DUALS Act of 2024

Medicare and Medicaid dual eligible integration; Performance evaluation/quality oversight; Monitoring of Medicare Advantage, particularly as it relates to changes in coding intensity, benchmarks, and health risk assessments; Issues related to Medicare Advantage marketing practices; S. 3950, Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024; Issues related to Calendar Year (CY) 2025 Rate Announcement for the Medicare Advantage (MA) and Medicare Part D Prescription Drug (Part D) Programs (Rate Notice); Congressional briefing on SNP Supplemental Benefits; Expiring healthcare extenders; H.R. 10545, American Relief Act, 2025

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare and Medicaid dual eligible integration; Monitoring of Medicare Advantage, particularly as it relates to changes in coding intensity, benchmarks, and health risk assessments; Issues related to Medicare Advantage marketing practices and provider directories; Issues related to 2024 Medicare Advantage star ratings; S. 3950, Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024; Calendar Year (CY) 2025 Rate Announcement for the Medicare Advantage (MA) and Medicare Part D Prescription Drug (Part D) Programs (Rate Notice); Issues related to Medcare Advantage prior authorization; Expiring healthcare extenders; H.R. 10545, American Relief Act, 2025

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Federal Affairs also lobbies for Medicaid and Medicare payment for health centers and Medicaid unwinding policies. This includes: Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 (S. 2016); HEALTH Act of 2023 (H.R. 5611); Telehealth Modernization Act (H.R. 7623); Preserving Telehealth, Hospital, and Ambulance Access Act (H.R.8261); Pay PCPs Act of 2024 (S.4338); DUALS Act of 2024 (S.3950).

Client expense: $152,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE, White House Office

S. 4532--A bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans--Prior Authorization in Medicare Advantage H.R. 8702--To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans--Prior Authorization in Medicare Advantage S. 3573--Medicare Advantage Supplemental Benefits Transparency Act--Improving Supplemental Benefits for MA beneficiaries H.R. 5380--To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage--Improving Supplemental Benefits for MA beneficiaries S. 3307--Encounter Data Enhancement Act--Encounter Data in MA H.R. 5746--Addressing Whole Health in Medicare Advantage Act--Supplemental Benefits for chronically ill enrollees H.R. 4968--Gold Card Act of 2023--Exemptions to Prior Authorization in Medicare Advantage S. 3950--Delivering Unified Access to Lifesaving Services Act (DUALS Act) of 2024--Care Delivery for those eligible for Medicare and Medicaid Issues related to data collection and sharing among health plans, providers, and community-based organizations issues In-home Heath Risk Assessments issues Issues related to mental and behavioral health issues in Medicare Advantage S 3059--Required Enhanced & Accurate Lists of Health Providers Act (REAL)--Reporting issues

Client expense: $730,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Federal Affairs also lobbies for Medicaid and Medicare payment for health centers and Medicaid unwinding policies. This includes: Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 (S. 2016); HEALTH Act of 2023 (H.R. 5611); Telehealth Modernization Act (H.R. 7623); Preserving Telehealth, Hospital, and Ambulance Access Act (H.R.8261); Pay PCPs Act of 2024 (S.4338); DUALS Act of 2024 (S.3950).

Client expense: $155,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE, White House Office

Federal Affairs lobbies for Teaching Health Centers; Nurse Corps; National Health Service Corps; 340B Drug Discount Program; Community Health Center Program Funding; Behavioral Health; Telehealth policies. This includes the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 (S. 2016); HEALTH Act of 2023 (H.R. 5611); Telehealth Modernization Act (H.R. 7623); Preserving Telehealth, Hospital, and Ambulance Access Act (H.R.8261); Pay PCPs Act of 2024 (S.4338); and the DUALS Act of 2024 (S.3950).

Client expense: $155,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Federal Affairs lobbies for Teaching Health Centers; Nurse Corps; National Health Service Corps; 340B Drug Discount Program; Community Health Center Program Funding; Behavioral Health; Telehealth policies. This includes the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 (S. 2016); HEALTH Act of 2023 (H.R. 5611); Telehealth Modernization Act (H.R. 7623); Preserving Telehealth, Hospital, and Ambulance Access Act (H.R.8261); Pay PCPs Act of 2024 (S.4338); and the DUALS Act of 2024 (S.3950).

Client expense: $152,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Federal Affairs also lobbies for Medicaid and Medicare payment for health centers and Medicaid unwinding policies. This includes: Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 (S. 2016); HEALTH Act of 2023 (H.R. 5611); Telehealth Modernization Act (H.R. 7623); Preserving Telehealth, Hospital, and Ambulance Access Act (H.R.8261); Pay PCPs Act of 2024 (S.4338); DUALS Act of 2024 (S.3950).

Client expense: $152,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE, White House Office

PACE regulations and PACE demonstration. Medicaid and Medicare reimbursement. Medicare Part D reform. ACO Reach. S. 1703/H.R. 3549 - PACE Part D Choice Act. H.R. 6590 - PACE Expanded Act. S. 3950 - DUALS Act of 2024. H.R. 10545 - American Relief Act.

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

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

S. 3950 Duels Act of 2024 institutional special needs plans, Medicare Advantage, network adequacy, duel eligibles

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

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

Issues related to Medicare Advantage payment rates and policies - no specific legislation. Issues related to Medicaid payment rates and policies - no specific legislation. S. 127 - Pharmacy Benefit Manager Transparency Act - entire bill. H.R. 3561 - PATIENT Act - entire bill. HR 5378 - Lower Costs, More Transparency Act. H.R. 4818 - Treat and Reduce Obesity Act of 2023. H.R. 7623 - Telehealth Modernization Act of 2024. S. 3950 - DUALS Act of 2024.

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

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

Monitoring legislation that could impact access to care for Medicare and dually-eligible individuals as well as legislation that could impact health insurance operations and educating on general health insurance matters that impact the Commonwealth Care Alliance, including the "Lower Costs, More Transparency Act (H.R. 5378)", the "Improving Seniors Timely Access to Care Act (S. 4532/H.R. 8702)", the "DUALS Act (S. 3950) and H.R. 10545, a bill making further continuing appropriations for the fiscal year ending September 30, 2025, and for other purposes.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 3950 Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024 Issues related to Calendar Year (CY) 2025 Rate Announcement for the Medicare Advantage (MA) and Medicare Part D Prescription Drug (Part D) Programs (Rate Notice) Monitoring of Medicare Advantage HRAs, coding intensity, marketing practices Monitoring prior authorization Congressional briefing on SNP Supplemental Benefits; Expiring healthcare extenders

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Draft, Medicare Compare Website (no bill number) - Rep. Guthrie, Brett - improvements to CMS Medicare compare website H.R. 35 - Close the Medigap Act of 2023 - Rep. Doggett, Lloyd - Medigap policies H.R. 3746 - Fiscal Responsibility Act of 2023 - Rep. McHenry, Patrick - work requirements for federal programs H.R. 3875 - Expanded Telehealth Access Act - Rep. Sherrill, Mikie - Medicare payment for telehealth services H.R. 4411 - Medicare Advantage Integrity Act - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 4818 - Treat and Reduce Obesity Act of 2023 - Rep. Wenstrup, Brad -Medicare Coverage of weight loss treatment H.R. 5526 - Seniors' Access to Critical Medications Act of 2023 - Rep. Harshbarger, Diana - exception for physician self-referral H.R. 5584 - Medicaid Third Party Liability Act - Rep. Burgess, Michael - amends Medicaid Third Party liability requirements H.R. 5746 - Addressing Whole Health in Medicare Advantage Act - Rep. Bilirakis, Gus - Medicare Advantage supplemental benefits H.R. 5854 - Medicare Advantage Consumer Protection and Transparency Act - Rep. Porter, Katie - Medicare Advantage organization reporting H.R. 6364 - Medicare Telehealth Privacy Act of 2023 - Rep. Balderson, Troy - Provider privacy provisions for telehealth under Medicare H.R. 6400 - To amend title XVIII of the Social Security Act to extend eligibility for certain payment increases for biosimilar biological products under the Medicare program - Rep. Cardenas, Tony - Medicare payment increase for biosimilars H.R. 6445 - Medicare Audiology Access Improvement Act of 2023 - Rep. Bilirakis, Gus - Medicare Audiology Coverage H.R. 7147 - Medicare Transaction Fraud Prevention Act - Rep. Schweikert, David - oversight of payments for medical equipment & clinical DLTs under Medicare H.R. 7148 - Medicare Home Health Accessibility Act - Rep. Smucker, Lloyd - occupational therapy eligibility for home health coverage under Medicare H.R. 7254 - Hearing Device Coverage Clarification Act - Rep. Fischbach, Michelle - excludes fully implanted active middle ear hearing devices from the hearing aid coverage exclusion under Medicare H.R. 7274 - Connecting Caregivers to Medicare Act of 2024 - Rep. Carey, Mike - outreach, education, and simplify information for family caregivers on Medicare benefits H.R. 7432 - Sickle Cell Disease Comprehensive Care Act - Rep. Burgess, Michael - enables State Medicaid programs to provide coordinated care through health home to individuals with sickle cell disease H.R. 7512 - Real-Time Benefit Tool Implementation Act - Rep. Arrington, Jodey - implementation of real-time benefit tools under part D of under Medicare H.R. 7573 - Stop Unfair Medicaid Recoveries Act - Rep. Schakowsky, Janice - Medicaid Estate Recovery Program H.R. 7619 - Expand the Behavioral Health Workforce Now Act - Rep. Neguse, Joe - education, training, recruitment, and retention of mental health and substance use disorder providers under Medicaid and CHIP H.R. 7623 - Telehealth Modernization Act of 2024 - Rep. Carter, Earl L. Buddy - makes certain telehealth flexibilities permanent under Medicare and adds requirements for Part D plan contracts with PBMs including reporting and delinking provisions H.R. 7856 - Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-based Strategies Act (PREVENT DIABETES Act)- Rep. DeGette, Diana - Medicare, coverage, preventive care, chronic care H.R. 7863 - To require the Secretary of Health and Human Services to issue guidance on furnishing behavioral health services via telehealth to individuals with limited English proficiency under Medicare program. - Rep. Steel, Michelle - Medicare, behavioral health, telehealth, accessibility H.R. 7939 - Patient Access to Innovative New Technologies Act of 2024 - Rep. Carey, Mike - Medicare, quality, medical devices, coverage H.R. 7996 - Improving CARE for Youth Act - Rep. Dunn, Neal - allows for same-day billing for mental health services for youth Medicaid beneficiaries who are being seen for a primary care service H.R. 8018 - Alleviating Barriers for Caregivers Act- Rep. Cammack, Kat - review and simplify caregiver paperwork, CHIP, Medicare, Medicaid H.R. 8064 - Help Extend Auditory Relief Act of 2024- Rep. Cartwright, Matt - Medicare coverage of hearing aids H.R. 8075 - Improving Access to Home Dialysis Act of 2024- Rep. Miller, Carol - Medicare coverage of home dialysis H.R. 8115 - To amend title XIX of the Social Security Act to allow for the deferral or disallowance of portions of payments for certain managed care violations under Medicaid- Rep. Sarbanes, John - Medicaid managed care payment deferral H.R. 8261 - Preserving Telehealth, Hospital, and Ambulance Access Act- Rep. Schweikert, David - extend flexibilities and payment for Medicare H.R. 8702 - Improving Seniors Timely Access to Care Act - Rep. Mike Kelly - prior authorization, transparency, MA S. 838 - Improving Access to Mental Health Act - Sen. Stabenow, Debbie - mental health services in Medicare S. 948 - Healthy Moms and Babies Act - Sen. Grassley, Chuck - establishes programs and requirements to support maternal health services under Medicaid and CHIP S. 1002 - No UPCODE Act - Sen. Cassidy, Bill - modifies certain factors that are used to determine Medicare Advantage (MA) payments, particularly relating to health status and related data S. 2880 - Expanded Telehealth Access Act - Sen. Daines, Steve - Medicare payment for telehealth services S. 3573 - Medicare Advantage Supplemental Benefits Transparency Act- Sen. Warner, Mike - MA, data transparency, supplemental benefits S. 3578 - Protect Medicaid Act - Sen. Cassidy, Bill - prohibits federal payments under Medicaid for noncitizens, requires reporting to HHS of states that provide such health benefits S. 3630 - Medicare Transaction Fraud Prevention Act- Sen. Braun, Mike- pilot program for predictive risk-scoring algorithm, oversight, Medicare S. 3651 - Telemental Health Care Access Act of 2024- Sen. Cassidy, Bill - Medicare, mental health services, telehealth S. 3766 - Connecting Caregivers to Medicare Act of 2024- Sen. Tillis, Thomas - Medicare, outreach and education, caregivers S. 3882 - Helping States Integrate Medicare and Medicaid Act- Sen. Casey, Robert - dual eligibles, quality measures, access, enrollment S. 3934 - Increasing Access to Biosimilars Act of 2023- Sen. Cornyn, John - Medicare drug access S. 3950 - Delivering Unified Access to Lifesaving Services Act of 2024 - Sen. Cassidy, Bill - reforming Integrated Medicare/Medicaid Care Programs for Dually Eligible Individuals S. 4094 - PREVENT DIABETES Act - Sen. Scott, Tim - Medicare, coverage, preventive care, chronic care S. 4532 - Improving Seniors Timely Access to Care Act - Sen. Marshall, Roger - prior authorization, transparency, MA S. 4767 - Insurance Fraud Accountability Act - Sen. Wyden, Ron - reduces fraudulent enrollments in qualified health plans Issues related to mental health and Medicare; Medicare and Medicaid funding; Medicaid expansion; State innovation waivers; Medicaid and CHIP; Medicaid FMAP; Medicare Supplement Coverage; Medicare Transparency in Coverage; Medicaid Access Final Rule; Medicaid Redeterminations; Medicaid rate actuarial soundness; value of Medicaid Managed Care; Medicare Advantage Health Risk Assessment and chart reviews; Medicare Advantage supplemental benefits and Social Determinants of health; coverage of weight loss drugs; and Inflation Reduction Act implementation.

Client expense: $2,560,000 · Firm income: Not reported

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

Medicare and Medicaid dual eligible integration; Performance evaluation/quality oversight; Monitoring of Medicare Advantage, particularly as it relates to changes in coding intensity, benchmarks, and health risk assessments; Issues related to Medicare Advantage marketing practices; S. 3950, Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024; Issues related to Calendar Year (CY) 2025 Rate Announcement for the Medicare Advantage (MA) and Medicare Part D Prescription Drug (Part D) Programs (Rate Notice); Congressional briefing on SNP Supplemental Benefits; Expiring healthcare extenders

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare and Medicaid dual eligible integration; Monitoring of Medicare Advantage, particularly as it relates to changes in coding intensity, benchmarks, and health risk assessments; Issues related to Medicare Advantage marketing practices and provider directories; Issues related to 2024 Medicare Advantage star ratings; S. 3950, Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024; Calendar Year (CY) 2025 Rate Announcement for the Medicare Advantage (MA) and Medicare Part D Prescription Drug (Part D) Programs (Rate Notice); Issues related to Medcare Advantage prior authorization; Expiring healthcare extenders

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

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

S. 4532--A bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans--Prior Authorization in Medicare Advantage H.R. 8702--To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans--Prior Authorization in Medicare Advantage S. 3573--Medicare Advantage Supplemental Benefits Transparency Act--Improving Supplemental Benefits for Medicare Advantage beneficiaries HR. 5746--Addressing Whole Health in Medicare Advantage Act--Supplemental Benefits for chronically Ill enrollees H.R. 4968--Gold Card Act of 2023--Exemptions to Prior Authorization in Medicare Advantage S. 3950--Delivering Unified Access to Lifesaving Services Act of 2024 (DUALS Act)--Care Delivery for those eligible for Medicare and Medicaid Issues related to data collection and sharing among health plans, providers, and community-based organizations issues In-home Heath Risk Assessments issues Issues related to mental and behavioral health issues in Medicare Advantage

Client expense: $490,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

PACE regulations and PACE demonstration. Medicaid and Medicare reimbursement. Medicare Part D reform. ACO Reach. S. 1703/H.R. 3549 - PACE Part D Choice Act. H.R. 6590 - PACE Expanded Act. S. 3950 - DUALS Act of 2024.

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

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

S. 3950 Duels Act of 2024 institutional special needs plans, Medicare Advantage, network adequacy, duel eligibles

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

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

Monitoring legislation that could impact access to care for Medicare and dually-eligible individuals as well as legislation that could impact health insurance operations and educating on general health insurance matters that impact the Commonwealth Care Alliance, including the "Lower Costs, More Transparency Act (H.R. 5378)", the "Improving Seniors Timely Access to Care Act (S. 4532/H.R. 8702)", the "DUALS Act (S. 3950) and the "Continuing Appropriations and Extensions Act, 2025 (H.R. 9747)".

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Federal Affairs also lobbies for Medicaid and Medicare payment for health centers and Medicaid unwinding policies. This includes: Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 (S. 2016); HEALTH Act of 2023 (H.R. 5611); Telehealth Modernization Act (H.R. 7623); Preserving Telehealth, Hospital, and Ambulance Access Act (H.R.8261); Pay PCPs Act of 2024 (S.4338); DUALS Act of 2024 (S.3950).

Client expense: $152,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE, White House Office

Federal Affairs lobbies for Teaching Health Centers; Nurse Corps; National Health Service Corps; 340B Drug Discount Program; Community Health Center Program Funding; Behavioral Health; Telehealth policies. This includes the 340B Affording Care for Communities and Ensuring a Strong Safety-net (ACCESS) Act (H.R. 8574); Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 (S. 2016); HEALTH Act of 2023 (H.R. 5611); Telehealth Modernization Act (H.R. 7623); Preserving Telehealth, Hospital, and Ambulance Access Act (H.R.8261); Pay PCPs Act of 2024 (S.4338); DUALS Act of 2024 (S.3950)

Client expense: $152,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Federal Affairs lobbies for Teaching Health Centers; Nurse Corps; National Health Service Corps; 340B Drug Discount Program; Community Health Center Program Funding; Behavioral Health; Telehealth policies. This includes the 340B Affording Care for Communities and Ensuring a Strong Safety-net (ACCESS) Act (H.R. 8574); Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 (S. 2016); HEALTH Act of 2023 (H.R. 5611); Telehealth Modernization Act (H.R. 7623); Preserving Telehealth, Hospital, and Ambulance Access Act (H.R.8261); Pay PCPs Act of 2024 (S.4338); DUALS Act of 2024 (S.3950)

Client expense: $145,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Office of Management & Budget (OMB), SENATE, White House Office

Federal Affairs also lobbies for Medicaid and Medicare payment for health centers and Medicaid unwinding policies. This includes: Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 (S. 2016); HEALTH Act of 2023 (H.R. 5611); Telehealth Modernization Act (H.R. 7623); Preserving Telehealth, Hospital, and Ambulance Access Act (H.R.8261); Pay PCPs Act of 2024 (S.4338); DUALS Act of 2024 (S.3950).

Client expense: $145,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE, White House Office

Issues related to Medicare Advantage payment rates and policies - no specific legislation. Issues related to Medicaid payment rates and policies - no specific legislation. S. 127 - Pharmacy Benefit Manager Transparency Act - entire bill. H.R. 3561 - PATIENT Act - entire bill. HR 5378 - Lower Costs, More Transparency Act. H.R. 4818 - Treat and Reduce Obesity Act of 2023. H.R. 7623 - Telehealth Modernization Act of 2024. S. 3950 - DUALS Act of 2024.

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

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

S. 3950 DUALS Act Monitoring of Medicare Advantage payment policies, coding intensity and marketing practices Monitoring prior authorization

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare and Medicaid dual eligible integration; Performance evaluation/quality oversight; Monitoring of Medicare Advantage, particularly as it relates to changes in coding intensity, benchmarks, and health risk assessments; Issues related to Medicare Advantage marketing practices; S. 3950, Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024; Issues related to Calendar Year (CY) 2025 Rate Announcement for the Medicare Advantage (MA) and Medicare Part D Prescription Drug (Part D) Programs (Rate Notice); Congressional briefing on SNP Supplemental Benefits

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare and Medicaid dual eligible integration; Monitoring of Medicare Advantage, particularly as it relates to changes in coding intensity, benchmarks, and health risk assessments; Issues related to Medicare Advantage marketing practices and provider directories; Issues related to 2024 Medicare Advantage star ratings; S. 3950, Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024; Calendar Year (CY) 2025 Rate Announcement for the Medicare Advantage (MA) and Medicare Part D Prescription Drug (Part D) Programs (Rate Notice); Issues related to Medcare Advantage prior authorization

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

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

Draft, Broker Accountability Act (no bill number) - ACA Agent/Broker accountability H.R. 35 - Close the Medigap Act of 2023 - Rep. Doggett, Lloyd - Medigap policies H.R. 3746 - Fiscal Responsibility Act of 2023 - Rep. McHenry, Patrick - work requirements for federal programs H.R. 3875 - Expanded Telehealth Access Act - Rep. Sherrill, Mikie - Medicare payment for telehealth services H.R. 4411 - Medicare Advantage Integrity Act - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 4818 - Treat and Reduce Obesity Act of 2023 - Rep. Wenstrup, Brad -Medicare Coverage of weight loss treatment H.R. 5526 - Seniors' Access to Critical Medications Act of 2023 - Rep. Harshbarger, Diana - exception for physician self-referral H.R. 5584 - Medicaid Third Party Liability Act - Rep. Burgess, Michael - amends Medicaid Third Party liability requirements H.R. 5746 - Addressing Whole Health in Medicare Advantage Act - Rep. Bilirakis, Gus - Medicare Advantage supplemental benefits H.R. 5854 - Medicare Advantage Consumer Protection and Transparency Act - Rep. Porter, Katie - Medicare Advantage organization reporting H.R. 6364 - Medicare Telehealth Privacy Act of 2023 - Rep. Balderson, Troy - Provider privacy provisions for telehealth under Medicare H.R. 6400 - To amend title XVIII of the Social Security Act to extend eligibility for certain payment increases for biosimilar biological products under the Medicare program - Rep. Cardenas, Tony - Medicare payment increase for biosimilars H.R. 6445 - Medicare Audiology Access Improvement Act of 2023 - Rep. Bilirakis, Gus - Medicare Audiology Coverage H.R. 7147 - Medicare Transaction Fraud Prevention Act - Rep. Schweikert, David - oversight of payments for medical equipment & clinical DLTs under Medicare H.R. 7148 - Medicare Home Health Accessibility Act - Rep. Smucker, Lloyd - occupational therapy eligibility for home health coverage under Medicare H.R. 7254 - Hearing Device Coverage Clarification Act - Rep. Fischbach, Michelle - excludes fully implanted active middle ear hearing devices from the hearing aid coverage exclusion under Medicare H.R. 7274 - Connecting Caregivers to Medicare Act of 2024 - Rep. Carey, Mike - outreach, education, and simplify information for family caregivers on Medicare benefits H.R. 7432 - Sickle Cell Disease Comprehensive Care Act - Rep. Burgess, Michael - enables State Medicaid programs to provide coordinated care through health home to individuals with sickle cell disease H.R. 7512 - Real-Time Benefit Tool Implementation Act - Rep. Arrington, Jodey - implementation of real-time benefit tools under part D of under Medicare H.R. 7573 - Stop Unfair Medicaid Recoveries Act - Rep. Schakowsky, Janice - Medicaid Estate Recovery Program H.R. 7619 - Expand the Behavioral Health Workforce Now Act - Rep. Neguse, Joe - education, training, recruitment, and retention of mental health and substance use disorder providers under Medicaid and CHIP H.R. 7623 - Telehealth Modernization Act of 2024 - Rep. Carter, Earl L. Buddy - makes certain telehealth flexibilities permanent under Medicare H.R. 7856 - Promoting Responsible and Effective Virtual Experiences through Novel Technology to Deliver Improved Access and Better Engagement with Tested and Evidence-based Strategies Act (PREVENT DIABETES Act)- Rep. DeGette, Diana - Medicare, coverage, preventive care, chronic care H.R. 7863 - To require the Secretary of Health and Human Services to issue guidance on furnishing behavioral health services via telehealth to individuals with limited English proficiency under Medicare program. - Rep. Steel, Michelle - Medicare, behavioral health, telehealth, accessibility H.R. 7939 - Patient Access to Innovative New Technologies Act of 2024 - Rep. Carey, Mike - Medicare, quality, medical devices, coverage H.R. 8018 - Alleviating Barriers for Caregivers Act- Rep. Cammack, Kat - review and simplify caregiver paperwork, CHIP, Medicare, Medicaid H.R. 8064 - Help Extend Auditory Relief Act of 2024- Rep. Cartwright, Matt - Medicare coverage of hearing aids H.R. 8075 - Improving Access to Home Dialysis Act of 2024- Rep. Miller, Carol - Medicare coverage of home dialysis H.R. 8115 - To amend title XIX of the Social Security Act to allow for the deferral or disallowance of portions of payments for certain managed care violations under Medicaid- Rep. Sarbanes, John - Medicaid managed care payment deferral H.R. 8261 - Preserving Telehealth, Hospital, and Ambulance Access Act- Rep. Schweikert, David - extend flexibilities and payment for Medicare H.R. 8702 - Improving Seniors Timely Access to Care Act - Rep. Mike Kelly - prior authorization, transparency, MA S. 838 - Improving Access to Mental Health Act - Sen. Stabenow, Debbie - mental health services in Medicare S. 2880 - Expanded Telehealth Access Act - Sen. Daines, Steve - Medicare payment for telehealth services S. 3573 - Medicare Advantage Supplemental Benefits Transparency Act- Sen. Warner, Mike - MA, data transparency, supplemental benefits S. 3578 - Protect Medicaid Act - Sen. Cassidy, Bill - prohibits federal payments under Medicaid for noncitizens, requires reporting to HHS of states that provide such health benefits S. 3630 - Medicare Transaction Fraud Prevention Act- Sen. Braun, Mike- pilot program for predictive risk-scoring algorithm, oversight, Medicare S. 3651 - Telemental Health Care Access Act of 2024- Sen. Cassidy, Bill - Medicare, mental health services, telehealth S. 3766 - Connecting Caregivers to Medicare Act of 2024- Sen. Tillis, Thomas - Medicare, outreach and education, caregivers S. 3882 - Helping States Integrate Medicare and Medicaid Act- Sen. Casey, Robert - dual eligibles, quality measures, access, enrollment S. 3934 - Increasing Access to Biosimilars Act of 2023- Sen. Cornyn, John - Medicare drug access S. 3950 - Delivering Unified Access to Lifesaving Services Act of 2024 - Sen. Cassidy, Bill - reforming Integrated Medicare/Medicaid Care Programs for Dually Eligible Individuals S. 4094 - PREVENT DIABETES Act - Sen. Scott, Tim - Medicare, coverage, preventive care, chronic care S. 4532 - Improving Seniors Timely Access to Care Act - Sen. Marshall, Roger - prior authorization, transparency, MA Issues related to mental health and Medicare; Medicare and Medicaid funding; Medicaid expansion; State innovation waivers; Medicaid and CHIP; Medicaid FMAP; Medicare Supplement Coverage; Medicaid Access Final Rule; Medicaid Redeterminations; value of Medicaid Managed Care; Medicare Advantage Health Risk Assessment; coverage of weight loss drugs; and Inflation Reduction Act implementation.

Client expense: $2,390,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, SENATE

Medicare Advantage Supplemental Benefits Medicare Advantage Star Ratings and Quality Bonus Payments Puerto Rico Medicaid Program Funding - Federal Matching Assistance Percentage (FMAP) Fairness in Medicare Part B Enrollment Act of 2023 (H.R. 4027) Fairness in Medicare Savings Program Act of 2023 (H.R. 4410) Medicare Advantage Integrity Act of 2023 (H.R. 4411) Medicare Advantage & Medicare Part D Prescription Drug Program Territories Medicare Prescription Drug Assistance Equality Act of 2021 (H.R. 1825) Medicaid Managed Care Medicaid Eligibility and Redetermination Medicare Site Neutrality Medicare & Medicaid Social Determinants of Health (SDOH) The DUALS Act of 2024 (S.3950) Medicare Fee For Service (FFS) Beneficiary Education & Engagement

Client expense: $1,330,000 · Firm income: Not reported

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

S. 3950--The Delivering Unified Access to Lifesaving Services Act (DUALS Act)--Medicaid, Medicare Managed Fee-for-Service (MFFS) Medicare Physician Fee Schedule (MPFS) Kidney Care Choices (KCC)

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, SENATE

S. 4532--A bill to amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans--Prior Authorization in Medicare Advantage H.R. 8702--To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans--Prior Authorization in Medicare Advantage S. 3573--Medicare Advantage Supplemental Benefits Transparency Act--Improving Supplemental Benefits for MA beneficiaries H.R. 5380--To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage--Improving Supplemental Benefits for MA beneficiaries S. 3307--Encounter Data Enhancement Act--Encounter Data in MA HR. 5746--Addressing Whole Health in Medicare Advantage Act--Supplemental Benefits for chronically Ill enrollees H.R. 4968--Gold Card Act of 2023--Exemptions to Prior Authorization in Medicare Advantage S. 3950--Delivering Unified Access to Lifesaving Services Act (DUALS) Act of 2024--Care Delivery for those eligible for Medicare and Medicaid Issues related to data collection and sharing among health plans, providers, and community-based organizations In-home Health Risk Assessments issues Issues related to mental and behavioral health issues in Medicare Advantage Issues related to oversight and governance of best practices related to misleading marketing practices and Third-Party Marketing Organizations (TPMO) Growth Rate and Normalization Factor in Calendar Year 2025 MA and Part D Advance Notice

Client expense: $470,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

PACE regulations and PACE demonstration. Medicaid and Medicare reimbursement. Medicare Part D reform. ACO Reach. S. 1703/H.R. 3549 - PACE Part D Choice Act. H.R. 6590 - PACE Expanded Act. S. 3950 - DUALS Act of 2024.

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

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

Federal Affairs also lobbies for Medicaid and Medicare payment for health centers and Medicaid unwinding policies. This includes: Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023 (S. 2016); HEALTH Act of 2023 (H.R. 5611); Telehealth Modernization Act (H.R. 7623); Preserving Telehealth, Hospital, and Ambulance Access Act (H.R.8261); Pay PCPs Act of 2024 (S.4338); DUALS Act of 2024 (S.3950).

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Office of Management & Budget (OMB), SENATE, White House Office

Monitoring legislation that could impact access to care for Medicare and dually-eligible individuals as well as legislation that could impact health insurance operations and educating on general health insurance matters that impact the Commonwealth Care Alliance, including the "Lower Costs, More Transparency Act (H.R. 5378)", the "Improving Seniors Timely Access to Care Act (S. 4532/H.R. 8702)" and the "DUALS Act (S. 3950).

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

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

S. 3950 Duels Act of 2024 institutional special needs plans, Medicare Advantage, network adequacy, duel eligibles

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

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

H.R. 5013 & S.3503 - The Value in Health Care Act of 2023 H.R. 2829 - Chronic Care Management Improvement Act of 2023 H.R. 2474 - Strengthening Medicare for Patients and Providers Act H.R. 6369 - To amend title XVIII of the Social Security Act to extend incentive payments for participation in eligible alternative payment models. H.R. 6545 - Physician Fee Schedule Update and Improvements Act    S. 3430 - Better Mental Health Care, Lower-Cost Drugs, and Extenders Act H.R. 4822 - Health Care Price Transparency Act of 2023 Issues related to Medicare & Medicaid payment and regulations, Medicare Shared Savings Program, ACO REACH, Medicare Advantage, Centers for Medicare and Medicaid Innovation model evaluation, alternative payment model incentives, and telehealth. H.R. 4366, the Consolidated Appropriations Act of 2024 H.R. 7665 & S. 3939 - The ACO Assignment Improvement Act of 2024 S 3950, The Delivering Unified Access to Lifesaving Services of 2024

Client expense: $117,138 · Firm income: Not reported

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

H.R. 35 - Close the Medigap Act of 2023 - Rep. Doggett, Lloyd - Medigap policies H.R. 3746 - Fiscal Responsibility Act of 2023 - Rep. McHenry, Patrick - work requirements for federal programs H.R. 3875 - Expanded Telehealth Access Act - Rep. Sherrill, Mikie - Medicare payment for telehealth services H.R. 4411 - Medicare Advantage Integrity Act - Resident Commissioner Gonzalez-Colon, Jenniffer - disparity in MA benchmark rates H.R. 5526 - Seniors' Access to Critical Medications Act of 2023 - Rep. Harshbarger, Diana - exception for physician self-referral H.R. 5584 - Medicaid Third Party Liability Act - Rep. Burgess, Michael - amends Medicaid Third Party liability requirements H.R. 5746 - Addressing Whole Health in Medicare Advantage Act - Rep. Bilirakis, Gus - Medicare Advantage supplemental benefits H.R. 5854 - Medicare Advantage Consumer Protection and Transparency Act - Rep. Porter, Katie - Medicare Advantage organization reporting H.R. 6364 - Medicare Telehealth Privacy Act of 2023 - Rep. Balderson, Troy - Provider privacy provisions for telehealth under Medicare H.R. 6400 - To amend title XVIII of the Social Security Act to extend eligibility for certain payment increases for biosimilar biological products under the Medicare program - Rep. Cardenas, Tony - Medicare payment increase for biosimilars H.R. 6445 - Medicare Audiology Access Improvement Act of 2023 - Rep. Bilirakis, Gus - Medicare Audiology Coverage H.R. 7147 - Medicare Transaction Fraud Prevention Act - Rep. Schweikert, David - oversight of payments for medical equipment & clinical DLTs under Medicare H.R. 7274 - Connecting Caregivers to Medicare Act of 2024 - Rep. Carey, Mike - outreach, education, and simplify information for family caregivers on Medicare benefits H.R. 7432 - Sickle Cell Disease Comprehensive Care Act - Rep. Burgess, Michael - enables State Medicaid programs to provide coordinated care through health home to individuals with sickle cell disease H.R. 7512 - Real-Time Benefit Tool Implementation Act - Rep. Arrington, Jodey - implementation of real-time benefit tools under part D of under Medicare H.R. 7573 - Stop Unfair Medicaid Recoveries Act - Rep. Schakowsky, Janice - Medicaid Estate Recovery Program H.R. 7619 - Expand the Behavioral Health Workforce Now Act - Rep. Neguse, Joe - education, training, recruitment, and retention of mental health and substance use disorder providers under Medicaid and CHIP H.R. 7623 - Telehealth Modernization Act of 2024 - Rep. Carter, Earl L. - makes certain telehealth flexibilities permanent under Medicare S. 838 - Improving Access to Mental Health Act - Sen. Stabenow, Debbie - mental health services in Medicare S. 2880 - Expanded Telehealth Access Act - Sen. Daines, Steve - Medicare payment for telehealth services S. 3573- Medicare Advantage Supplemental Benefits Transparency Act- Sen. Warner, Mike - MA, data transparency, supplemental benefits S. 3578- Protect Medicaid Act - Sen. Cassidy, Bill - prohibits federal payments under Medicaid for noncitizens, requires reporting to HHS of states that provide such health benefits S. 3630- Medicare Transaction Fraud Prevention Act- Sen. Braun. Mike- pilot program for predictive risk-scoring algorithm, oversight, Medicare S. 3651- Telemental Health Care Access Act of 2024- Sen. Cassidy, Bill - Medicare, mental health services, telehealth S. 3766- Connecting Caregivers to Medicare Act of 2024- Sen. Tillis, Thomas - Medicare, outreach and education, caregivers S. 3882- Helping States Integrate Medicare and Medicaid Act- Sen. Casey, Robert - dual eligibles, quality measures, access, enrollment S. 3934- Increasing Access to Biosimilars Act of 2023- Sen. Cornyn, John - Medicare drug access S. 3950 - Delivering Unified Access to Lifesaving Services Act of 2024 - Sen. Cassidy, Bill - reforming Integrated Medicare/Medicaid Care Programs for Dually Eligible Individuals Issues related to mental health and Medicare; Medicare and Medicaid funding; Medicaid expansion; State innovation waivers; Medicaid and CHIP; Medicaid FMAP; issues related to Medicare Advantage payment, including Medicare Payment Advisory Commission analyses and the 2025 Advance Rate Notice for MA and Part D; MedPAC analysis of MA payments, MA CY 2025 rate notice; MA risk adjustment; prior authorization in Medicare and Medicaid; MA coverage in rural areas; and issues related to implementation of the Inflation Reduction Act, including reform of the Medicare Part D program. Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, network adequacy and provider directories, encounter data and other data-related issues, and risk adjustment data validation (RADV) audit issues including RADV regulation for MA; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, Part D direct and indirect remuneration (DIR), and audits); issues related to Medicare for All, Medicare buy-in, reduced Medicare eligibility age, and public option; issues relating to 2024 Rate Notice; issues related to the expiration of Medicaid continuous eligibility and transitions in coverage; issues related to coverage in non-Medicaid Expansion States (e.g., Gap Population); issues related to expanded Medicare fee for service benefits (dental, hearing and vision); issues related to specialty infant formula; issues related to the Inflation Reduction Act implementation; contraceptive coverage and reproductive health; Medicare NCD relating to monoclonal antibodies for treatment of Alzheimers disease; issues related to Managed Long Term Services and Supports (MLTSS); issues relating to COVID-19, including testing, vaccines and therapeutics; issues related to the end of the public health emergency, including the Medicaid unwinding; telehealth; issues related to the cost of insulin, including price, copays, rebates, and medical management tools; issues related to health equity; issues related to artificial intelligence; issues related to vaccination; issues related to audio-only telehealth; issues related to addressing the social determinants of health, including housing, transportation, nutrition, educational opportunities, and MA supplemental benefits; issues related to Medicaid presumptive eligibility and continuous eligibility; issues relating to Medicaid best price; in-home health risk assessments; Medicare Medical Loss Ratio issues; issues related to changes to prior authorization regulations or legislation, electronic documentation, and related issues; issues relating to sequestration under the Medicare Advantage and Part D programs; implications of physician fee schedule on MA; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, enrollment rules, requirements for notice and denial forms, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible SNPs; Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; issues raised by Part D coverage of new specialty drugs, the Part D non-interference policy and related issues (e.g., preferred pharmacy and any willing pharmacy requirements, standards for network pharmacy reimbursement, and policies regarding sponsor negotiation of pharmacy price concessions); issues related to the international price index; issues related to child and maternal health; issues related to Medicaid supplemental and disproportionate share hospital (DSH) funding; issues related to Medicaid funding for territories; issues related to medical management; issues relating to MA supplemental benefits; Medication Therapy Management Program requirements and the Center for Medicare and Medicaid Innovation (CMMI) Demonstration; MA EGWP issues; CMMI's value based payment models; Part D requirements for offering basic and enhanced alternative plans; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; issues relating to MA and Part D Star Rating system including measures, the methodology for calculating ratings, and the role of the ratings for payment purposes; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; issues relating to MACRA, including implications for MA and Part D plans; Medicare/Medicaid integration for dual eligibles, including implementation of the Capitated Financial Alignment Demonstration and related issues (e.g., quality ratings); issues relating to potential Medicare mental health parity requirements; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans including issues raised by Medicaid coverage of new specialty drugs; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues and CHIP reauthorization; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; issues related to Medicaid Managed long-term care including home and community-based waiver services (HCBS); expanding the availability of Medicare Advantage and Medicaid health plan telemedicine programs; implications of the new non-discrimination rules for health plans participating in public programs; issues related to Medigap coverage; issues related to business continuity in relation to pandemics or natural events (e.g., hurricane, tornado, etc.); cybersecurity; provider directories; value-based insurance design models; Part D prescriber enrollment requirements; Part D recovery audit contractor programs; issues related to health homes for children with medically complex conditions; socioeconomic status impacts on star ratings related to MA and Part D programs; issues related to private equity ownership transparency; and other issues relating to health care reform implementation.

Client expense: $4,210,000 · Firm income: Not reported

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

Medicare and Medicaid dual eligible integration; Monitoring of Medicare Advantage, particularly as it relates to changes in coding intensity, benchmarks, and health risk assessments; Senator Cassidy draft legislation on dual eligible beneficiaries; Issues related to Medicare Advantage marketing practices; Issues related to 2024 Medicare Advantage star ratings; S. 3950, Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024; Calendar Year (CY) 2025 Rate Announcement for the Medicare Advantage (MA) and Medicare Part D Prescription Drug (Part D) Programs (Rate Notice)

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

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

Medicare and Medicaid dual eligible integration; Performance evaluation/quality oversight; SES (socio-economic status) issues related to SNP payment rates and quality measures; Monitoring of Medicare Advantage, particularly as it relates to changes in coding intensity, benchmarks, and health risk assessments; Issues related to Medicare Advantage marketing practices; S. 3950, Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024; Calendar Year (CY) 2025 Rate Announcement for the Medicare Advantage (MA) and Medicare Part D Prescription Drug (Part D) Programs (Rate Notice)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Outreach in support of the Acute Hospital Care at Home Waiver Program. Support for the DUALS Act of 2024 (S. 3950) Support for the At HOME Services Act of 2024 (S.3756) Issues related to Physician Fee Schedule cuts. Outreach in support of the Advanced Alterative Payment Model (APM) Incentive. Support for the Resident Physician Shortage Reduction Act of 2023 (S. 1302/H.R. 2389) Outreach in support of emergency and trauma service access. Reauthorization of the Dr. Lorna Breen Health Care Provider Protection Act (S. 3679)

Client expense: $5,807 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Outreach in support of the Acute Hospital Care at Home Waiver Program. Issues related to Physician Fee Schedule cuts. Outreach in support of the Advanced Alterative Payment Model (APM) Incentive. Support for the DUALS Act of 2024 (S. 3950) Support for the At HOME Services Act of 2024 (S.3756)

Client expense: $5,807 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4822, Health Care Price Transparency Act of 2023, including provisions related to Improving Seniors Timely Access to Care Act concerning the modernization of the prior authorization process S. 3950, Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024, including provisions requiring each state to select, develop and implement a comprehensive, integrated health plan for dual-eligible beneficiaries, and plans to develop and update care coordination plans, establish ombudsman offices, and establish a care coordinator for each beneficiary, reduce look-alike plans, create a single appeals process, and reduce third-party marketing organization incentives to target beneficiaries, expanding Program of All-Inclusive Care for the Elderly (PACE) coverage, and acknowledge dual eligibles are a diverse group with complex needs, including individuals with multiple chronic conditions, physical disabilities, mental illness, and cognitive impairments such as dementia and developmental disabilities. Issues related to Medicaid Redetermination unwinding process. Issues related to CMMI VBID (Value Based Insurance Design) application and criteria and new guidelines. Issues related to Pharmacy Benefit Management (PBM). Issues related to behavioral health. Issues related to prior authorization.

Client expense: $1,410,000 · Firm income: Not reported

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

PACE regulations and PACE demonstration. Medicaid and Medicare reimbursement. Medicare Part D reform. ACO Reach. S. 1703/H.R. 3549 - PACE Part D Choice Act. H.R. 6590 - PACE Expanded Act. S. 3950 - DUALS Act of 2024.

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

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