Improving Access to Medicare Coverage Act of 2024

Issues pertaining to physician payment and patient access to hospital care in PL 119-21, the One Big Beautiful Bill Act; various Presidential executive orders affecting health care providers; S. 1640/HR 879, the Medicare Patient Access and Practice Stabilization Act; S. 1816/HR 3514, the Improving Seniors' Timely Access to Care Act; S. 4137/HR 3954, the Improving Access to Medicare Coverage Act; HR 538, the Critical Access Hospitals Relief Act of 2025; provisions in CMS-1832-F, the CY 2026 Medicare Physician Fee Schedule Final Rule; health policy extensions in PL 119-75, FY2026 Consolidated Defense, LHHSED, Nat. Sec.-State, THUD, FSGG Approps. Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to drinking water and clean water infrastructure. Implementation of H.R. 7776/S. 4137 James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 (P.L. 117-263); the Infrastructure Investment and Jobs Act (P.L. 117-58). Reauthorization of EPA water infrastructure programs.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues pertaining to physician payment and patient access to hospital care in PL 119-21, the One Big Beautiful Bill Act; various Presidential executive orders affecting health care providers; S. 1640/HR 879, the Medicare Patient Access and Practice Stabilization Act; S. 1816/HR 3514, the Improving Seniors' Timely Access to Care Act; S. 4137/HR 3954, the Improving Access to Medicare Coverage Act; HR 538, the Critical Access Hospitals Relief Act of 2025; provisions in CMS-1832-F, the CY 2026 Medicare Physician Fee Schedule Final Rule; health policy extensions in PL 119-37, FY2026 Continuing Appropriations, Agriculture, Leg. Branch, MCVA and Extensions Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to drinking water and clean water infrastructure. Implementation of H.R. 7776/S. 4137 James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 (P.L. 117-263); the Infrastructure Investment and Jobs Act (P.L. 117-58).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues pertaining to physician payment and patient access to hospital care in PL 119-21, the One Big Beautiful Bill Act; various Presidential executive orders affecting health care providers; S. 1640/HR 879, the Medicare Patient Access and Practice Stabilization Act; S. 1816/HR 3514, the Improving Seniors' Timely Access to Care Act; S. 4137/HR 3954, the Improving Access to Medicare Coverage Act; HR 538, the Critical Access Hospitals Relief Act of 2025

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to drinking water and clean water infrastructure. Implementation of H.R. 7776/S. 4137 James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 (P.L. 117-263); the Infrastructure Investment and Jobs Act (P.L. 117-58).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues pertaining to physician payment in HR 1; the One Big Beautiful Bill Act various Presidential executive orders affecting health care providers; S. 1640/HR 879, the Medicare Patient Access and Practice Stabilization Act; S. 1816/HR 3514, the Improving Seniors' Timely Access to Care Act; S. 4137/HR 3954, the Improving Access to Medicare Coverage Act; HR 538, the Critical Access Hospitals Relief Act of 2025

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to drinking water and clean water infrastructure. Implementation of H.R. 7776/S. 4137 James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 (P.L. 117-263); the Infrastructure Investment and Jobs Act (P.L. 117-58).

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to drinking water and clean water infrastructure. Implementation of H.R. 7776/S. 4137 James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 (P.L. 117-263); the Infrastructure Investment and Jobs Act (P.L. 117-58); and the Inflation Reduction Act (P.L. 117-169).

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

Government targets: Army, Dept of (Corps of Engineers), Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, SENATE

Issues related to drinking water and clean water infrastructure. Implementation of H.R. 7776/S. 4137 James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 (P.L. 117-263); the Infrastructure Investment and Jobs Act (P.L. 117-58); and the Inflation Reduction Act (P.L. 117-169).

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

Government targets: Environmental Protection Agency (EPA), 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: $1,170,000 · Firm income: Not reported

(S.3138/H.R.5434) - Stabilize Medicaid and CHIP Coverage Act - Urged Congress to pass the Stabilize Medicaid and CHIP Coverage Act. This legislation ensures 12-month continuous eligibility for adults in Medicaid and the Children's Health Insurance Program (CHIP). (H.J. Res.139) - Expressed support for H.J. Res. 139 a joint resolution for congressional disapproval of the rule related to Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. The rule would establish minimum staffing standards for Medicare- and Medicaid-certified long-term care facilities and require them to have a registered nurse on site 24 hours per day. (H.R. 7858) Telehealth Enhancement for Mental Health Act - Expressed support for the Telehealth Enhancement for Mental Health Act. This legislation would revolutionize access to mental health care by changing Medicare reimbursement policies for mental health services provided via telehealth. (H.R. 8261) Preserving Telehealth, Hospital and Ambulance Access Act: Expressed support for the Preserving Telehealth, Hospital and Ambulance Access Act. This legislation would expand Medicare telehealth for two years, hospital-at-home flexibilities for five years, and Medicare supplemental payments for rural hospitals and ambulatory services. (H.R. 5378) Lower Costs, More Transparency Act - Urged Congress to reject policies that reduce reimbursements under the Medicare program, especially site-neutral proposals. (S. 4137/H.R. 5138) - Improving Access Medicare Coverage Act - Expressed support for the Improving Access Medicare Coverage Act. This legislation will make days spent in observation count towards Medicare's three-day inpatient stay requirement for Skilled Nursing Facility (SNF) coverage. Urged the Centers for Medicare and Medicaid Services (CMS) to take action to prevent millions of Medicaid beneficiaries from losing coverage as states unwind the temporary Medicaid provisions in place during the pandemic. (H.R. 2665) - Supporting Safety Net Hospitals Act - Expressed support for the Supporting Safety Net Hospitals Act. The legislation would address spending cuts to Medicaid DSH payments. Urged Congress to address the Medicaid disproportionate share hospital (DSH) cuts scheduled to begin in fiscal year (FY) 2025.

Issues pertaining to physician payment and quality measurement, including HR 2474, Strengthening Medicare for Patients and Providers Act; observation care, including S 4137/HR 5138, Improving Access to Medicare Coverage Act of 2023; S 4532/HR 8702, Improving Seniors Timely Access to Care Act of 2024

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

Government targets: HOUSE OF REPRESENTATIVES, 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.

Issues related to drinking water and clean water infrastructure. Implementation of H.R. 7776/S. 4137 James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 (P.L. 117-263); the Infrastructure Investment and Jobs Act (P.L. 117-58); and the Inflation Reduction Act (P.L. 117-169).

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

Government targets: Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, SENATE

(S.3138/H.R.5434) - Stabilize Medicaid and CHIP Coverage Act - Urged Congress to pass the Stabilize Medicaid and CHIP Coverage Act. This legislation ensures 12-month continuous eligibility for adults in Medicaid and the Children's Health Insurance Program (CHIP). (H.J. Res.139) - Expressed support for H.J. Res. 139 a joint resolution for congressional disapproval of the rule related to Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. The rule would establish minimum staffing standards for Medicare- and Medicaid-certified long-term care facilities and require them to have a registered nurse on site 24 hours per day. Urged CMS to issue guidance on the DACA eligibility rule which would expand eligibility for recipients of the Deferred Action for Childhood Arrivals program to enroll in qualified health plans through the Affordable Care Act Health Insurance Marketplace and qualify for subsidies and cost-sharing reductions based on income. (H.R. 7858) Telehealth Enhancement for Mental Health Act - Expressed support for the Telehealth Enhancement for Mental Health Act. This legislation would revolutionize access to mental health care by changing Medicare reimbursement policies for mental health services provided via telehealth. (H.R. 8261) Preserving Telehealth, Hospital and Ambulance Access Act: Expressed support for the Preserving Telehealth, Hospital and Ambulance Access Act. This legislation would expand Medicare telehealth for two years, hospital-at-home flexibilities for five years, and Medicare supplemental payments for rural hospitals and ambulatory services. (H.R. 5378) Lower Costs, More Transparency Act - Urged Congress to reject policies that reduce reimbursements under the Medicare program, especially site-neutral proposals. Urged the Centers for Medicare and Medicaid Services (CMS) to revise its rule for Medicaid managed care programs. The rule includes significant provisions related to state directed payments (SDPs), supplemental payments states can utilize for managed care. Urged the Centers for Medicare and Medicaid Services (CMS) CMS to continue providing vital information about Medicaid redeterminations, including making information and data pertaining to Medicaid renewals publicly available and to work with states to provide information about Medicaid beneficiaries whose coverage has been reinstated after being previously terminated, as well as breaking the information down by race and ethnicity. (S. 4137/H.R. 5138) - Improving Access Medicare Coverage Act - Expressed support for the Improving Access Medicare Coverage Act. This legislation will make days spent in observation count towards Medicare's three-day inpatient stay requirement for Skilled Nursing Facility (SNF) coverage. Urged the Centers for Medicare and Medicaid Services (CMS) to take action to prevent millions of Medicaid beneficiaries from losing coverage as states unwind the temporary Medicaid provisions in place during the pandemic. (H.R. 2665) - Supporting Safety Net Hospitals Act - Expressed support for the Supporting Safety Net Hospitals Act. The legislation would address spending cuts to Medicaid DSH payments. Urged Congress to address the Medicaid disproportionate share hospital (DSH) cuts scheduled to begin in fiscal year (FY) 2025.

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

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.

Affordable Connectivity Program (ACP) S. 4137 - Secure and Affordable Broadband Extension Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues pertaining to physician payment and quality measurement, including HR 2474, Strengthening Medicare for Patients and Providers Act; observation care, including S 4137/HR 5138, Improving Access to Medicare Coverage Act of 2023; S 4532/HR 8702, Improving Seniors Timely Access to Care Act of 2024

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues related to drinking water and clean water infrastructure. Implementation of H.R. 7776/S. 4137 James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 (P.L. 117-263); the Infrastructure Investment and Jobs Act (P.L. 117-58); and the Inflation Reduction Act (P.L. 117-169).

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

Government targets: Army, Dept of (Corps of Engineers), Environmental Protection Agency (EPA), 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.

Urged CMS to finalize the DACA eligibility rule which would expand eligibility for recipients of the Deferred Action for Childhood Arrivals program to enroll in qualified health plans through the Affordable Care Act Health Insurance Marketplace and qualify for subsidies and cost-sharing reductions based on income. (H.R. 7858) Telehealth Enhancement for Mental Health Act - Expressed support for the Telehealth Enhancement for Mental Health Act. This legislation would revolutionize access to mental health care by changing Medicare reimbursement policies for mental health services provided via telehealth. (H.R. 8261) Preserving Telehealth, Hospital and Ambulance Access Act: Expressed support for the Preserving Telehealth, Hospital and Ambulance Access Act. This legislation would expand Medicare telehealth for two years, hospital-at-home flexibilities for five years, and Medicare supplemental payments for rural hospitals and ambulatory services. (H.R. 5378) Lower Costs, More Transparency Act - Urged Congress to reject policies that reduce reimbursements under the Medicare program, especially site-neutral proposals. Urged the Centers for Medicare and Medicaid Services (CMS) to revise its proposed rule for Medicaid managed care programs. The proposed rule includes significant provisions related to state directed payments (SDPs), supplemental payments states can utilize for managed care. Urged the Centers for Medicare and Medicaid Services (CMS) CMS to continue providing vital information about Medicaid redeterminations, including making information and data pertaining to Medicaid renewals publicly available and to work with states to provide information about Medicaid beneficiaries whose coverage has been reinstated after being previously terminated, as well as breaking the information down by race and ethnicity. (S. 4137/H.R. 5138) - Improving Access Medicare Coverage Act - Expressed support for the Improving Access Medicare Coverage Act. This legislation will make days spent in observation count towards Medicare's three-day inpatient stay requirement for Skilled Nursing Facility (SNF) coverage. Urged the Centers for Medicare and Medicaid Services (CMS) to take action to prevent millions of Medicaid beneficiaries from losing coverage as states begin unwinding the temporary Medicaid provisions in place during the pandemic. (H.R. 2665) - Supporting Safety Net Hospitals Act - Expressed support for the Supporting Safety Net Hospitals Act. The legislation would address spending cuts to Medicaid DSH payments. Urged Congress to address the Medicaid disproportionate share hospital (DSH) cuts scheduled to begin in fiscal year (FY) 2024.

Affordable Connectivity Program (ACP) S. 4137 - Secure and Affordable Broadband Extension Act

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

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.

Issues related to drinking water and clean water infrastructure. Implementation of H.R. 7776/S. 4137 James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 (P.L. 117-263); the Infrastructure Investment and Jobs Act (P.L. 117-58); and the Inflation Reduction Act (P.L. 117-169).

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

Government targets: Army, Dept of (Corps of Engineers), Environmental Protection Agency (EPA), HOUSE OF REPRESENTATIVES, SENATE