5138 HR 5796, S. 3410 - Protecting Rural Seniors Access to Care Act Outreach to hill on needed telehealth reforms (sign on letters only) Improving Seniors Timely Access to Care Act

Client expense: $890,000 · Firm income: Not reported

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

The Elder Justice Reauthorization and Modernization Act of 2023 AHCA/NCAL proposal of Care For Our Seniors Act Staff Agency Practices - Outreach to the Hill Immigration Delays - outreach to U.S. Departments of State, Homeland Security, & USCIS Advocating for providing temporary nurse aides a reasonable grace period as the public health emergency ends Administration nursing home reform plan Appropriations related outreach Support of the 21st Century Long-Term Care Caucus Outreach to DOL in support of LTC apprenticeship programs Outreach to LTC workforce related and appropriations matters Outreach to CMS and the Hill on the TNA waiver issue Outreach to CMS and the Hill on minimum staffing standards Outreach to DOE on SNF Loan Repayment Issues impacting the LTC workforce, including advocacy on the Care for Seniors Act H.R. 9067 Building Americas Health Care Workforce Act Senate HELP Comm Workforce RFI Comments S.1749/H.R. 3227 -- Ensuring Seniors Access to Quality Care Act Joined coalition in support for the bipartisan resolution S.J.Res.49/H.J.Res.98 Protecting American's Seniors' Access to Care Act (S. 3410/H.R. 7513) Outreach to DOL and NLRB on regulatory related workforce matters impacting LTC providers Advocacy around observation stays bill in the Senate Advocacy around the mark-up of the Protecting Americans Seniors Access to Care Act in the House Ways and Means Committee Advocacy around LTC workforce and AL with the Senate Aging Committee on policies they are considering Support for the SENIOR Act (H.R. 7605), which increases access and affordability of assisted living and address our workforce needs. Outreach to Dept of Labor, Employment and Training Admin on RIN 1205-AC13 - National Apprenticeship System Enhancements Train More Nurses Act (S. 2853/H.R. 6122) Safeguarding Elderly Needs for Innovation and Occupational Resources (SENIOR) Act (H.R. 7605) Protecting America's Seniors' Access to Care Act (S. 3410/H.R. 7513) Support for the Health Care Workforce Investment Act (H.R. 9812)

Client expense: $890,000 · 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)

S. 3109/H.R. 8018, the Alleviating Barriers for Caregivers Act. S. 3766/H.R. 7274, the Connecting Caregivers to Medicare Act. No bill number. Discussed funding for SHIP low-income outreach and enrollment programs. No bill number. Discussed Medicare Advantage and health savings accounts. H.R.7623/S.3697, the Telehealth Modernization Act. S. 5070/H.R. 8107, the Ensuring Access to Medicaid Buy-In Programs Act. No bill number. Discussed Medicare Physician Fee Schedule for calendar year 2025. No bill number. Discussed Medicare Hospital Outpatient Prospective Payment System for calendar year 2025. No bill number. Discussed Fiscal Year 2025 Home Health Prospective Payment System Rate Update. No bill number. Discussed Medicare open enrollment. H.R. 8702/S.4532, the Improving Seniors Timely Access to Care Act of 2024. H.R. 8331/S. 4280, the Essential Caregivers Act. H.J.Res.139, Providing for Congressional disapproval of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. S.J.Res.91, A joint resolution providing for Congressional disapproval of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting" H.R. 8244, the Ensuring Seniors Access to Quality Care Act. S.1749/H.R. 3227, the Ensuring Seniors Access to Quality Care Act. S.3410/H.R. 7513, the Protecting Americas Seniors Access to Care Act. H.R. 468, the Building Americas Health Care Workforce Act. H.R. 9067, the Building Americas Health Care Workforce Act. S. 5023, the Stand Strong Falls Prevention Act. S.1190, the Direct Support Worker Training Reimbursement Act of 2023. S.1196, the Mollie Baldwin Upskilling of Personal and Home Care Aides Act of 2023. S.1192, the CADSAW Act of 2023. No bill number. Discussed Medicaid home and community-based services and presumptive eligibility and self-directed services. No bill number. Discussed Caregiver Training Services. No bill number. Discussed GUIDE Model. No bill number. Discussed Medicare, Medicaid, and family caregivers. No bill number. Discussed Medicaid access final rule. H.R. 8108, the Care for Military Kids Act. H. R. 8106, to increase transparency and expand coverage options for home and community-based services under a Medicaid waiver. No bill number. Discussed long-term care. H.R. 9803, the Hospice Care Act.

Client expense: $4,820,000 · Firm income: Not reported

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

Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2023 (H.R. 5138 and S. 4137): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Medicare Drug Prices (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act; to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer; to block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. Medicare Drug Costs. The Pharmaceutical Research Transparency Act of 2023 (S. 1476 and H.R. 3160): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Medicare Drug Savings. The Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 2893): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. (No bills): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and to raise the income threshold for the Low-Income Subsidy program offering assistance in paying for drugs. Medicare Prescription Drugs. The Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2023 (H.R. 3093): Proposals to require companies that receive federal funding for research (or a license of the rights to a patent or regulatory test data) for a biomedical product or service to agree to set reasonable prices for the resulting biomedical product or service and authorize to determine a reasonable price based on a formula that ensures the U.S. price for the product or service is not more than the median price for the product or service in Canada and six other reference countries. Medicare Prescription Drugs. (No bill): A regulatory proposal encouraging the Secretaries of the Departments of Health and Human Services (HHS) and Commerce to exercise march in rights that would aim to better control the pricing of prescription drugs. Medicare Prescription Drugs. (No bill): An HHS regulatory proposal to ensure robust negotiation rules and processes that aim to curtail the cost of certain prescription drugs, as authorized by the Inflation Reduction Act (Public Law No: 117-169). Medicare and Medicaid Prescription Drugs. (No bill): Joined comments with 19 other organizations urging HHS to use its existing authority to license competition in order to lower consumer and taxpayer costs for semaglutide drugs treating diabetes and weight management (e.g., Ozempic and Wegovy). Medicare Prescription Drugs. The PACE Part D Choice Act (H.R. 3549 and S. 1703): Proposal to increase the affordability of the Program of All-Inclusive Care for the Elderly (PACE) for Medicare beneficiaries by lowering the cost of Part D premiums substantially for Medicare-only enrollees, thus opening up the PACE program to this population. Medicare Low-Income Subsidy (LIS) Program. (No bill): Proposal to increase funding for LIS outreach and enrollment, so that low-income beneficiaries can more readily access needed medications at prices they can afford. Medicare Reform. The Assuring Medicares Promise Act (H.R. 34) and The Medicare and Social Security Fair Share Act (S. 1174 and H.R. 4535): Proposals to close the loophole for wealthy individuals who bypass paying net investment income tax (NIIT) and directing the revenue to the Hospital Insurance Trust Fund, which pays for Medicare Part A that covers inpatient care in hospitals, and to the Social Security Trust Funds. Medicare Trustees Report (No bill). Review of the findings on economic, legislative and other developments affecting the actuarial soundness of the Medicare Part A (Hospital Insurance) Trust Fund and the Trust Funds for Parts B and D coverage. Medicare Dental Coverage. The Medicare Dental Benefit Act (S. 2012 and H.R. 4146): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Help Extend Auditory Relief Act of 2024 (H.R. 8064): Proposal to expand Medicare coverage to include hearing examinations and diagnoses, fittings and hearing aids. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with the Department of Health and Humans Services/Center for Medicare and Medicaid Services) HHS/CMS. Public Health Emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage (MA). (No bill): Proposals to create transparency around Medicare Advantage plans using prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Advantage. (No bill): Proposals to apply a higher coding adjustment factor to fully account for intensive upcoding by MA plans and to exclude certain information for MA risk adjustment scores and payments; to use two years of traditional Medicare and MA diagnostic data for calculating MA risk-adjusted payments; and to promulgate more fundamental changes to the Hierarchical Condition Category (HCC) risk adjustment model. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid Home and Community-Based Services. The HCBS Access Act (H.R. 1493 and S. 762): Proposals to make home and community-based services (HCBS) a mandatory benefit within Medicaid, and to ensure eligible older adults and people with disabilities have the option to choose between home care and institutional care. Caregiving. The Alleviating Barriers to Caregiving Act (H.R. 8018 and S. 3109): Proposal to require the Secretaries of HHS and SSA to review and streamline enrollment in coverage and benefits for family caregivers in Medicare, Medicaid, CHIP and Social Security. Medicare and Medicaid Nursing Homes. The Nursing Home Disclosure Act (H.R. 177): Proposal to direct HHS to establish a national registry of medical directors. Medicare, Medicaid Nursing Homes. The Protecting Americas Seniors Access to Care Act (H.R. 7513 and S. 3410): Proposal to prohibit the HHS Secretary from promulgating national staffing standards in nursing homes. Medicare, Medicaid Nursing Homes. (H.J. Res. 139 and S.J. Res. 91): Proposal to use the Congressional Review Act to disapprove the HHS Secretarys final rule promulgating national staffing standards in nursing homes Medicare, Medicaid Nursing Homes. The Building Americas Health Care Workforce Act (H.R. 9067): Proposal to allow time spent working in a nursing home (prior to any formal training, and permitted during the COVID-19 pandemic) to count toward a 75-hour minimum federal training standard that is required for certified nursing assistants. Medicare, Medicaid Nursing Homes. The Ensuring Seniors Access to Quality Care Act (H.R. 3227): Proposal to repeal regulations that prohibit certified nursing assistant training and competency evaluation programs in skilled nursing facilities that have a record of health and safety deficiencies and have incurred penalties (e.g., civil monetary penalties for substandard quality of care). Medicare, Medicaid Nursing Homes, Assisted Living and Other Long Term Care Services and Supports (LTSS) Settings. The Long-Term Care Workforce Support Act (H.R. 7994 and S. 4120): Proposals to increase the number of direct care professionals, including in rural communities; pathways to enter and be supported in the workforce for women, people of color, and people with disabilities; and to improve compensation for direct care professionals to reduce vacancies and turnover. Medicare and Medicaid Nursing Home Ownership. (No bill): A final HHS regulation for comprehensive ownership disclosure in the nursing home sector issued on November 17th, 2023. Rule calls for strengthened cost reporting requirements, together with ongoing national analyses and monitoring of the performance of the nursing home sector that uses ownership, staffing, cost report data and inspection data. Medicare and Medicaid Nursing Home Staffing. (No bill): Final regulations establishing national staffing standards in nursing homes that would safeguard the health and safety of all elderly and disabled residents. Medicaid Long-Term Services and Supports (LTSS). (No bill): Proposals to request that CMS collect standardized LTSS expenditure data annually from every state and across all LTSS programs and for disaggregation of expenditure data by the delivery system and demographic characteristics in order to identify disparities in access and use of LTSS and help states and CMS deploy targeted strategies to meet the needs of older adults and people with disabilities. Oversight of Health Care Industry Owned by Private Equity Firms. (No bill): Joined with other organizations in submitting comments (April 2024) to HHS, the Federal Trade Commission and the Department of Justice urging sustained, stepped up and rigorous oversight be extended to health care industry transactions that are financed by private equity company companies and other types of private investors.

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Meetings, Letters, Press Conference and Briefings in House and Senate on CMS Nursing Home Staffing Rule, and sharing SEIU strong Opposition to HR 5796, H.R. 7513, S. 3410, H.J. Res. 139 and S.J. Res. 91 that would prohibit the rule. Sent letter and held meetings with several House and Senate individual officers and Committee Staff of House Energy and Commerce, House Ways and Means and Senate Finance in Opposition to HR 6860/S.5018, the Restore Protections for Dialysis Patients Act (RPDPA). Meetings with House Offices in Opposition to H.R. 3227, Ensuring Seniors' Access to Quality Care Act.

Client expense: $240,000 · Firm income: Not reported

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

S. 495/H.R. 1815 Expanding Veterans Options for Long Term Care Act - Seeking expanded flexibility and access to Assisted Living for Veterans; H.R. 6835 Caring Across Generations Act - Seeking additional support for funding of multigenerational programs in Long-Term care; S. 3410/H.R. 5796 Protecting Rural Seniors' Access to Care Act - establishing an advisory panel to support the nursing home workforce; H.R. 6025/S. 3211 Healthcare Workforce Resilience Act - Carrying forward unused visas from prior fiscal years for health care providers. S. 2853 Train More Nurses Act - Requiring the Secretary of HHS and Secretary of Labor to conduct a study and issue a report on grant programs to support the nursing workforce. H.R. 6586 Bipartisan Workforce Pell Act - Expanding Pell Grant coverage for healthcare workforce needs.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 5796/S 3410 Protecting Rural Seniors Access to Care Act S.1749/HR 3227 Ensuring Seniors' Access to Quality Care Act S100/HR4131 Better Care Better Jobs Act HR 2713/S2418 Improving Care and Access to Nurses Act S 2137/HR5159 Preserving Access to Home Health Care Act S 3118 HCBS Relief Act H.R.7513 s 3307: encounter data enhancement act Hospice Program Integrity and Reform (Hospice CARE Act discussion) Home Health Payment Adult Day Reimbursement Congressional Review Act -- Nursing home staffing mandate

Client expense: $11,563 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Observation Stays and 3 Day Stay Issue Outreach to HHS/CMS/Administration Survey Relief/Civil Monetary Penalties CMS on Public Health Waiver and other waivers SNF Payment Rule OSHA Emergency Temporary Standards Care For Our Seniors Act Medicare Advantage H.R. 177 - To amend title XI of the Social Security Act to ensure nursing facilities report information on medical directors of such facilities. CDC/COVID Safety Guidance Outreach to hill, HHS and ONC on LTPAC health information technology needs (zoom meetings and letters) Outreach to hill on needed Physician Fee Schedule reforms (sign on letters only) Improve Access to Mental Access Act S838/HR1638 (sign on letters) Improving Access to Medicare Coverage Act of 2023 HR 5138 HR 5796, S. 3410 - Protecting Rural Seniors Access to Care Act Outreach to hill on needed telehealth reforms (sign on letters only) Improving Seniors Timely Access to Care Act

Client expense: $1,020,000 · Firm income: Not reported

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

The Elder Justice Reauthorization and Modernization Act of 2023 AHCA/NCAL proposal of Care For Our Seniors Act Staff Agency Practices - Outreach to the Hill Immigration Delays - outreach to U.S. Departments of State, Homeland Security, & USCIS Advocating for providing temporary nurse aides a reasonable grace period as the public health emergency ends Administration nursing home reform plan Appropriations related outreach Support of the 21st Century Long-Term Care Caucus Outreach to DOL in support of LTC apprenticeship programs Outreach to LTC workforce related and appropriations matters Outreach to CMS and the Hill on the TNA waiver issue Outreach to CMS and the Hill on minimum staffing standards Outreach to DOE on SNF Loan Repayment Issues impacting the LTC workforce, including advocacy on the Care for Seniors Act H.R.468 - Building America's Health Care Workforce Act Senate HELP Comm Workforce RFI Comments S.1749/H.R. 3227 -- Ensuring Seniors Access to Quality Care Act Joined coalition in support for the bipartisan resolution S.J.Res.49/H.J.Res.98 Protecting American's Seniors' Access to Care Act (S. 3410/H.R. 7513) Outreach to DOL and NLRB on regulatory related workforce matters impacting LTC providers Advocacy for re-intro of the observation stays bill in the Senate Advocacy around the mark-up of the Protecting Americans Seniors Access to Care Act in the House Ways and Means Committee Advocacy around LTC workforce and AL with the Senate Aging Committee on policies they are considering Support for the SENIOR Act (H.R. 7605), which increases access and affordability of assisted living and address our workforce needs. Outreach to Dept of Labor, Employment and Training Admin on RIN 1205-AC13 - National Apprenticeship System Enhancements Train More Nurses Act (S. 2853/H.R. 6122) Safeguarding Elderly Needs for Innovation and Occupational Resources (SENIOR) Act (H.R. 7605) Protecting America's Seniors' Access to Care Act (S. 3410/H.R. 7513)

Client expense: $1,020,000 · 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)

S.4503, the Corporate Crimes Against Health Care Securing Continued Healthcare for Our Operations and Logistics Professionals Act S.4278, the Physician and Patient Safety Act H.R.8444 , the Mental Health in Schools Act S.4286, the Comprehensive Addiction Resources Emergency Act H.R.8524, the Elementary and Secondary School Counseling Act H.R. 7153/ S. 3679, the Dr. Lorna Breen Health Care Provider Protection Reauthorization Act H.R. 468, the Building Americas Health Care Workforce Act H.R. 3227, the Ensuring Seniors Access to Quality Care Act H.R.8526, the Trauma-Informed Schools Act S.1999 the Right to Contraception Act H.RES.1180, a resolution recognizing the importance of diversity, equity, and inclusion efforts in medical education H.R.7513/S.3410/H.J Res 139, legislation related to the administrations nursing home staffing regulation Health over Wealth Act IAQ and Healthy Schools Act (draft bill) Cognitive behavioral therapy and schools (draft bill) Abortion bans Long COVID Rural healthcare and hospital workforce challenges and related issues Shortage of minority healthcare professionals Impact of private equity on healthcare S.4381, Right to Contraception Act, Entirety Monitor the following: Mental Health Service Professional Demonstration Grant and the School-Based Mental Health Services Grant in FY2025 Supporting investments in school-based mental health professionals S.3612, the Access to Family Building Act H.R.7546/S.3860, the Nurse Overtime and Patient Safety Act S.3770, the Future Advancement of Academic Nursing Act S.3779 Child Suicide Prevention and Lethal Means Safety Act S.3701, the FACTS Act H.R.6914, the Pregnant Students Rights Act Private Equity and Healthcare Healthcare high school apprenticeships Safe staffing levels Indoor Air Quality and Outdoor pesticide school and environmental related issues Artificial Intelligence, Healthcare related issues S.1409, Kids Online Safety Act (KOSA), Entirety S.2660, Get Toxic Substances Out of Schools Act, Entirety Public Law 118-31, National Defense Authorization Act for Fiscal Year 2024, Teacher healthcare coverage H.R.485, the Protecting Health Care for All Patients Act Proposed regulation: File Code 1210-AC11, Requirements Related to the Mental Health Parity and Addiction Equity Act Safe staffing levels at nursing homes H.R.4771, the Childrens Health Insurance Program Permanency Act Affordable Drug Manufacturing Act, not introduced S.2530, the Mental Health of Educators and Staff Act Primary Care and Health Workforce Expansion Act (draft bill) Medicare drug negotiation program PMB reform H.R.5378, the Lower Costs, More Transparency Act Reauthorization of healthcare workforce programs S.2333, Pandemic and All-Hazards Preparedness and Response Act S.1113, Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act Appropriations regarding but not limited to community violence intervention, School-Based Mental Health Services Professional Demonstration Grants/ School-Based Mental Health Services Grant Program, gun violence prevent and removing abortion prohibition language from future appropriations bills. H.R.3727 Teacher Health and Wellness Act S.1446, Nurse Corps Tax Parity Act H.R.3761/S.1774, Advancing Student Services in Schools Today Act H.R.3726, Student Mental Health Rights Act H.R.3305, Black Maternal Health Momnibus Act Funding for CDCs Social Determinants of Health program H.R.3682, Cady Housh and Gemesha Thomas Student Suicide Prevention Act of 2023, Entirety Public Law 117-169, Inflation Reduction Act, Prescription drug reform Public Law 117-159, Bipartisan Safer Communities Act Medicaid DSH Payments, Hospital funding formula Abortion Access related issues Supporting Trauma Informed Education Practices Act Restoring Hope for Mental Health and Well‐Being Act Health Force and Resilience Force Act Black Maternal Health Momnibus Act Student Loan Forgiveness for Frontline Health Workers Affordability of pharmaceuticals, generally Treating gun violence as a public health epidemic related issues The National Nurse Act, Entirety Telehealth issues H.R.12/S.701, the Women's Health Protection Act, Entirety Mental health supports for educators Closing Health Coverage Gaps for Public Servants Act Workplace Violence Prevention for Health Care and Social Service Worker Act Visas for international healthcare professionals Dobbs vs Jackson, United States Supreme Court decision Workplace violence related issues Green New Deal for Health, Entirety H.R.1485/S.727, Insulin for All Act H.R.1692, Health Care Affordability Act S.1139 A bill to apply prescription drug inflation rebates to drugs furnished in the commercial market Minimum staffing levels in skilled nursing facilities related issues Health Worker Shortage/Staffing Crisis ACCESS in Mental Health Act (draft bill) Mental Health CARE Act (draft bill) Supporting All Students Act (draft bill) Epi-pen Price Cap legislation, (draft bill) Funding for Medicare low-income outreach and enrollment efforts Public Law 118-47, Further Consolidated Appropriations Act, 2024, Division D - Departments of Labor, Health and Human Services, and Education, and related agencies for the fiscal year ending September 30, 2024, and for other purposes, FY2024, Opposing restrictions on reproductive rights Public Law 118-42, Consolidated Appropriations Act, 2024, Division B - Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, FY2024, Protect access to Mifepristone H.R. 4771, the Childrens Health Insurance Program Permanency Act S.3090/H.R.6004, the Maximizing Outcomes for Moms through Medicaid Improvement and Enhancement of Services Act Prevention and Public Health Fund related issues H.R.6204, the See the Board Act Requirements Related to the Mental Health Parity and Addiction Equity Act, File Code 1210-AC11 Ensuring Safe Drinking Water at Schools, Lead & Copper Rule Improvements The Employee Retirement Income Security Act and related issues S.4445, The right to IVF Act, Reproductive healthcare and technology Rights and access to reproductive healthcare Department of Health and Human Services, Voter registration related issues on Federal Marketplace application Data Collection related issues Healthcare cybersecurity related issues

Client expense: $280,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2023 (H.R. 5138 and S. 4137): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Medicare Drug Prices (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act; to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer; to block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. Medicare Drug Costs. The Pharmaceutical Research Transparency Act of 2023 (S. 1476 and H.R. 3160): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Medicare Drug Savings. The Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 2893): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. (No bills): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and to raise the income threshold for the Low-Income Subsidy program offering assistance in paying for drugs. Medicare Prescription Drugs. The Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2023 (H.R. 3093): Proposals to require companies that receive federal funding for research (or a license of the rights to a patent or regulatory test data) for a biomedical product or service to agree to set reasonable prices for the resulting biomedical product or service and authorize to determine a reasonable price based on a formula that ensures the U.S. price for the product or service is not more than the median price for the product or service in Canada and six other reference countries. Medicare Prescription Drugs. (No bill): A regulatory proposal encouraging the Secretaries of the Departments of Health and Human Services (HHS) and Commerce to exercise march in rights that would aim to better control the pricing of prescription drugs. Medicare Prescription Drugs. (No bill): An HHS regulatory proposal to ensure robust negotiation rules and processes that aim to curtail the cost of certain prescription drugs, as authorized by the Inflation Reduction Act. Medicare Low-Income Subsidy (LIS) Program. (No bill): Proposal to increase funding for LIS outreach and enrollment, so that low-income beneficiaries can more readily access needed medications at prices they can afford. Medicare Reform. The Assuring Medicares Promise Act (H.R. 34) and The Medicare and Social Security Fair Share Act (S. 1174 and H.R. 4535): Proposals to close the loophole for wealthy individuals who bypass paying net investment income tax (NIIT) and directing the revenue to the Hospital Insurance Trust Fund, which pays for Medicare Part A that covers inpatient care in hospitals, and to the Social Security Trust Funds. Medicare Dental Coverage. The Medicare Dental Benefit Act (S. 2012 and H.R. 4146): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Medicare Hearing Aid Coverage Act of 2021 (H.R. 244): Proposal to expand Medicare coverage to include hearing aids and services for seniors under Medicare Part B. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with the Department of Health and Humans Services/Center for Medicare and Medicaid Services) HHS/CMS. Public Health Emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage (MA). (No bill): Proposals to create transparency around Medicare Advantage plans using prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Advantage. (No bill): Proposals to apply a higher coding adjustment factor to fully account for intensive upcoding by MA plans and to exclude certain information for MA risk adjustment scores and payments; to use two years of traditional Medicare and MA diagnostic data for calculating MA risk-adjusted payments; and to promulgate more fundamental changes to the Hierarchical Condition Category (HCC) risk adjustment model. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid Home And Community-Based Services. The HCBS Access Act (H.R. 1493 and S. 762): Proposals to make home and community-based services (HCBS) a mandatory benefit within Medicaid, and to ensure eligible older adults and people with disabilities have the option to choose between home care and institutional care. Caregiving. The Alleviating Barriers to Caregiving Act (H.R. 8018 and S. 3109): Proposal to require the Secretaries of HHS and SSA to review and streamline enrollment in coverage and benefits for family caregivers in Medicare, Medicaid, CHIP and Social Security. Medicare and Medicaid Nursing Homes. The Nursing Home Disclosure Act (H.R. 177): Proposal to direct HHS to establish a national registry of medical directors. Medicare, Medicaid Nursing Homes. The Protecting Americas Seniors Access to Care Act (H.R. 7513 and S. 3410): Proposal to prohibit the HHS Secretary from promulgating national staffing standards in nursing homes. Medicare, Medicaid Nursing Homes. (H.J. Res. 139 and S.J. Res. 91): Proposal to use the Congressional Review Act to disapprove the HHS Secretarys final rule promulgating national staffing standards in nursing homes Medicare, Medicaid Nursing Homes, Assisted Living and Other Long Term Care Services and Supports (LTSS) Settings. The Long-Term Care Workforce Support Act (H.R. 7994 and S. 4120): Proposal to increase the number of direct care professionals, including in rural communities; pathways to enter and be supported in the workforce for women, people of color, and people with disabilities; and to improve compensation for direct care professionals to reduce vacancies and turnover. Medicare and Medicaid Nursing Home Ownership. (No bill): A proposed final HHS regulation for comprehensive ownership disclosure in the nursing home sector issued on November 17th, 2023. Rule calls for strengthened cost reporting requirements, together with ongoing national analyses and monitoring of the performance of the nursing home sector that uses ownership, staffing, cost report data and inspection data. Medicare and Medicaid Nursing Home Staffing. (No bill): Final regulations establishing national staffing standards in nursing homes that would safeguard the health and safety of all elderly and disabled residents. Medicaid Long-Term Services and Supports (LTSS). (No bill): Proposal to request that CMS collect standardized LTSS expenditure data annually from every state and across all LTSS programs and for disaggregation of expenditure data by the delivery system and demographic characteristics in order to identify disparities in access and use of LTSS and help states and CMS deploy targeted strategies to meet the needs of older adults and people with disabilities.

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), Commerce, Dept of (DOC), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

S. 495/H.R. 1815 Expanding Veterans Options for Long Term Care Act - Seeking expanded flexibility and access to Assisted Living for Veterans; H.R. 6835 Caring Across Generations Act - Seeking additional support for funding of multigenerational programs in Long-Term care; S. 3410/H.R. 5796 Protecting Rural Seniors' Access to Care Act - establishing an advisory panel to support the nursing home workforce; H.R. 6025/S. 3211 Healthcare Workforce Resilience Act - Carrying forward unused visas from prior fiscal years for health care providers. S. 2853 Train More Nurses Act - Requiring the Secretary of HHS and Secretary of Labor to conduct a study and issue a report on grant programs to support the nursing workforce. H.R. 6586 Bipartisan Workforce Pell Act - Expanding Pell Grant coverage for healthcare workforce needs.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Urged Congress to provide adequate resources including increased training and development programs to bolster the workforce, as well as to provide more flexibility in meeting staffing requirements and standards, including telehealth options. (H.R. 7623) Telehealth Modernization Act: Expressed support for the Telehealth Modernization Act - This legislation ensures that seniors and rural patients who may not have internet connectivity can receive the care they need through audio-only telehealth services, in addition to allowing health centers and rural health clinics to provide telehealth services. (H.R. 3305/S. 1606) Black Maternal Health Momnibus Act - Expressed support for the Black Maternal Health Momnibus Act. This legislation would make critical investments in the social determinants of health, address behavioral health needs, cultural competency, and gaps in the perinatal workforce, and bolster the collection of data to address every driver of maternal mortality, morbidity, and disparities in the United States. (H.R. 8245) Rural Hospital Stabilization Act: Expressed support for the Rural Hospital Stabilization Act. This legislation would ensure that healthcare providers in rural areas continue to provide services and meet their communities' needs. (H.R. 8244) Ensuring Seniors' Access to Care Act: Expressed support for the Ensuring Seniors' Access to Care Act. This legislation would allow nursing home providers, who have been prohibited from training staff to be certified nurse aids (CNA) because of compliance penalties, to begin training staff once they have demonstrated their return to compliance, rather than having to wait a full two years. Urged Congress to make essential telehealth flexibilities permanent well before the statutory deadline of Dec. 31, 2024. (S. 3410/H.R. 5796) The Protecting Rural Seniors' Access to Care Act - Expressed support for the Protecting Rural Seniors' Access to Care Act. This legislation would prohibit HHS from finalizing a proposed nursing home staffing requirement rule and establish an advisory panel on nursing home staffing. (H.R. 3226/S.1573) The PREMIE Reauthorization Act - Expressed support for the PREMIE Reauthorization Act. This legislation would reauthorize essential maternal and infant health programs and research at a time when maternal and infant death rates, especially in communities of color, have increased dramatically. (2584/S.2768) The Safety from Violence for Healthcare Employees Act - Expressed support for the Safety from Violence for Healthcare Employees Act. This legislation would address rising incidents of violence in healthcare settings by establishing stronger legal penalties for people who knowingly and intentionally assault or intimidate hospital employees. (H.R. 5568) The Care for Moms Act - Expressed support for the Care for Moms Act. This legislation supports the maternal health workforce, promotes access to prenatal and postpartum care, and provides essential resources to providers in rural areas. Supports legislation on Proposed Nursing Home Staffing Requirements that prohibits the HHS Secretary from finalizing a proposed nursing home staffing rule. (H.R. 4771) - Children's Health Insurance Program Permanency (CHIPP) Act - Expressed support for the Children's Health Insurance Program Permanency (CHIPP) Act. This legislation would make the Children's Health Insurance Program (CHIP) permanent and place it on par with other federal public health insurance programs rather than needing periodic reauthorization. (S. 2415/H.R. 3838) - Preventing Maternal Deaths Reauthorization Act of 2023 - Expressed support for Preventing Maternal Deaths Reauthorization Act of 2023. This legislation continues crucial federal support for the state-based maternal mortality review committees (MMRCs) that review pregnancy-related deaths to identify causes and make recommendations for the prevention of future mortalities. Provided the Senate with information regarding the 340B program and expressed strong support for continuing to strengthen and protect this vital program. Urged Congress to provide a $1 billion increase for the Title V Maternal and Child Health (MCH) Services Block Grant in the FY2024 Labor, Health and Human Services, Education & Related Agencies Appropriations bill. Urged Congress to provide $100 million for the Surveillance for Emerging Threats to Mothers and Babies (SET-NET) at the Centers for Disease Control and Prevention (CDC). Provided written testimony for the House and Commerce Health Subcommittee hearing on Examining Existing Federal Programs to Build a Strong Health Workforce and Improve Primary Care. The testimony recommended several actions and pieces of legislation to assist health providers in hiring and retaining workers. (H.R. 2389) - Resident Physician Shortage Reduction Act - Expressed support for the Resident Physician Shortage Reduction Act. (H.R. 3290) - To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program-Expressed opposition. (H.R. 3561) Section 302 - Expressed opposition to Section 302. This legislative provision would reduce payments for the drug administration services furnished in off-campus provider-based departments. Urged Congress to support access to quality palliative care and appropriate effective pain management by prioritizing a Palliative Care, Trans-Institute Strategy by the National Institute of Aging (NIA) in the Fiscal Year 2024 Labor, Health and Human Services, Education, and Related Agencies appropriations bill. Urged Congress to increase funding for federally qualified health centers (FQHCs) as part of the Community Health Center Fund reauthorization. (S.2243) - Palliative Care and Hospice Education and Training Act (PCHETA). Urged Congress to support the Palliative Care and Hospice Education and Training Act. This legislation would address the palliative care workforce shortage and help respond to pressing issues including appropriate pain management and pandemic preparedness.

Client expense: $171,047 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Healthcare supply chain, resiliency, product continuity, domestic manufacturing, Protecting America's Seniors' Access to Care Act (S. 3410/H.R. 7513), Reauthorization of the Pandemic and All-Hazards Preparedness Act (S. 2333/H.R. 4421)

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

Government targets: Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Economic Council (NEC), Natl Security Council (NSC), SENATE, White House Office

1. S. 762, The HCBS Access Act, entire bill 2. H.R. 1493, The HCBS Access Act, entire bill 3. S. 842, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 4. H.R. 33, Medicare and Medicaid Dental, Vision and Hearing Benefit Act, entire bill 5. Proposals regarding the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost-sharing subsidies under part D of the Medicare program 6. Medicare ACO Realizing Equity, Access, and Community Health (REACH) program 7. Proposals to reduce Medicaid funding 8. H.R. 3069, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 9. S. 1296, John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act, entire bill 10. Implementation of provisions of the Inflation Reduction Act of 2022 regarding drug prices under the Medicare program 11. Proposals regarding revisions to Medicare rules regarding inpatient hospital stays 12. Proposed CMS rule: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting 13. H.R. Improving Access to Mental Health Act of 2023, entire bill 14. S. 838,Improving Access to Mental Health Act of 2023, entire bill 15. Proposals regarding the Medicare Low Income Subsidy program 16. H.R. 7513, Protecting Americas Seniors Access to Care Act, entire 17. S. 3410, Protecting Rural Seniors Access to Care Act, entire bill 18. H.J.Res. 139, providing for Congressional disapproval of the CMS rule Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting," entire resolution 19. H.R. 8106, To amend title XIX of the Social Security Act to increase transparency and expand coverage options with respect to home and community-based services under a Medicaid waiver, entire bill 20. H.R. 8107, Ensuring Access to Medicaid Buy-in Programs Act of 2024, entire bill 21. H.R. 8109, Money Follows the Person Permanency Act of 2024, entire bill 22. H.R. 8110, Protecting Married Seniors from Impoverishment Act of 2024, entire bill 23. H.R. 8018, Alleviating Barriers for Caregivers Act, entire bill 24. S. 3109, Alleviating Barriers for Caregivers Act, entire bill 25. Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program rule, entire rule

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

Government targets: Administration on Aging, Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, White House Office

Meetings, Letters, Press Conference and Briefings in House and Senate on CMS Nursing Home Staffing Rule, and sharing SEIU strong Opposition to HR 5796, H.R. 7513, S. 3410, H.J. Res. 139 and S.J. Res. 91 that would prohibit the rule. Meeting in House in Opposition to HR 6860, the Restore Protections for Dialysis Patients Act (RPDPA) Letter and meetings in Opposition to H.R. 8114, Legislation that would prohibit the Secretary of Health and Human Services from finalizing a rule proposed by the Centers for Medicare & Medicaid Services to place certain limitations on Medicaid payments for home or community-based services. Letter and meetings with House Offices in Opposition to H.R. 3227, Ensuring Seniors Access to Quality Care Act. Letter in Support for H.R. 7573, the Stop Unfair Medicaid Recoveries Act which seeks to halt unfair Medicaid recovery practices, and H.R. 8106 which proposes to remove institutional care criteria for Home and Community-Based Services (HCBS) eligibility, improving access and equity within the long-term care system.

Client expense: $230,000 · Firm income: Not reported

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

H.R. 5378 - Lower Costs, More Transparency Act - Re: Site Neutral and Hospital Price Transparency H.R. 5796/ S. 3410 - "The Protecting Rural Seniors' Access to Care Act" - Re: Skilled Nursing Facility Staffing Mandates H.R. 3173/ S.5044 - "Improving Seniors' Timely Access to Care Act" - Re: Medicare Advantage Prior Authorization provisions H.R. 6430/ S.1110 - "The Assistance for Rural Community Hospitals (ARCH) Act" - Re: Discussions around Medicare rural extenders (LVH/MDH) Payment delays and denials - Re: Medicare Advantage coverage requirements H.R. 8113 - "Transparency into State Directed Payments Act of 2024" - Re: Discussed importance of Medicaid payment adequacy Discussions around Medicaid DSH funding - Re: Medicare DSH cut delay H.R. 7623/ S. 3967 - "Telehealth Modernization Act of 2024"; H.R. 4189/ S. 2016 - "CONNECT for Health Act of 2023"; H.R. 3432/ S. 3651 - "Telemental Health Care Access Act of 2023" - Re: Telehealth flexibilities Mandatory CMMI Models - Re: Value-based Care

Client expense: $480,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

No bill number. Discussed medically necessary dental coverage and oral health care in Medicare. No bill number. Discussed Medicare coverage for telehealth services. No bill number. Discussed workforce training, physician reimbursement, and Medicare provider access. No bill number. Discussed Improving Seniors Timely Access to Care Act of 2024. H.R. 2407, the Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act. No bill number. Discussed Medicaid estate recovery. No bill number. Discussed Medicare Advantage data. H.R. 3549/ S. 1703, the PACE Part D Choice Act of 2023. No bill number. Discussed family caregivers and Medicare and Medicaid policy. No bill number. Discussed Medicare FY25 Skilled Nursing Facility Payment Proposed Rule. No bill number. Discussed Medicare FY25 Hospital Inpatient Payment Proposed Rule. No bill number. Discussed hospitals and a buffer of essential medicines. No bill number. Discussed Medicaid unwinding. H.R. 8114, To prohibit the Secretary of Health and Human Services from finalizing a rule proposed by the Centers for Medicare & Medicaid Services to place certain limitations on Medicaid payments for home or community-based services. No bill number. Discussed Care Executive Order. H.R. 8018, the Alleviating Barriers for Caregivers Act. S. 3109, Alleviating Barriers for Caregivers Act. S. 3766/H.R. 7274, Connecting Caregivers to Medicare Act. No bill number. Discussed Acute Hospital Care at Home waiver and family caregivers. No bill number. Discussed family caregivers, direct care workers, care at home, and in other settings. S. 4120/H.R. 7994, the Long-Term Care Workforce Support Act. H.R. 8094, to amend Title XIX of the Social Security Act to modify certain asset recovery rules. H.R. 7573, the Stop Unfair Medicaid Recoveries Act. No bill number. Discussed the Coordinating Care for Veterans and Wounded Warriors Act. No bill number. Discussed nursing home staffing standards. No bill number. Discussed Medicare home health and hospice benefits. No bill number. Discussed health care coverage expansion. H.R. 8331/S. 4280, the Essential Caregivers Act. H.R. 7442, Philippine Medicare Portability Study Act. H.R. 3227, the Ensuring Seniors Access to Quality Care Act. H.R. 8244, Ensuring Seniors Access to Quality Care Act. H.R.468, the Building Americas Health Care Workforce Act. HR 7513/S.3410, the Protecting Americas Seniors Access to Care Act. H.J.Res.139, Providing for Congressional disapproval of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. S.J.Res.91, A joint resolution providing for congressional disapproval of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting" S.4137, the Improving Access to Medicare Coverage Act of 2024.

Client expense: $5,170,000 · Firm income: Not reported

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

HR 5796/S 3410 Protecting Rural Seniors Access to Care Act S.1749/HR 3227 Ensuring Seniors' Access to Quality Care Act S100/HR4131 Better Care Better Jobs Act HR 2713/S2418 Improving Care and Access to Nurses Act S 2137/HR5159 Preserving Access to Home Health Care Act S 3118 HCBS Relief Act Hospice Program Integrity Home Health Payment Adult Day Reimbursement

Client expense: $11,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

The Elder Justice Reauthorization and Modernization Act of 2023 AHCA/NCAL proposal of Care For Our Seniors Act Staff Agency Practices - Outreach to the Hill Immigration Delays - outreach to U.S. Departments of State, Homeland Security, & USCIS Advocating for providing temporary nurse aides a reasonable grace period as the public health emergency ends Administration nursing home reform plan Appropriations related outreach Support of the 21st Century Long-Term Care Caucus Outreach to DOL in support of LTC apprenticeship programs Outreach to LTC workforce related and appropriations matters Outreach to CMS and the Hill on the TNA waiver issue Outreach to CMS and the Hill on minimum staffing standards Outreach to DOE on SNF Loan Repayment Issues impacting the LTC workforce, including advocacy on the Care for Seniors Act H.R.468 - Building America's Health Care Workforce Act Senate HELP Comm Workforce RFI Comments S.1749/H.R. 3227 -- Ensuring Seniors Access to Quality Care Act Joined coalition in support for the bipartisan resolution S.J.Res.49/H.J.Res.98 Protecting American's Seniors' Access to Care Act (S. 3410/H.R. 7513) Outreach to DOL and NLRB on regulatory related workforce matters impacting LTC providers Advocacy for re-intro of the observation stays bill in the Senate Advocacy around the mark-up of the Protecting Americans Seniors Access to Care Act in the House Ways and Means Committee Advocacy around LTC workforce and AL with the Senate Aging Committee on policies they are considering Support for the SENIOR Act (H.R. 7605), which increases access and affordability of assisted living and address our workforce needs. Outreach to Dept of Labor, Employment and Training Admin on RIN 1205-AC13 - National Apprenticeship System Enhancements

Client expense: $990,000 · 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)

Observation Stays and 3 Day Stay Issue Outreach to HHS/CMS/Administration Survey Relief/Civil Monetary Penalties CMS on Public Health Waiver and other waivers SNF Payment Rule OSHA Emergency Temporary Standards Care For Our Seniors Act Medicare Advantage H.R. 177 - To amend title XI of the Social Security Act to ensure nursing facilities report information on medical directors of such facilities. CDC/COVID Safety Guidance Outreach to hill, HHS and ONC on LTPAC health information technology needs (zoom meetings and letters) Outreach to hill on needed Physician Fee Schedule reforms (sign on letters only) Improve Access to Mental Access Act S838/HR1638 (sign on letters) Improving Access to Medicare Coverage Act of 2023 HR 5138 HR 5796, S. 3410 - Protecting Rural Seniors Access to Care Act Outreach to hill on needed telehealth reforms (sign on letters only)

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

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

Urged Congress to make essential telehealth flexibilities permanent well before the statutory deadline of Dec. 31, 2024. (S. 3410/H.R. 5796) The Protecting Rural Seniors' Access to Care Act - Expressed support for the Protecting Rural Seniors' Access to Care Act. This legislation would prohibit HHS from finalizing a proposed nursing home staffing requirement rule and establish an advisory panel on nursing home staffing. (H.R. 3226/S.1573) The PREMIE Reauthorization Act - Expressed support for the PREMIE Reauthorization Act. This legislation would reauthorize essential maternal and infant health programs and research at a time when maternal and infant death rates, especially in communities of color, have increased dramatically. (2584/S.2768) The Safety from Violence for Healthcare Employees Act - Expressed support for the Safety from Violence for Healthcare Employees Act. This legislation would address rising incidents of violence in healthcare settings by establishing stronger legal penalties for people who knowingly and intentionally assault or intimidate hospital employees. (H.R. 5568) The Care for Moms Act - Expressed support for the Care for Moms Act. This legislation supports the maternal health workforce, promotes access to prenatal and postpartum care, and provides essential resources to providers in rural areas. Supports legislation on Proposed Nursing Home Staffing Requirements that prohibits the HHS Secretary from finalizing a proposed nursing home staffing rule. (H.R. 4771) - Children's Health Insurance Program Permanency (CHIPP) Act - Expressed support for the Children's Health Insurance Program Permanency (CHIPP) Act. This legislation would make the Children's Health Insurance Program (CHIP) permanent and place it on par with other federal public health insurance programs rather than needing periodic reauthorization. (S. 2415/H.R. 3838) - Preventing Maternal Deaths Reauthorization Act of 2023 - Expressed support for Preventing Maternal Deaths Reauthorization Act of 2023. This legislation continues crucial federal support for the state-based maternal mortality review committees (MMRCs) that review pregnancy-related deaths to identify causes and make recommendations for the prevention of future mortalities. Provided the Senate with information regarding the 340B program and expressed strong support for continuing to strengthen and protect this vital program. Urged Congress to provide a $1 billion increase for the Title V Maternal and Child Health (MCH) Services Block Grant in the FY2024 Labor, Health and Human Services, Education & Related Agencies Appropriations bill. Urged Congress to provide $100 million for the Surveillance for Emerging Threats to Mothers and Babies (SET-NET) at the Centers for Disease Control and Prevention (CDC). Provided written testimony for the House and Commerce Health Subcommittee hearing on Examining Existing Federal Programs to Build a Strong Health Workforce and Improve Primary Care. The testimony recommended several actions and pieces of legislation to assist health providers in hiring and retaining workers. (H.R. 2389) - Resident Physician Shortage Reduction Act - Expressed support for the Resident Physician Shortage Reduction Act. (H.R. 3290) - To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program-Expressed opposition. (H.R. 3561) Section 302 - Expressed opposition to Section 302. This legislative provision would reduce payments for the drug administration services furnished in off-campus provider-based departments. Urged Congress to support access to quality palliative care and appropriate effective pain management by prioritizing a Palliative Care, Trans-Institute Strategy by the National Institute of Aging (NIA) in the Fiscal Year 2024 Labor, Health and Human Services, Education, and Related Agencies appropriations bill. Urged Congress to increase funding for federally qualified health centers (FQHCs) as part of the Community Health Center Fund reauthorization. (S.2243) - Palliative Care and Hospice Education and Training Act (PCHETA). Urged Congress to support the Palliative Care and Hospice Education and Training Act. This legislation would address the palliative care workforce shortage and help respond to pressing issues including appropriate pain management and pandemic preparedness.

Client expense: $136,413 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 495/H.R. 1815 Expanding Veterans Options for Long Term Care Act - Seeking expanded flexibility and access to Assisted Living for Veterans; H.R. 6835 Caring Across Generations Act - Seeking additional support for funding of multigenerational programs in Long-Term care; S. 3410/H.R. 5796 Protecting Rural Seniors' Access to Care Act - establishing an advisory panel to support the nursing home workforce; H.R. 6025/S. 3211 Healthcare Workforce Resilience Act - Carrying forward unused visas from prior fiscal years for health care providers. S. 2853 Train More Nurses Act - Requiring the Secretary of HHS and Secretary of Labor to conduct a study and issue a report on grant programs to support the nursing workforce. H.R. 6586 Bipartisan Workforce Pell Act - Expanding Pell Grant coverage for healthcare workforce needs.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 5378 - Lower Costs, More Transparency Act - Re: Site Neutral and Hospital Price Transparency H.R. 5796/ S. 3410 - "The Protecting Rural Seniors' Access to Care Act" - Re: Skilled Nursing Facility Staffing Mandates H.R. 3173/ S.5044 - "Improving Seniors' Timely Access to Care Act" - Re: Medicare Advantage Prior Authorization H.R. 4968 - The Gold Card Act of 2023 - Re: Reforms to the Medicare Prior Authorization Process H.R. 6430/ S.1110 - "The Assistance for Rural Community Hospitals (ARCH) Act" - Re: Making permanent rural payment programs (LVH/MDH) Re: Two-Midnight Rule - Medicare Advantage coverage requirements Re: Medicaid State Directed Payments Providing for the concurrence by the House in the Senate amendment to H.R. 4366, with an amendment (2024 Government Funding Bill) - Re: Medicare DSH cut delay H.R. 7623/ S. 3967 - "Telehealth Modernization Act of 2024"; H.R. 4189/ S. 2016 - "CONNECT for Health Act of 2023"; H.R. 3432/ S. 3651 - "Telemental Health Care Access Act of 2023" - Re: Extending telehealth provisions

Client expense: $650,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

1. S. 2584 - Supporting Our Seniors Act 2. S. 3410 / H.R. 5796 - Protecting Rural Seniors Access to Care Act

Client expense: $75,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 3766/H.R. 7274, the Connecting Family Caregivers to Medicare Act. S. 3109, the Alleviating Barriers for Caregivers Act. S. 3410/HR 5796, the Protecting Rural Seniors Access to Care Act. H.R. 7513, the Protecting Americas Seniors Access to Care Act. No bill number. Discussed Medicare low-income outreach and enrollment programs. No bill number. Discussed medically necessary dental coverage in Medicare. No bill number. Discussed Medicare Advantage and Medicare Prescription Drug Benefit Programs for contract year 2025. No bill number. Discussed Medicare capitation rates, and Part C and Part A payment policies for contract year 2025. No bill number. Discussed the Medicare Prescription Payment Plan (MPPP) program. No bill number. Discussed nursing home staffing rule. No bill number. Discussed long-term care workforce issues. No bill number. Discussed proposed rule on observation status appeals. No bill number. Discussed coverage of Medicaid, Medicare, and dual eligibles. No bill number. Discussed primary care. No bill number. Discussed Appeal Rights for Certain Changes in Patient Status. No bill number. Discussed family caregivers and Hospital-at-Home programs. No bill number. Discussed Medicare hospice benefit and respite care. No bill number. Discussed family caregivers and Medicare. No bill number. Discussed family caregivers and Medicaid self-direction programs. No bill number. Discussed state Long-Term Services and Supports Scorecard. No bill number. Discussed Veterans Administration care and Medicare. No bill number. Discussed paid direct care workforce. No bill number. Discussed access to physicians in Medicare. No bill number. Discussed observation stays in Medicare. No bill number. Discussed GUIDE Model.

Client expense: $4,370,000 · Firm income: Not reported

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

HR 5796/S 3410 Protecting Rural Seniors Access to Care Act S.1749/HR 3227 Ensuring Seniors' Access to Quality Care Act S100/HR4131 Better Care Better Jobs Act HR 2713/S2418 Improving Care and Access to Nurses Act S 2137/HR5159 Preserving Access to Home Health Care Act S 3118 HCBS Relief Act Hospice Program Integrity Home Health Payment Adult Day Reimbursement

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

The Elder Justice Reauthorization and Modernization Act of 2023 AHCA/NCAL proposal of Care For Our Seniors Act Staff Agency Practices - Outreach to the Hill Immigration Delays - outreach to U.S. Departments of State, Homeland Security, & USCIS Advocating for providing temporary nurse aides a reasonable grace period as the public health emergency ends Administration nursing home reform plan Appropriations related outreach Support of the 21st Century Long-Term Care Caucus Outreach to DOL in support of LTC apprenticeship programs Outreach to LTC workforce related and appropriations matters Outreach to CMS and the Hill on the TNA waiver issue Outreach to CMS and the Hill on minimum staffing standards Outreach to DOE on SNF Loan Repayment Issues impacting the LTC workforce, including advocacy on the Care for Seniors Act H.R.468 - Building America's Health Care Workforce Act Senate HELP Comm Workforce RFI Comments 1749/H.R. 3227 -- Ensuring Seniors Access to Quality Care Act Joined coalition in support for the bipartisan resolution S.J.Res.49/H.J.Res.98 Support for the Protecting Rural Seniors Access to Care Act (S. 3410/H.R. 5796) Outreach to DOL and NLRB on regulatory related workforce matters impacting LTC providers

Client expense: $1,340,000 · 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)

Observation Stays and 3 Day Stay Issue Outreach to HHS/CMS/Administration Survey Relief/Civil Monetary Penalties CMS on Public Health Waiver and other waivers SNF Payment Rule OSHA Emergency Temporary Standards Care For Our Seniors Act Medicare Advantage H.R. 177 - To amend title XI of the Social Security Act to ensure nursing facilities report information on medical directors of such facilities. CDC/COVID Safety Guidance Outreach to hill, HHS and ONC on LTPAC health information technology needs (zoom meetings and letters) Outreach to hill on needed Physician Fee Schedule reforms (sign on letters only) Improve Access to Mental Access Act S838/HR1638 (sign on letters) Improving Access to Medicare Coverage Act of 2023 HR 5138 HR 5796, S. 3410 - Protecting Rural Seniors Access to Care Act

Client expense: $1,340,000 · Firm income: Not reported

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

S.495 Expanding Veterans Options for Long Term Care Act - Seeking expanded flexibility and access to Assisted Living for Veterans; H.R. 6835 Caring Across Generations Act - Seeking additional support for funding of multigenerational programs in Long-Term care; S. 3410/H.R. 5796 Protecting Rural Seniors' Access to Care Act - establishing an advisory panel to support the nursing home workforce; H.R. 6025/S. 3211 Healthcare Workforce Resilience Act - Carrying forward unused visas from prior fiscal years for health care providers.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE