Patient Access to Higher Quality Health Care Act of 2023

Nominations Supported the nomination of Andrew Hughes to serve as the Deputy Secretary of the U.S. Department of Housing and Urban Development. Legislation/Guidance/Housing Issues CARES Act 30-day notice of eviction requirement H.R. 1981, Choice in Affordable Housing Act of 2025, to increase the number of landlords participating in the Housing Choice Voucher program, all provisions. S. 890, Choice in Affordable Housing Act of 2025, to increase the number of landlords participating in the Housing Choice Voucher program, all provisions. H.R. 3507 (118h Congress), Yes In My Backyard Act, all provisions S. 1688 (118h Congress), Yes In My Backyard Act, all provisions. H.R. __ the Identifying Regulatory Barriers to Housing Supply Act, DRAFT legislation, to require certain grantees under title I of the Housing and Community Development Act of 1974 to submit a plan to track discriminatory land use policies, and for other purposes, all provisions. S. _the Identifying Regulatory Barriers to Housing Supply Act, DRAFT legislation, to require certain grantees under title I of the Housing and Community Development Act of 1974 to submit a plan to track discriminatory land use policies, and for other purposes, all provisions. H.R. 1078, Respect State Housing Laws Act, to amend the CARES Act to remove a requirement on lessors to provide notice to vacate, and for other purposes, all provisions. S. 470, Respect State Housing Laws Act, to amend the CARES Act to remove a requirement on lessors to provide notice to vacate, and for other purposes, all provisions. H.R. ___,Reducing Regulatory Barriers to Housing Act - A bill to reduce regulatory barriers to housing, and for other purposes. H.R.__, the Housing for Americas Middle Class Act, reviewed draft legislation. S.1299/ H.R. 2840 the Housing Supply Frameworks Act, all provisions. H.R. 6199 (118th Congress), Build More Housing Near Transit Act of 2023, to amend title 49, United States Code, to include affordable housing incentives in certain capital investment grants, and for other purposes, all provisions. S. 3216 (118th Congress), Build More Housing Near Transit Act of 2023, to amend title 49, United States Code, to include affordable housing incentives in certain capital investment grants, and for other purposes, all provisions. Draft legislative proposal, Housing Production Partnership Program Act of 2025, for Federal subsidy for state and local multifamily property tax abatement matching program to be administered through the Department of Housing and Urban Development's Pathways to Removing Obstacles to Housing program. Draft legislative proposal, Housing Production Partnership Program Act of 2025, for Federal subsidy for state and local multifamily property tax abatement matching program to be administered through the Department of Housing and Urban Development's HOME program Draft legislation, to amend title 23, United States Code, to direct the Secretary of Transportation to establish creditworthiness standards required for transit-oriented development projects that include commercial and residential development activities to be eligible to receive TIFIA funds, and for other purposes, all provisions. Draft legislative proposal, Investing in Housing Affordability Act of 2025, to create a new program based off the Small Business Investment Company model, operated at zero subsidy cost to taxpayers, and housed at the Treasury Department to provide low-cost capital to funds that invest equity or debt in affordable rental housing and homeownership projects. Requested that Fiscal Year 2026 Transportation, Housing and Urban Development (THUD) Appropriations bill include language striking subsection (c) from Section 4024 of the CARES Act (15 U.S.C. 9058), making clear that the requirement that a lessor of a covered property provide a tenant 30-days notice before requiring the tenant to vacate has ended. Lessons learned from COVID-era Emergency Rental Assistance Program that could inform future efforts. Request that FY2026 appropriations legislation fully fund: Housing Choice Voucher program (including renewals of special purpose vouchers), Housing Choice Voucher Administrative Fee Account, Emergency Housing Voucher households, Project-Based Rental Assistance. We also asked that FY2026 appropriations address the housing needs of rural communities. Federal Housing Finance Agency interpretation of 15 U.S.C. 9058, which requires that the lessor of a covered property provide a tenant 30-days notice before requiring the tenant to vacate. Study regarding the impact of state and local tenant protection laws on the cost of rent. HOME Investments Partnership Program reforms Fiscal Year 2026 Transportation-HUD Appropriations S.1527 - Housing Affordability Act A bill to modify the multifamily loan limits under title II of the National Housing Act, and for other purposes. Fees in rental housing. Fair Housing Act (Disparate Impact Rule, Screening, Criminal History Policy, and Reporting) Fair Housing Rules as they pertain to Emotional Support Animals. Possible legislation related to federal building code requirements, exemptions or studies. Possible legislation on Fire Safety Requirements related to Single Stair Entry Regulatory Review and Reform Rules and Regulations Pertaining to the Section 8 Housing Choice Voucher Program (HCV) 30-Day Notification Requirement Prior To Termination of Lease for Nonpayment of Rent (Docket # 89 FR 101270) Final Rule (24 CFR Parts 247, 880, 884, 886, 891, and 966) Reinstatement of HUD's Discriminatory Effects Standard (Docket #88 FR 19450) Final Rule (88 FR 19450) Reducing Barriers to HUD-Assisted Housing (Docket # FR-6362-P-01) Proposed Rule (24 CFR Parts 5, 245, 882, 960, 966, and 982) Withdrawn on January 16, 2025 Floodplain Management and Protection of Wetlands; Minimum Property Standards for Flood Hazard Exposure; Building to the Federal Flood Risk Management Standard (Docket # 89 FR 30850) Final Rule (24 CFR Parts 50, 55, 58, and 200) HOME Investment Partnerships Program: Program Updates and Streamlining (Docket # 90 FR 746) Final Rule (24 CFR Parts 91, 92, 570, and 982) Adoption of Energy Efficiency Standards for New Construction of HUD- and USDA-Financed Housing; Extension of HUD Compliance Dates (Docket # 90 FR 11622) Final Determination and Reconsideration Draft Notice on Solar, Cell Tower and Rooftop Leases (Drafting Table) Guidance on Application of the Fair Housing Act to the Advertising of Housing, Credit, and Other Real Estate-Related Transactions through Digital Platforms Guidance on Application of the Fair Housing Act to the Screening of Applicants for Rental Housing Build America, Buy America Act (BABA): Request for Information Regarding Iron, Steel, Construction Materials and Manufactured Products Used in Housing Programs Pursuant to the Build America, Buy America Act (Docket # 88 FR 24690) Request for Information (FR-6331-N-01) Affirmatively Furthering Fair Housing (Docket # 90 FR 4686) Proposed Rule, withdrawn by HUD (24 CFR Parts 5, 91, 92, 93, 570, 574, 576, 903 and 983) National Standards for the Physical Inspection of Real Estate: Inspection Standards (Docket # 88 FR 40832) Notice of Proposed Rulemaking Changes to the Methodology Used for Calculating Section 8 Income Limits Under the United States Housing Act of 1937 (Docket # 89 FR 1583) Notice of Proposed Rulemaking Department of Housing and Urban Development, FR-6436-N-01-Changes to the Methodology Used for Calculating Section 8 Income Limits Under the United States Housing Act of 1937, HUD-2024-0003. Department of Housing and Urban Development, Docket No. FR-6522-N-01, Office of the Assistant Secretary of Housing-Federal Housing Commissioner, HUD, Proposed Changes in Mortgage Insurance Premiums Applicable to FHA Multifamily Insurance Programs (FR Doc. 2025-11814). Review Current Rules, Notices and Guidance pertaining to Criminal Screening, Digital Advertisements, and Discriminatory Standards Reform Rules and Regulations Pertaining to the Section 8 Housing Choice Voucher program (HCV)

Client expense: $2,720,000 · Firm income: Not reported

Government targets: Council of Economic Advisers (CEA), Federal Housing Finance Agency (FHFA), HOUSE OF REPRESENTATIVES, Housing & Urban Development, Dept of (HUD), Justice, Dept of (DOJ), Office of Management & Budget (OMB), SENATE

Behavioral Health H. 8526, Elementary and Secondary School Counseling Act Childcare Issues related to childcare - no specific bill Gun Safety Issues related to gun safety - no specific bill H.R. 4283, Gun Violence Prevention and Community Safety Act Health Care S. 4503, A bill to prevent exploitative private equity practices, and for other purposes Issues related to health care/universal access to quality, equitable, affordable coverage - no specific bill Issues related to mental and behavioral health care - no specific bill Issues related to Private Equity/Healthcare - no specific bill H.R. 9001, Physician Led and Rural Access to Quality Care Act Support of community water fluoridation - no specific bill Health Care Workforce Issues related to health care workforce shortages - no specific bill Issues related to the affordability of medical education and federal loan programs - no specific bill Issues related to scope of practice - no specific bill Issues related to the Department of Veterans Affairs Federal Supremacy Project - no specific bill Demographic data collection - no specific bill H.R. 929/S.266 the Lorna Breen Health Care Provider Protection Reauthorization Act H.R.2483 the SUPPORT for Patients and Communities Reauthorization Act of 2025 H.R. 2389/S. 1302, the Resident Physician Shortage Reduction Act H.R. 6205/S. 3211, the Healthcare Workforce Resilience Act HIV/AIDS Presidents Emergency Plan for AIDS Relief (PEPFAR) Immigration Issues related to Immigration - no specific bill H.R.1585/S.709 the Conrad State 30 and Physician Access Reauthorization Act Protecting Immigrant Families (PIF) Campaign Infrastructure Issues related to broadband access - no specific bill Issues related to the Build Back Better framework - no specific bill Interoperability/ONC Issues related to interoperability and information blocking - no specific bill Maternal Health and Reproductive Health S. 4381, Right to Contraception Act S. 4368, IVF Protection Act S.4304/H.R.8317 MAMAS First Act S.1834 - Supporting Healthy Moms and Babies Act Issues related to maternal health - no specific bill S. 712, The Connected Maternal Online Monitoring (MOM) Act Medical Education Issues related to the affordability of medical education - no specific bill Issues related to student loan forgiveness - no specific bill Support for physicians, residents and medical students - no specific bill Medicare/Medicaid S. 4532 / H.R. 8702, Seniors Timely Access to Care Act Cigna Modifier 25 Budget neutrality rules in the Medicare Physician Fee Schedule - no specific bill H.R. 6445 / S. 2377, Medicare Audiology Access Improvement Act H.R. 2474 the Strengthening Medicare for Patients and Providers Act H.R. 6545 Physician Fee Schedule Update and Improvements Act H.R. 6683 Preserving Seniors Access to Physicians Act of 2023 H.R.2173 the Improving Care and Access to Nurses Act H.R.2670 - National Defense Authorization Act for Fiscal Year 2024 H.R. 6371, the Provider Reimbursement Stability Act H.R. 5013/S. 3503, the Value in Health Care (VALUE) Act S. 4935, Physician Fee Stabilization Act H.R. 879 the Medicare Patient Access and Practice Stabilization Act H.R. 8816, the American Medical Innovation and Investment Act of 2024 H.R. 2474, the Strengthening Medicare for Patients and Providers Act Issues related to Medicare physician payment - no specific bill Issues related to Medicare/Medicaid - no specific bill H.R. 2433, Reducing Medically Unnecessary Delays in Care Act of 2025 Issues related to Medicare Advantage - no specific bill H.R. 1, One Big Beautiful Bill Act H.R. 2757, Medicare Audiology Access Improvement Act  S. 106/H.R. 539, the Chiropractic Medicare Coverage Modernization Act of 2025 Nutrition Issues related to nutrition and food security - no specific bill Issues related to SNAP funding - - no specific bill (including H.R.1) Opioids/ Substance Use Disorder LABEL Opioids Act of 2023 MATE ACT Adds New Education Mandate for 8 Hours of Continuing Education on Opioid Treatment S.1785, STOP Fentanyl Overdoses Act of 2023 H.R. 4531/S.3393 Support for Patients and Communities Reauthorization Act S. 644 - the Modernizing Opioid Treatment Access Act (MOTAA) S. 3418 Comprehensive Addiction Resources Emergency (CARE) Act Issues related to opioids and substance use disorder - no specific bill Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act Publications Open access to information based on publicly funded research - no specific bill Request for Information for NIH Plan to Enhance Public Access to the Results of NIH-Supported Research Issues related to scholarly and scientific publishing and public access - no specific bill H.R. 9378, Sunshine Act of 2023 Racial Justice/Health Equity Issues related to racial justice/health care equity - no specific bill Health disparities and protecting vulnerable populations - no specific bill Issues related to equitable policies around blood, tissue donations - no specific bill Surprise Billing Issues related to surprise billing - no specific bill Issues related to the implementation of the No Surprises Act - no specific bill Telehealth H.R.8261, the Preserving Telehealth, Hospital, and Ambulance Access Act H.R.4189, the CONNECT for Health Act of 2023 H.R.7623, the Telehealth Modernization Act of 2024 H.R.1843, the Telehealth Expansion Act of 2023 Issues related to telehealth - no specific bill Issues related to telebehavioral health access - no specific bill Issues related to physician licensing - no specific bill Issues related to telehealth PHE flexibilities/waivers - no specific bill Tobacco Issues related to prohibiting sale of menthol cigarettes and flavored cigars - no specific bill Issues related to increasing awareness about lung cancer screening on cigarette packages - no specific bill Vaccines Issues related to vaccines - no specific bill Regulatory FDA's proposed rule to eliminate menthol cigarettes Issues related to Medicare physician payment Issues related to implementation of the No Surprises Act Issues related to telehealth Issues related to Medicare Advantage Star Rating Health Equity Index calculation HIPAA-related Reporting Requirements Involving the Change Healthcare Cyber Incident Marketplace Integrity and Affordability Proposed Rule (CMS-9884-P) Medicaid Program; Preserving Medicaid Funding for Vulnerable Populations-Closing a Health Care-Related Tax Loophole Proposed Rule (CMS-2448-P)

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Science & Technology Policy (OSTP), SENATE, Veterans Affairs, Dept of (VA)

Behavioral Health H. 8526, Elementary and Secondary School Counseling Act Childcare Issues related to childcare - no specific bill Gun Safety Issues related to gun safety - no specific bill H.R. 4283, Gun Violence Prevention and Community Safety Act Health Care S. 4503, A bill to prevent exploitative private equity practices, and for other purposes Issues related to health care/universal access to quality, equitable, affordable coverage - no specific bill Issues related to mental and behavioral health care - no specific bill Issues related to Private Equity/Healthcare - no specific bill H.R. 9001, Physician Led and Rural Access to Quality Care Act Support of community water fluoridation - no specific bill Health Care Workforce Issues related to health care workforce shortages - no specific bill Issues related to the affordability of medical education and federal loan programs - no specific bill Issues related to scope of practice - no specific bill Issues related to the Department of Veterans Affairs Federal Supremacy Project - no specific bill Demographic data collection - no specific bill H.R. 929/S.266 the Lorna Breen Health Care Provider Protection Reauthorization Act H.R.2483 the SUPPORT for Patients and Communities Reauthorization Act of 2025 H.R. 2389/S. 1302, the Resident Physician Shortage Reduction Act H.R. 6205/S. 3211, the Healthcare Workforce Resilience Act HIV/AIDS Presidents Emergency Plan for AIDS Relief (PEPFAR) Immigration Issues related to Immigration - no specific bill H.R.1585/S.709 the Conrad State 30 and Physician Access Reauthorization Act Protecting Immigrant Families (PIF) Campaign Infrastructure Issues related to broadband access - no specific bill Issues related to the Build Back Better framework - no specific bill Interoperability/ONC Issues related to interoperability and information blocking - no specific bill Maternal Health and Reproductive Health S. 4381, Right to Contraception Act S. 4368, IVF Protection Act S.4304/H.R.8317 MAMAS First Act S.1834 - Supporting Healthy Moms and Babies Act Issues related to maternal health - no specific bill S. 712, The Connected Maternal Online Monitoring (MOM) Act Medical Education Issues related to the affordability of medical education - no specific bill Issues related to student loan forgiveness - no specific bill Support for physicians, residents and medical students - no specific bill Medicare/Medicaid S. 4532 / H.R. 8702, Seniors Timely Access to Care Act Cigna Modifier 25 Budget neutrality rules in the Medicare Physician Fee Schedule - no specific bill H.R. 6445 / S. 2377, Medicare Audiology Access Improvement Act H.R. 2474 the Strengthening Medicare for Patients and Providers Act H.R. 6545 Physician Fee Schedule Update and Improvements Act H.R. 6683 Preserving Seniors Access to Physicians Act of 2023 H.R.2173 the Improving Care and Access to Nurses Act H.R.2670 - National Defense Authorization Act for Fiscal Year 2024 H.R. 6371, the Provider Reimbursement Stability Act H.R. 5013/S. 3503, the Value in Health Care (VALUE) Act S. 4935, Physician Fee Stabilization Act H.R. 879 the Medicare Patient Access and Practice Stabilization Act H.R. 8816, the American Medical Innovation and Investment Act of 2024 H.R. 2474, the Strengthening Medicare for Patients and Providers Act Issues related to Medicare physician payment - no specific bill Issues related to Medicare/Medicaid - no specific bill H.R. 2433, Reducing Medically Unnecessary Delays in Care Act of 2025 Issues related to Medicare Advantage - no specific bill H.R. 1, One Big Beautiful Bill Act H.R. 2757, Medicare Audiology Access Improvement Act  S. 106/H.R. 539, the Chiropractic Medicare Coverage Modernization Act of 2025 Nutrition Issues related to nutrition and food security - no specific bill Issues related to SNAP funding - - no specific bill (including H.R.1) Opioids/ Substance Use Disorder LABEL Opioids Act of 2023 MATE ACT Adds New Education Mandate for 8 Hours of Continuing Education on Opioid Treatment S.1785, STOP Fentanyl Overdoses Act of 2023 H.R. 4531/S.3393 Support for Patients and Communities Reauthorization Act S. 644 - the Modernizing Opioid Treatment Access Act (MOTAA) S. 3418 Comprehensive Addiction Resources Emergency (CARE) Act Issues related to opioids and substance use disorder - no specific bill Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act Racial Justice/Health Equity Issues related to racial justice/health care equity - no specific bill Health disparities and protecting vulnerable populations - no specific bill Issues related to equitable policies around blood, tissue donations - no specific bill Surprise Billing Issues related to surprise billing - no specific bill Issues related to the implementation of the No Surprises Act - no specific bill Telehealth H.R.8261, the Preserving Telehealth, Hospital, and Ambulance Access Act H.R.4189, the CONNECT for Health Act of 2023 H.R.7623, the Telehealth Modernization Act of 2024 H.R.1843, the Telehealth Expansion Act of 2023 Issues related to telehealth - no specific bill Issues related to telebehavioral health access - no specific bill Issues related to physician licensing - no specific bill Issues related to telehealth PHE flexibilities/waivers - no specific bill Tobacco Issues related to prohibiting sale of menthol cigarettes and flavored cigars - no specific bill Issues related to increasing awareness about lung cancer screening on cigarette packages - no specific bill Vaccines Issues related to vaccines - no specific bill Regulatory FDA's proposed rule to eliminate menthol cigarettes Issues related to Medicare physician payment Issues related to implementation of the No Surprises Act Issues related to telehealth Issues related to Medicare Advantage Star Rating Health Equity Index calculation HIPAA-related Reporting Requirements Involving the Change Healthcare Cyber Incident Marketplace Integrity and Affordability Proposed Rule (CMS-9884-P) Medicaid Program; Preserving Medicaid Funding for Vulnerable Populations-Closing a Health Care-Related Tax Loophole Proposed Rule (CMS-2448-P)

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.Res.493 - Expressing the sense of the House of Representatives that the United States must take urgent, coordinated action to address the national housing crisis through preservation and production of affordable housing. Rep. Brown, Shontel M. [D-OH-11] (Introduced 06/10/2025) Public Law No: 119-21: One Big Beautiful Bill Act. This bill reduces taxes, reduces or increases spending for various federal programs, increases the statutory debt limit, and otherwise addresses agencies and programs throughout the federal government. The bill provides a permanent 12 percent increase to the 9 Percent Housing Credit and permanently lowers the 50 percent test for bond-financed 4 Percent Credit properties. Signed into Law by President Trump on 07/04/2025. Public Law No: 119-4 Full-Year Continuing Appropriations and Extensions Act, 2025. This bill provides continuing FY2025 appropriations for federal agencies and extends various expiring programs and authorities. Signed into by President Trump on March 15, 2025. HR9062/S470 Respect State Housing Laws Act. This bill eliminates a provision that requires a 30-day notice period before a landlord may begin eviction proceedings against a tenant in federally assisted or federally backed housing. Identifying Regulatory Barriers to Housing Supply Act: Similar to H.R. 3507 in the 118th Congress, this discussion draft would require communities that receive CDBG program funds to submit to HUD information regarding their implementation of certain land-use policies, such as policies for expanding high-density single-family and multifamily zoning. Housing Supply and Innovation Framework Act: Similar to H.R. 10351 in the 118th Congress, this discussion draft would require HUD to publish best practices guidelines to assist communities in maintaining modern local and state zoning frameworks that support production of adequate housing options at every income level. HR1981/S890 Choice in Affordable Housing Act of 2025. This bill would make it easier to access Housing Choice Vouchers (HCV) and attract and retain landlords to participate in the program. S1260 Rural Housing Service Reform Act of 2025. This bill would improve federal rural housing programs and strengthen the supply of affordable housing in rural America. HR2031/S948 HOME Investment Partnerships Reauthorization and Improvement Act of 2025. This bill would reauthorize the HOME Investment Partnerships Program. Affordable Housing Credit Improvement Act of 2025 (H.R. 2725, S.1515) is comprehensive legislation to expand and strengthen the Low-Income Housing Tax Credit (Housing Credit). Introduced by Senators Todd Young (R-IN), Maria Cantwell (D-WA), Marsha Blackburn (R-TN), and Senate Finance Committee Ranking Member Ron Wyden (D-OR); Representatives Darin LaHood (R-IL), Suzan DelBene (D-WA), Claudia Tenney (R-NY), Don Beyer (D-VA), Randy Feenstra (R-IA), and Jimmy Panetta (D-CA). All Policies Related to the U.S. Dept. HUD and its workforce and affordable housing programs All Policies Related to Projected-Based Rental Assistance Programs (including Sec. 202/811) All Polices Related to Tenant-Based Rental Assistance Programs All Policies Related to HOME, HTF, and CDBG Programs All Policies Related to preservation, development, insurance cost and coverage, and clean energy retrofit/investments for federally-assisted affordable housing programs. All Policies Related to USDA rural development, rural housing programs, and rental assistance programs. All Polices Related to Low Income Housing Tax Credit (LIHTC) programs

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

Government targets: Agriculture, Dept of (USDA), Bureau of the Census, Centers For Disease Control & Prevention (CDC), Commerce, Dept of (DOC), Consumer Financial Protection Bureau (CFPB), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office

Behavioral Health H. 8526, Elementary and Secondary School Counseling Act Childcare Issues related to childcare - no specific bill Gun Safety Issues related to gun safety - no specific bill H.R. 4283, Gun Violence Prevention and Community Safety Act Health Care S. 4503, A bill to prevent exploitative private equity practices, and for other purposes Issues related to health care/universal access to quality, equitable, affordable coverage - no specific bill Issues related to mental and behavioral health care - no specific bill Issues related to Private Equity/Healthcare - no specific bill H.R. 9001, Physician Led and Rural Access to Quality Care Act Health Care Workforce Issues related to health care workforce shortages - no specific bill Issues related to the affordability of medical education and federal loan programs - no specific bill Issues related to scope of practice - no specific bill Issues related to the Department of Veterans Affairs Federal Supremacy Project - no specific bill Demographic data collection - no specific bill H.R. 929/S.266 the Lorna Breen Health Care Provider Protection Reauthorization Act H.R.2483 the SUPPORT for Patients and Communities Reauthorization Act of 2025 H.R. 2389/S. 1302, the Resident Physician Shortage Reduction Act H.R. 6205/S. 3211, the Healthcare Workforce Resilience Act HIV/AIDS Presidents Emergency Plan for AIDS Relief (PEPFAR) Immigration Issues related to Immigration - no specific bill H.R.1585/S.709 the Conrad State 30 and Physician Access Reauthorization Act Protecting Immigrant Families (PIF) Campaign Infrastructure Issues related to broadband access - no specific bill Issues related to the Build Back Better framework - no specific bill Interoperability/ONC Issues related to interoperability and information blocking - no specific bill Maternal Health and Reproductive Health S. 4381, Right to Contraception Act S. 4368, IVF Protection Act S.4304/H.R.8317MAMAS First Act Issues related to maternal health - no specific bill S. 712, The Connected Maternal Online Monitoring (MOM) Act Medical Education Issues related to the affordability of medical education - no specific bill Issues related to student loan forgiveness - no specific bill Support for physicians, residents and medical students - no specific bill Medicare/Medicaid S. 4532 / H.R. 8702, Seniors Timely Access to Care Act Cigna Modifier 25 Budget neutrality rules in the Medicare Physician Fee Schedule - no specific bill H.R. 6445 / S. 2377, Medicare Audiology Access Improvement Act H.R. 2474 the Strengthening Medicare for Patients and Providers Act H.R. 6545 Physician Fee Schedule Update and Improvements Act H.R. 6683 Preserving Seniors Access to Physicians Act of 2023 H.R.2173 the Improving Care and Access to Nurses Act H.R.2670 - National Defense Authorization Act for Fiscal Year 2024 H.R. 6371, the Provider Reimbursement Stability Act H.R. 5013/S. 3503, the Value in Health Care (VALUE) Act S. 4935, Physician Fee Stabilization Act H.R. 879 the Medicare Patient Access and Practice Stabilization Act H.R. 8816, the American Medical Innovation and Investment Act of 2024 H.R. 2474, the Strengthening Medicare for Patients and Providers Act Issues related to Medicare physician payment - no specific bill Issues related to Medicare/Medicaid - no specific bill H.R. 2433, Reducing Medically Unnecessary Delays in Care Act of 2025 Issues related to Medicare Advantage - no specific bill Nutrition Issues related to nutrition and food security - no specific bill Issues related to SNAP funding - - no specific bill Opioids/ Substance Use Disorder LABEL Opioids Act of 2023 MATE ACT Adds New Education Mandate for 8 Hours of Continuing Education on Opioid Treatment S.1785, STOP Fentanyl Overdoses Act of 2023 H.R. 4531/S.3393 Support for Patients and Communities Reauthorization Act S. 644 - the Modernizing Opioid Treatment Access Act (MOTAA) S. 3418 Comprehensive Addiction Resources Emergency (CARE) Act Issues related to opioids and substance use disorder - no specific bill Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act Publications Open access to information based on publicly funded research - no specific bill Request for Information for NIH Plan to Enhance Public Access to the Results of NIH-Supported Research Issues related to scholarly and scientific publishing and public access - no specific bill H.R. 9378, Sunshine Act of 2023 Racial Justice/Health Equity Issues related to racial justice/health care equity - no specific bill Health disparities and protecting vulnerable populations - no specific bill Issues related to equitable policies around blood, tissue donations - no specific bill Surprise Billing Issues related to surprise billing - no specific bill Issues related to the implementation of the No Surprises Act - no specific bill Telehealth H.R.8261, the Preserving Telehealth, Hospital, and Ambulance Access Act H.R.4189, the CONNECT for Health Act of 2023 H.R.7623, the Telehealth Modernization Act of 2024 H.R.1843, the Telehealth Expansion Act of 2023 Issues related to telehealth - no specific bill Issues related to telebehavioral health access - no specific bill Issues related to physician licensing - no specific bill Issues related to telehealth PHE flexibilities/waivers - no specific bill Tobacco Issues related to prohibiting sale of menthol cigarettes and flavored cigars - no specific bill Issues related to increasing awareness about lung cancer screening on cigarette packages - no specific bill Vaccines Issues related to vaccines - no specific bill Regulatory FDA's proposed rule to eliminate menthol cigarettes Issues related to Medicare physician payment Issues related to implementation of the No Surprises Act Issues related to telehealth Issues related to Medicare Advantage Star Rating Health Equity Index calculation HIPAA-related Reporting Requirements Involving the Change Healthcare Cyber Incident

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Science & Technology Policy (OSTP), SENATE, Veterans Affairs, Dept of (VA)

Behavioral Health H. 8526, Elementary and Secondary School Counseling Act Childcare Issues related to childcare - no specific bill Gun Safety Issues related to gun safety - no specific bill H.R. 4283, Gun Violence Prevention and Community Safety Act Health Care S. 4503, A bill to prevent exploitative private equity practices, and for other purposes Issues related to health care/universal access to quality, equitable, affordable coverage - no specific bill Issues related to mental and behavioral health care - no specific bill Issues related to Private Equity/Healthcare - no specific bill H.R. 9001, Physician Led and Rural Access to Quality Care Act Health Care Workforce Issues related to health care workforce shortages - no specific bill Issues related to the affordability of medical education and federal loan programs - no specific bill Issues related to scope of practice - no specific bill Issues related to the Department of Veterans Affairs Federal Supremacy Project - no specific bill Demographic data collection - no specific bill H.R. 929/S.266 the Lorna Breen Health Care Provider Protection Reauthorization Act H.R.2483 the SUPPORT for Patients and Communities Reauthorization Act of 2025 H.R. 2389/S. 1302, the Resident Physician Shortage Reduction Act H.R. 6205/S. 3211, the Healthcare Workforce Resilience Act HIV/AIDS Presidents Emergency Plan for AIDS Relief (PEPFAR) Immigration Issues related to Immigration - no specific bill H.R.1585/S.709 the Conrad State 30 and Physician Access Reauthorization Act Protecting Immigrant Families (PIF) Campaign Infrastructure Issues related to broadband access - no specific bill Issues related to the Build Back Better framework - no specific bill Interoperability/ONC Issues related to interoperability and information blocking - no specific bill Maternal Health and Reproductive Health S. 4381, Right to Contraception Act S. 4368, IVF Protection Act S.4304/H.R.8317MAMAS First Act Issues related to maternal health - no specific bill S. 712, The Connected Maternal Online Monitoring (MOM) Act Medicare/Medicaid S. 4532 / H.R. 8702, Seniors Timely Access to Care Act Cigna Modifier 25 Budget neutrality rules in the Medicare Physician Fee Schedule - no specific bill H.R. 6445 / S. 2377, Medicare Audiology Access Improvement Act H.R. 2474 the Strengthening Medicare for Patients and Providers Act H.R. 6545 Physician Fee Schedule Update and Improvements Act H.R. 6683 Preserving Seniors Access to Physicians Act of 2023 H.R.2173 the Improving Care and Access to Nurses Act H.R.2670 - National Defense Authorization Act for Fiscal Year 2024 H.R. 6371, the Provider Reimbursement Stability Act H.R. 5013/S. 3503, the Value in Health Care (VALUE) Act S. 4935, Physician Fee Stabilization Act H.R. 879 the Medicare Patient Access and Practice Stabilization Act H.R. 8816, the American Medical Innovation and Investment Act of 2024 H.R. 2474, the Strengthening Medicare for Patients and Providers Act Issues related to Medicare physician payment - no specific bill Issues related to Medicare/Medicaid - no specific bill H.R. 2433, Reducing Medically Unnecessary Delays in Care Act of 2025 Issues related to Medicare Advantage - no specific bill Nutrition Issues related to nutrition and food security - no specific bill Issues related to SNAP funding - - no specific bill Opioids/ Substance Use Disorder LABEL Opioids Act of 2023 MATE ACT Adds New Education Mandate for 8 Hours of Continuing Education on Opioid Treatment S.1785, STOP Fentanyl Overdoses Act of 2023 H.R. 4531/S.3393 Support for Patients and Communities Reauthorization Act S. 644 - the Modernizing Opioid Treatment Access Act (MOTAA) S. 3418 Comprehensive Addiction Resources Emergency (CARE) Act Issues related to opioids and substance use disorder - no specific bill Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act Racial Justice/Health Equity Issues related to racial justice/health care equity - no specific bill Health disparities and protecting vulnerable populations - no specific bill Issues related to equitable policies around blood, tissue donations - no specific bill Surprise Billing Issues related to surprise billing - no specific bill Issues related to the implementation of the No Surprises Act - no specific bill Telehealth H.R.8261, the Preserving Telehealth, Hospital, and Ambulance Access Act H.R.4189, the CONNECT for Health Act of 2023 H.R.7623, the Telehealth Modernization Act of 2024 H.R.1843, the Telehealth Expansion Act of 2023 Issues related to telehealth - no specific bill Issues related to telebehavioral health access - no specific bill Issues related to physician licensing - no specific bill Issues related to telehealth PHE flexibilities/waivers - no specific bill Tobacco Issues related to prohibiting sale of menthol cigarettes and flavored cigars - no specific bill Issues related to increasing awareness about lung cancer screening on cigarette packages - no specific bill Vaccines Issues related to vaccines - no specific bill Regulatory FDA's proposed rule to eliminate menthol cigarettes Issues related to Medicare physician payment Issues related to implementation of the No Surprises Act Issues related to telehealth Issues related to Medicare Advantage Star Rating Health Equity Index calculation HIPAA-related Reporting Requirements Involving the Change Healthcare Cyber Incident

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Administration: Policies affecting apartment operations and management, specifically consumer reporting, resident screening (financial, criminal, resident history), consumer debt collection and eviction. Issues pertaining to addressing the nations housing affordability crisis and undersupply of housing. Nominations Supported the nomination of William (Bill) Pulte to serve as the Director of the Federal Housing Finance Agency (FHFA). LEB, BF Supported the nomination of Scott Turner to serve as the Secretary of the U.S. Department of Housing and Urban Development (HUD). LEB BF Supported the nomination of Andrew Hughes to serve as the Deputy Secretary of the U.S. Department of Housing and Urban Development (HUD). LEB BF Supported the nomination of Jonathan McKernan to serve as the Director of the Consumer Financial Protection Bureau (CFPB) LEB Legislation/Guidance/Housing Issues Sought clarification that the federal CARES Act 30-day notice of eviction requirement ended in 2020. House Financial Services Committee, hearing entitled Building Our Future: Increasing Housing Supply in America Senate Banking, Housing, and Urban Affairs Committee, hearing entitled Housing Roadblocks: Paving a New Way to Address Affordability H.R. 1981, Choice in Affordable Housing Act of 2025, to increase the number of landlords participating in the Housing Choice Voucher program, all provisions. S. 890, Choice in Affordable Housing Act of 2025, to increase the number of landlords participating in the Housing Choice Voucher program, all provisions. S. 32 (118th Congress), Choice in Affordable Housing Act of 2023, to increase the number of landlords participating in the Housing Choice Voucher program, all provisions. H.R. 4606 (118th Congress), Choice in Affordable Housing Act of 2023, to increase the number of landlords participating in the Housing Choice Voucher program, all provisions. H.R. 3507 (118h Congress, Yes In My Backyard, all provisions S. 1688 (118h Congress), Yes In My Backyard, all provisions. H.R. __ the Identifying Regulatory Barriers to Housing Supply Act, DRAFT legislation, to require certain grantees under title I of the Housing and Community Development Act of 1974 to submit a plan to track discriminatory land use policies, and for other purposes, all provisions. MB LEB BF S. _the Identifying Regulatory Barriers to Housing Supply Act, , DRAFT legislation, to require certain grantees under title I of the Housing and Community Development Act of 1974 to submit a plan to track discriminatory land use policies, and for other purposes, all provisions. H.R. 802 (118th Congress), Respect State Housing Laws Act, to amend the CARES Act to remove a requirement on lessors to provide notice to vacate, and for other purposes, all provisions. S. 3755 (118th Congress), Respect State Housing Laws Act, to amend the CARES Act to remove a requirement on lessors to provide notice to vacate, and for other purposes, all provisions. H.R. 1078 , Respect State Housing Laws Act, to amend the CARES Act to remove a requirement on lessors to provide notice to vacate, and for other purposes, all provisions. S. 470 , Respect State Housing Laws Act, to amend the CARES Act to remove a requirement on lessors to provide notice to vacate, and for other purposes, all provisions. S.4460/H.R. 8604 (118th Congress) - Reducing Regulatory Barriers to Housing Act - A bill to reduce regulatory barriers to housing, and for other purposes. H.R.__, the Housing for Americas Middle Class Act, reviewed draft legislation. S.1299/ H.R. 2840 the Housing Supply and Innovation Frameworks Act, reviewed draft legislation. H.R. 6199 (118th Congress), Build More Housing Near Transit Act of 2023, to amend title 49, United States Code, to include affordable housing incentives in certain capital investment grants, and for other purposes, all provisions. S. 3216 (118th Congress), Build More Housing Near Transit Act of 2023, to amend title 49, United States Code, to include affordable housing incentives in certain capital investment grants, and for other purposes, all provisions. H.R. 10351 (118th Congress), Housing Supply and Innovation Frameworks Act, to direct the Secretary of Housing and Urban Development, acting through the Assistant Secretary for Policy Development and Research, to publish guidelines and best practices for State zoning and local zoning frameworks, and for other purposes, all provisions. H.R. 10465, the Know Who Owns Your Home Act H.R.1777, the Securing and Enabling Commerce Using Remote and Electronic (SECURE) Notarization Act Draft legislative proposal, Housing Production Partnership Program Act of 2025, for Federal subsidy for state and local multifamily property tax abatement matching program to be administered through the Department of Housing and Urban Development's Pathways to Removing Obstacles to Housing program. Additional proposals to address the housing affordability crisis: Appoint a White House Housing Czar & Require the Council of Economic Advisors to Create a Housing Production Goal; Enable GSEs to Use Below-Market Interest Rates to Promote Production and Preservation; Remove Regulatory Barriers to Housing Construction, Including Permitting Use of Project Labor Agreements to Meet Davis-Bacon Wage Rule Requirements for Multifamily Projects; Incentivize Localities to Modify Building Code Requirements to Reduce Cost of Building; Allow FHA Programs to Use Below-Market Interest Rate Debt for Development and Preservation; Modify TIFIA to Promote Transit-Oriented Development; Exempt Infill Housing Development from the National Environmental Protection Act (NEPA); Reform HUD Programs to Promote Housing Production: Establish Commission to Address Elevated Property Insurance Premiums; Authorize the Free Disposition of Federal Land and Buildings to Spur Affordable Housing; and Reform the Housing Choice Voucher Program. Fees in rental housing. Fair Housing Act (Disparate Impact Rule, Screening, Criminal History Policy, and Reporting) Fair Housing Rules as they pertain to Emotional Support Animals. Regulatory Improvements to Department of Transportation Infrastructure Finance and Innovation Act (TIFIA) loan program to encourage transit-oriented multifamily development. Not on the March 3 or March 28 letter. Review and Reform Rules and Regulations Pertaining to the Section 8 Housing Choice Voucher Program (HCV) 30-Day Notification Requirement Prior To Termination of Lease for Nonpayment of Rent (Docket # 89 FR 101270) Final Rule (24 CFR Parts 247, 880, 884, 886, 891, and 966) Reinstatement of HUD's Discriminatory Effects Standard (Docket #88 FR 19450) Final Rule (88 FR 19450) Reducing Barriers to HUD-Assisted Housing (Docket # FR-6362-P-01) Proposed Rule (24 CFR Parts 5, 245, 882, 960, 966, and 982) Withdrawn on January 16, 2025 Floodplain Management and Protection of Wetlands; Minimum Property Standards for Flood Hazard Exposure; Building to the Federal Flood Risk Management Standard (Docket # 89 FR 30850) Final Rule (24 CFR Parts 50, 55, 58, and 200) HOME Investment Partnerships Program: Program Updates and Streamlining (Docket # 90 FR 746) Final Rule (24 CFR Parts 91, 92, 570, and 982) Adoption of Energy Efficiency Standards for New Construction of HUD- and USDA-Financed Housing; Extension of HUD Compliance Dates (Docket # 90 FR 11622) Final Determination Draft Notice on Solar, Cell Tower and Rooftop Leases (Drafting Table) * Guidance on Application of the Fair Housing Act to the Advertising of Housing, Credit, and Other Real Estate-Related Transactions through Digital Platforms Guidance on Application of the Fair Housing Act to the Screening of Applicants for Rental Housing Build America, Buy America Act (BABA): Request for Information Regarding Iron, Steel, Construction Materials and Manufactured Products Used in Housing Programs Pursuant to the Build America, Buy America Act (Docket # 88 FR 24690) Request for Information (FR-6331-N-01) Affirmatively Furthering Fair Housing (Docket # 90 FR 4686) Proposed Rule, withdrawn by HUD (24 CFR Parts 5, 91, 92, 93, 570, 574, 576, 903 and 983) National Standards for the Physical Inspection of Real Estate: Inspection Standards (Docket # 88 FR 40832) Notice of Proposed Rulemaking Changes to the Methodology Used for Calculating Section 8 Income Limits Under the United States Housing Act of 1937 (Docket # 89 FR 1583) Notice of Proposed Rulemaking Review Current Rules, Notices and Guidance pertaining to Criminal Screening

Client expense: $1,820,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Council of Economic Advisers (CEA), Energy, Dept of, Environmental Protection Agency (EPA), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Housing Finance Agency (FHFA), HOUSE OF REPRESENTATIVES, Homeland Security, Dept of (DHS), Housing & Urban Development, Dept of (HUD), Labor, Dept of (DOL), Natl Economic Council (NEC), Office of Management & Budget (OMB), President of the U.S., SENATE, Securities & Exchange Commission (SEC), Vice President of the U.S., White House Office

Public Law No: 119-4 Full-Year Continuing Appropriations and Extensions Act, 2025. This bill provides continuing FY2025 appropriations for federal agencies and extends various expiring programs and authorities. Signed into by President Trump on March 15, 2025. HR9062/S470 Respect State Housing Laws Act. This bill eliminates a provision that requires a 30-day notice period before a landlord may begin eviction proceedings against a tenant in federally assisted or federally backed housing. Identifying Regulatory Barriers to Housing Supply Act: Similar to H.R. 3507 in the 118th Congress, this discussion draft would require communities that receive CDBG program funds to submit to HUD information regarding their implementation of certain land-use policies, such as policies for expanding high-density single-family and multifamily zoning. Housing Supply and Innovation Framework Act: Similar to H.R. 10351 in the 118th Congress, this discussion draft would require HUD to publish best practices guidelines to assist communities in maintaining modern local and state zoning frameworks that support production of adequate housing options at every income level. HR1981/S890 Choice in Affordable Housing Act of 2025. This bill would make it easier to access Housing Choice Vouchers (HCV) and attract and retain landlords to participate in the program. S1260 Rural Housing Service Reform Act of 2025. This bill would improve federal rural housing programs and strengthen the supply of affordable housing in rural America. HR2031/S948 HOME Investment Partnerships Reauthorization and Improvement Act of 2025. This bill would reauthorize the HOME Investment Partnerships Program. All Policies Related to the U.S. Dept. HUD and its workforce and affordable housing programs All Policies Related to Projected-Based Rental Assistance Programs (including Sec. 202/811) All Polices Related to Tenant-Based Rental Assistance Programs All Policies Related to HOME, HTF, and CDBG Programs All Policies Related to preservation, development, insurance cost and coverage, and clean energy retrofit/investments for federally-assisted affordable housing programs. All Policies Related to USDA rural development, rural housing programs, and rental assistance programs. All Polices Related to Low Income Housing Tax Credit (LIHTC) programs

Client expense: $110,000 · Firm income: Not reported

Government targets: Agriculture, Dept of (USDA), Bureau of the Census, Centers For Disease Control & Prevention (CDC), Commerce, Dept of (DOC), Consumer Financial Protection Bureau (CFPB), Executive Office of the President (EOP), Federal Communications Commission (FCC), Federal Emergency Management Agency (FEMA), Federal Trade Commission (FTC), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Housing & Urban Development, Dept of (HUD), Internal Revenue Service (IRS), Office of Management & Budget (OMB), SENATE, Treasury, Dept of, White House Office

H.R. 6645, Medicare Audiology Access Improvement Act of 2023, all provisions S. 2377, Medicare Audiology Access Improvement Act of 2023, all provisions H.R. 1610, Chiropractic Medicare Coverage Modernization Act of 2023, all provisions S. 799, Chiropractic Medicare Coverage Modernization Act of 2023, all provisions H.R. 4189, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023, all provisions S. 2016, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023, all provisions H.R. 8532, Connected MOM Act, all provisions S. 712, Connected MOM Act, all provisions H.R. 1770, Equitable Community Access to Pharmacist Services Act, all provisions S. 2477, Equitable Community Access to Pharmacist Services Act, all provisions H.R. 751, Fair Access In Residency (FAIR) Act, all provisions H.R. 4968, Getting Over Lengthy Delays in Care As Required by Doctors (GOLD CARD) Act of 2023, all provisions H.R. 2713, Improving Care and Access to Nurses (I CAN) Act, all provisions S. 2418, Improving Care and Access to Nurses (I CAN) Act, all provisions H.R. 2583, Increasing Access to Quality Cardiac Rehabilitation Care Act of 2023, all provisions H.R. 6487, No Fees for EFTs Act, all provisions S. 3805, No Fees for EFTs Act, all provisions H.R. 977, Patient Access to Higher Quality Health Care Act of 2023, all provisions S. 470, Patient Access to Higher Quality Health Care Act of 2023, all provisions H.R. 2389, Resident Physician Shortage Reduction Act of 2023, all provisions S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions H.R. 7050, Substance Use Disorder Workforce Act, all provisions H.R. 7623, Telehealth Modernization Act of 2024, all provisions H.R. 2474, Strengthening Medicare for Patients and Providers Act, all provisions H.R. 830, Help Ensure Lower Patient (HELP) Copays Act, all provisions S. 1375, Help Ensure Lower Patient (HELP) Copays Act, all provisions H.R. 6371, Provider Reimbursement Stability Act of 2023, all provisions H.R. 6545, Physician Fee Schedule Update and Improvements Act, all provisions H.R. 5378, Lower Costs, More Transparency Act, all provisions H.R. 6683, Preserving Seniors Access to Physicians Act of 2023, all provisions H.R. 5013, Value in Health Care Act of 2023, all provisions S. 3503, Value in Health Care Act of 2023, all provisions H.R. 8702, Improving Seniors Timely Access to Care Act of 2024, all provisions S. 4532, Improving Seniors Timely Access to Care Act of 2024, all provisions S. 4518, Improving Seniors Timely Access to Care Act of 2024, all provisions S. 4935, Physician Fee Stabilization Act, all provisions H.R. 6366, To amend title XVIII of the Social Security Act with respect to the work geographic index for physician payments under the Medicare program, and to revise the phase-in of clinical laboratory test payment changes under such program, all provisions H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024, provisions relating to Medicare payments H.R. 7931, Preserving Emergency Access in Key Sites (PEAKS) Act, all provisions S. 4338, Pay PCPs Act of 2024, all provisions H.R. 8563, Preserving Access To Care in Hawaii (PATCH) Act, all provisions S. 4395, Protecting Access To Care in Hawaii (PATCH) Act, all provisions H.R. 6369, To amend title XVIII of the Social Security Act to extend incentive payments for participation in eligible alternative payment models, all provisions H.R. 7665, ACO Assignment Improvement Act of 2024, all provisions S. 3939, ACO Assignment Improvement Act of 2024, all provisions H.R. 8404, Radiation Oncology Case Rate (ROCR) Value Based Program Act of 2024, all provisions S. 4330, Radiation Oncology Case Rate (ROCR) Value Based Program Act of 2024, all provisions H.R. 4829, Physical Therapist Workforce and Patient Access Act of 2023, all provisions H.R. 8235, Rural Physician Workforce Preservation Act, all provisions H.R. 1745, Medicare Fraud Detection and Deterrence Act of 2023, all provisions H.R. 1746, Preventing Medicare Telefraud Act, all provisions H.R. 8261, Preserving Telehealth, Hospital, and Ambulance Access Act, all provisions S. 1491, Pharmacy and Medically Underserved Areas Enhancement Act, all provisions S. 669, Increasing Mental Health Options Act of 2023, all provisions H.R. 7618, Stopping Addiction and Falls for the Elderly (SAFE) Act, all provisions H.R. 3730, Rural Health Clinic Burden Reduction Act, all provisions H.R. 7279, Remove Duplicative Unnecessary Clerical Exchanges (REDUCE) Act, all provisions H.R. 7708, Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act, all provisions S. 3508, Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act, all provisions H.R. 9001, Physician Led and Rural Access to Quality Care Act, all provisions S. 5218, A bill to amend titles XI and XVIII of the Social Security Act to strengthen, increase oversight of, and compliance with, security standards for health information, and for other purposes, all provisions S. 4054, Health Care Cybersecurity Improvement Act of 2024, all provisions H.R. 8588, Linking Seniors to Needed Legal Services Act of 2024, all provisions H.R. 5526, Seniors Access to Critical Medications Act of 2024, all provisions H.R. 9129, Patient Debt Relief Act, all provisions Fewer Burdens for Better Care Act/draft MACRA/MIPS program reform legislation/draft FY 2025 Medicare physician payment increase/draft Medical Chaperones in Medicare/draft Medicare program: No Surprises Act implementation Medicare program: 21st Century Cures Act implementation Medicare program: FY 2025 Physician payment cut Medicare program: Information Blocking Disincentives Medicare program: Merit-based Incentive Payment System (MIPS) reform Medicare program: Medicare Economic Index (MEI) Medicare program: Medicare Access and CHIP Reauthorization Act (MACRA) reform Medicare program: Budget neutrality reforms/Inflationary update Medicare program: G2211 Inherent complexity code Medicare program: Protecting Access to Medicare Act (PAMA 2014) lab cut reform Medicare program: High-cost disposable services payment Medicare program: Medicare Administrative Contractor/local-coverage determinations Medicare program: Making Care Primary alternative payment models (APM) Medicare program: Rural physicians APM Medicare program: Site neutral payment Medicare program: Physician-owned hospitals Medicare program: Graduate Medical Education (GME) funding Medicare program: Audio-visual supervision of residents/permanent expansion Medicare program: Conditions of Participation (COP)/Obstetrical service Medicare program: MACRA/physician burdens Medicare program: Health Information Technology/physician burdens Medicare program: Prior authorization/Medicare Advantage plans Medicare program: Interoperability/data sharing/information blocking/provider disincentives Medicare program: Promoting interoperability reporting Medicare program: Trusted exchange framework/common agreement Medicare program: Data segmentation Medicare program: Quality payment program Medicare program: Medicare Shared Savings Program/Advanced APM Medicare program: Public health reporting and data exchange Medicare program: Accountable Care Organizations/APM flexibilities Medicare program: Certified Electronic Health Record (EHR) Technology Medicare program: Physician Practice Information (PPI) survey/practice expense Medicare program: MIPS Value Pathways (MVPs)/APMs Medicare program: Telehealth flexibilities Medicare and Medicaid programs: Data Privacy and Cybersecurity Medicare and Medicaid programs: Health Insurance Portability and Accountability Act (HIPAA)/electronic records

Client expense: $5,330,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Science & Technology Policy (OSTP), SENATE, Veterans Affairs, Dept of (VA)

S.470/H.R.977, Patient Access to Higher Quality Health Care Act: To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. S.4532/H.R. 8702), Improving Seniors Timely Access to Care Act: To streamline prior authorization in the Medicare Advantage program. H.R. 9001, Physician Led and Rural Access to Quality Care Act: To amend title XVIII of the Social Security Act to revise certain physician self-referral exemptions relating to physician-owned hospitals and allow physician ownership of rural hospitals H.R.9805, Access to Claims Data Act: To require the Secretary of Health and Human Services to establish a process to expand access to claims data under certain Federal health plans in order to facilitate research and quality improvement. H.R. 10073, Medicare Patient Access and Practice Stabilization Act of 2024 (H.R.10073): To eliminate the 2.8% Medicare physician fee schedule(MPFS) cut and provide an inflationary update for calendar year 2025. No bill: Medicare payment reforms, including positive annual updates, adjustments to Medicare's budget neutrality requirements, improving alternative payment models, modifying the Merit-based Improvement Payment System and expanding relevant quality improvement measures.

Client expense: $35,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.470/H.R.977, Patient Access to Higher Quality Health Care Act: To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. S.4532/H.R. 8702), Improving Seniors Timely Access to Care Act: To streamline prior authorization in the Medicare Advantage program. H.R. 9001, Physician Led and Rural Access to Quality Care Act: To amend title XVIII of the Social Security Act to revise certain physician self-referral exemptions relating to physician-owned hospitals and allow physician ownership of rural hospitals H.R.9805, Access to Claims Data Act: To require the Secretary of Health and Human Services to establish a process to expand access to claims data under certain Federal health plans in order to facilitate research and quality improvement. H.R. 10073, Medicare Patient Access and Practice Stabilization Act of 2024 (H.R.10073): To eliminate the 2.8% Medicare physician fee schedule (MPFS) cut and provide an inflationary update for calendar year 2025. No bill: Medicare payment reforms, including positive annual updates, adjustments to Medicare's budget neutrality requirements, improving alternative payment models, modifying the Merit-based Improvement Payment System and expanding relevant quality improvement measures.

Client expense: $35,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discussions involving proposed legislation requiring new National Provider Identifier (NPI) policies Discussions involving GME reform proposals impacting Medicare reimbursement to teaching hospitals Discussions pertaining to CMS hospital directed payment program Discussions pertaining to reductions to the Medicaid disproportionate share hospital (DSH) program S 470 Patient Access to Higher Quality Health Care Act of 2023 (all sections of full text)(oppose) HR 977 Patient Access to Higher Quality Health Care Act of 2023 (all sections of full text) (oppose) HR 8246 Second Chances for Rural Hospitals Act (all sections of full text)(oppose) S 1869 Site-based Invoicing and Transparency Enhancement (SITE) Act (all sections of full text) Discussions relating to site neutral payment reform Discussions pertaining to prior authorization Monitored Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 Monitored Medicare Advantage reform legislation on CMS action

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.5378, Lower Costs, More Transparency Act, Issues related to site neutral payment cuts, hospital price transparency, unique health identifier, 340B Program; H.R. 3173 / S. 4532, Improving Seniors' Timely Access to Care, all provisions; S.4350 / H.R. 8260, Hospital Inpatient Services Modernization Act of 2024, all provisions; H.R. 7623, Telehealth Modernization Act, Issues pertaining to Telehealth, Hospital at Home, Unique Health Identifier; S. 1110, the Rural Hospital Support Act, all provisions; H.R. 6430, Assistance for Rural Community Hospitals (ARCH)Act, all provisions; H. Jes Res 139 / S.J. Res 91 A, joint resolution for congressional disapproval of a rule relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting", All provisions; S. 2016/ H.R. 4189, The CONNECT for Health Act of 2023, specifically telehealth waivers, geographic restrictions, originating site requirements, in person requirement behavioral health, RHCs and FQHCs access; H.R. 1110, KEEP Telehealth Option Act, All provisions; H.R. 5541, the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, All provisions; HR 2389/ S. 1302, Resident Physician Shortage Reduction Act of 2023, All provisions ; H.R. 977/S. 470, Patient Access to Higher Quality Care Act, all provisions; H.R. 4946, Medicare Mental Health Inpatient Equity Act of 2023, all provisions; H.R. 6033,Supporting Patient Education and Knowledge (SPEAK) Act of 2023all provisions; H.R. 1406, Sustainable Cardiopulmonary Rehabilitation Services in the Home Act, all provisions; DRAFT, DRAFT Clarifying that Rural Emergency Hospitals are eligible for Medicaid hospital reimbursement; DRAFT, DRAFT, Expanding services Rural Emergency Hospitals (REHs) are paid at the enhanced outpatient prospective payment system rate, allow eligibility for Small Rural Hospital improvement Grants; DRAFT, DRAFT, Issues pertaining to freestanding emergency departments; H.R. 1666, Protecting Access to Ground Ambulance Medical Services Act of 2023, All provisions; H. R. 8246, Second Chances for Rural Hospitals Act, Issues pertaining to expansion of physician-owned Rural Emergency Hospitals; Draft Bill, Issues pertaining to proposed changes to the Medicare Graduate Medical Education program and solutions to address workforce shortages in rural areas; Centers for Medicare & Medicaid Services (CMS), Medicare Severity-Long Term Care-Diagnosis Related Groups (MS-LTC-DRGs) used as part of the LTCH prospective payment system (PPS), Feedback on Medicare Severity-Long Term Care-Diagnosis Related Groups (MS-LTC-DRGs) used as part of the LTCH prospective payment system (PPS); Centers for Medicare & Medicaid Services (CMS), Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2026, Navigators and non-navigator assistance personnel working within hospitals and health systems to assist consumers; Centers for Medicare & Medicaid Services (CMS) Medicare Part C Utilization Management Annual Data Submission and Audit Protocol Data Request, Proposed Medicare Part C Utilization Management and data submission and audit protocol; Medicare Payment Advisory Commission (MedPAC), Physician fee schedule payments, advanced alternative payment model (A-APM) incentives and Medicare Advantage (MA) network adequacy; Centers for Medicare & Medicaid Services (CMS), Affordable drugs, Medicare $2 Drug List Model request for information; Centers for Medicare & Medicaid Services (CMS), Changes to the Fiscal Year 2025 Hospital Inpatient Prospective Payment System (IPPS) Rates Due to Court Decision, Low Wage Index Policy changes due to recent court change; Centers for Medicare & Medicaid Services (CMS), Medicare Transaction Facilitator and the Medicare drug negotiation program, Information collection request (ICR) regarding the Medicare Transaction Facilitator (MTF) and the Medicare drug negotiation program; Site Neutral Payments, Issues related to site neutral payment cuts for drug administration; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees, DSH cuts; Medicaid Disproportionate Share Hospital (DSH) program, Medicaid DSH program; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay and cost-based reimbursement for critical access hospitals under Medicare Advantage; Physician Payments, Issues pertaining to proposed solutions to improve MACRA, alternative payment models, mental health of workforce, scheduled physician reimbursement cuts for 2025, extension of Medicare's Advanced Alternative Payment Model (AAPM) incentive payments; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, REH's; National Provider Identifier (NPI), Unique identifiers for off-campus Hospital Outpatient Departments (HOPDs); Organ Transplant Final Rule, Increasing Organ Transplant Access (IOTA) Final Rule, IOTA Model impact on hospitals.

Client expense: $6,570,000 · Firm income: Not reported

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

H.R. 6445, Medicare Audiology Access Improvement Act, all provisions S. 2377, Medicare Audiology Access Improvement Act, all provisions H.R. 1610, Chiropractic Medicare Coverage Modernization Act, all provisions S. 799, Chiropractic Medicare Coverage Modernization Act, all provisions H.R. 4189, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, all provisions S. 2016, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, all provisions H.R. 1770, Equitable Community Access to Pharmacist Services Act, all provisions S. 2477, Equitable Community Access to Pharmacist Services Act, all provisions H.R. 751, Fair Access In Residency (FAIR) Act, all provisions H.R. 4968, GOLD CARD Act, all provisions H.R. 2713, Improving Care and Access to Nurses (I CAN) Act, all provisions S. 2418, Improving Care and Access to Nurses (I CAN) Act, all provisions H.R. 2583, Increasing Access to Quality Cardiac Rehabilitation Care Act, all provisions H.R. 6487, No Fees for EFTs Act, all provisions S. 3805, No Fees for EFTs Act, all provisions H.R. 977, Patient Access to Higher Quality Health Care Act of 2023, all provisions S. 470, Patient Access to Higher Quality Health Care Act of 2023, all provisions H.R. 2389, Resident Physician Shortage Reduction Act of 2023, all provisions S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions H.R. 2630, Safe Step Act, all provisions S. 652, Safe Step Act, all provisions H.R. 7050, Substance Use Disorder Workforce Act, all provisions H.R. 7623, Telehealth Modernization Act of 2024, all provisions H.R. 2474, Strengthening Medicare for Patients and Providers Act, all provisions H.R. 6371, Provider Reimbursement Stability Act of 2023, all provisions H.R. 6545, Physician Fee Schedule Update and Improvements Act, all provisions H.R. 5378, Lower Costs, More Transparency Act, all provisions H.R. 6683, Preserving Seniors Access to Physicians Act of 2023, all provisions H.R. 5013, Value in Health Care Act of 2023, all provisions S. 3503, Value in Health Care Act of 2023, all provisions H.R. 8702, Improving Seniors Timely Access to Care Act of 2024, all provisions S. 4532, Improving Seniors Timely Access to Care Act of 2024, all provisions S. 4935, Physician Fee Stabilization Act, all provisions H.R. 10073, Medicare Patient Access and Practice Stabilization Act of 2024, all provisions H.R. 7856, PREVENT DIABETES Act, all provisions H.R. 3838, Preventing Maternal Deaths Reauthorization Act of 2023, all provisions S. 2415, Preventing Maternal Deaths Reauthorization Act of 2023, all provisions H.R. 8532, Connected MOM Act, all provisions S. 712, Connected MOM Act, all provisions H.R. 6369, To amend title XVIII of the Social Security Act to extend incentive payments for participation in eligible alternative payment models, all provisions H.R. 8404, Radiation Oncology Case Rate (ROCR) Value Based Program Act of 2024, all provisions S. 4330, Radiation Oncology Case Rate (ROCR) Value Based Program Act of 2024, all provisions H.R. 8235, Rural Physician Workforce Preservation Act, all provisions H.R. 1745, Medicare Fraud Detection and Deterrence Act of 2023, all provisions H.R. 1746, Preventing Medicare Telefraud Act, all provisions H.R. 8261, Preserving Telehealth, Hospital, and Ambulance Access Act, all provisions S. 1491, Pharmacy and Medically Underserved Areas Enhancement Act, all provisions S. 669, Increasing Mental Health Options Act of 2023, all provisions H.R. 7618, Stopping Addiction and Falls for the Elderly (SAFE) Act, all provisions H.R. 3730, Rural Health Clinic Burden Reduction Act, all provisions H.R. 7279, Remove Duplicative Unnecessary Clerical Exchanges (REDUCE) Act, all provisions H.R. 6230, Doctor Knows Best Act of 2023, all provisions H.R. 9572, Enhanced Enforcement of Health Coverage Act, all provisions H.R. 9001, Physician Led and Rural Access to Quality Care Act, all provisions S. 5218, Health Infrastructure Security and Accountability Act of 2024, all provisions S. 4054, Health Care Cybersecurity Improvement Act of 2024, all provisions H.R. 9572, Enhanced Enforcement of Health Coverage Act, all provisions Supporting Health Moms and Babies Act/draft Fewer Burdens for Better Healthcare Act/draft Medicaid Primary Care Improvement Act/Senate draft Opioid Workforce Act of 2021/Senate draft Electronic clinical quality measures (eCQM) reporting/draft Medicare program: Medicare physician payment/2.83% cut for FY2025 Medicare program: Payment reform/Medicare Part B cuts Medicare program: Medicare Economic Index (MEI) inflation update Medicare program: Budget neutrality reforms Medicare program: Merit-based Incentive Payment System (MIPS) reforms and penalties Medicare program: G2211 inherent complexity codes Medicare program: Protecting Access to Medicare Act (PAMA 2014)/clinical lab cut reforms Medicare Program: Medicare Access and CHIP Reauthorization Act (MACRA) physician burdens Medicare program: Alternative Payment Models (APMs) Medicare program: Advanced APMs reporting requirements Medicare program: APMs for rural physicians Medicare program: Graduate Medical Education (GME) cap flexibility Medicare program: Physician-owned hospitals Medicare program: Telehealth Medicare program: Prior Authorization Medicare program: Site neutral payment Medicare program: Physician-Focused Payment Model Technical Advisory Committee (PTAC) reform Medicare program: Sunsetting of web interface Medicare program: Access to claims data Medicare program: Coding Medicare program: Accountable Care Organization (ACO)/APM/Medicare Shared Savings Program Medicare program: Medicare Diabetes Prevention Program Medicare program: Physician burden Medicare program: Promoting Interoperability (PI) program Medicare program: Quality Payment Program Medicare program: Certified electronic health record technology and PI Medicare program: Shared Savings program Medicare program: Public Health Reporting and Data Exchange Medicare program: Patient engagement Medicare program: Medicare Advantage plans/Prior Authorization Medicare program: Physician-owned hospitals Medicare program: Medigap/modified community rating Medicare and Medicaid programs: Artificial intelligence Medicare and Medicaid programs: Substance use disorder Medicare and Medicaid programs: Cybersecurity/health care clearinghouses Medicare and Medicaid programs: Health IT Medicare and Medicaid programs: Interoperability Medicare and Medicaid programs: Mandatory models Medicaid and Medicare programs: Quality programs/physician choice Medicaid program: Maternal health Medicaid program: Maternal mortality

Client expense: $6,590,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Management & Budget (OMB), Office of Natl Drug Control Policy (NDCP), Office of Science & Technology Policy (OSTP), SENATE

Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program (H.R. 3290) Rural health care innovation (PA Rural Health Model) Public Health Emergency designation SAVE Act (H.R. 2584) Fairness for Rural Teaching Hospitals Act (H.R.2433) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Behavioral health PATIENT Act of 2023 (H.R.3561) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (S.1113, H.R.2530) CHGME Youth behavioral health Electronic health records Pandemic and All-Hazards Preparedness Reauthorization Act Nursing and allied health education (NAHE) program Bipartisan Primary Care and Health Workforce Act (S.2840) Transparent PRICE Act (H.R.3281) Save Americas Rural Hospitals Act (H.R.833) Supporting Safety Net Hospitals Act (H.R.2665) Patient Access to Higher Quality Care Act (H.R.977/S.470) FEMA Covid-19 reimbursement Health Care Price Transparency Act (H.R.4822) Providers and Payers Compete Act (H.R.3284) Lower Costs, More Transparency Act (H.R.5378) Health Care Prices Revealed and Information to Consumers Explained Transparency Act (S.3548) Medical and Nurse Licensure Compact Health care consolidation, mergers and acquisitions Accelerating Kids Access to Care Act (H.R. 4758, S.2372)

Client expense: $60,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Repeal Section 6001 of the Affordable Care Act - section 6001 prohibits expansion of physician-led hospitals - including related provisions in H.R. 977/S. 470, the Patient Access to Higher Quality Care Act; and in H.R. 9001, the Physician Led and Rural Access to Quality Care Act, to revise certain physician self-referral exemptions relating to physician-owned hospitals in rural areas; and related issues regarding hospital competition and consolidation. Center for Medicare & Medicaid Innovation demonstration to expand patient access to physician-led hospitals. Reform Medicare Advantage prior authorization, including related provisions in: H.R. 4968, the GOLD Card Act; H.R. 4822, the Health Care Price Transparency Act; H.R. 5378, the Lower Costs, More Transparency Act; and S. 4518/S. 4532/H.R. 8702, to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Advocacy related to H.R. 8246, Second Chances for Rural Hospitals Act, and access to physician-led entities.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR977/S470, Patient Access to Higher Quality Health Care Act of 2023; HR5378, Lower Costs, More Transparency Act; HR3561, PATIENT Act of 2023; S3394, Rural Emergency Hospital Adjustment Act;

Client expense: $700,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR977/S470, Patient Access to Higher Quality Health Care Act of 2023; HR5378, Lower Costs, More Transparency Act; HR3561, PATIENT Act of 2023; S3394, Rural Emergency Hospital Adjustment Act;

Client expense: $700,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

issues relating to hospitals and healthcare H.R.1129 To direct the Secretary of Health and Human Services to revise regulations to remove the requirement under the Medicare program that an off-campus facility or organization shall be located within a 35-mile radius of a hospital or critical access hospital; S.468 Hospital Transparency Compliance Enforcement Act; H.R.990,S 407 SAFE Hospitals Act of 2023; H.R.1565 Critical Access Hospital Relief Act of 2023; H.R.2530 & S1113 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act; H.R.977-S.470 Patient Access to Higher Quality Health Care Act of 2023; H.R.1475 Hospital Adoption Education Act of 2023; H.R.410 Health Care PRICE Transparency Act; H.R.3417 FAIR Act; HR 2859 Holding Nonprofit Hospitals Accountable Act; H.R.5007, S2657 GREEN Hospitals Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

PL 115-97 Tax Cuts and Jobs Act - amendments to the IRC and other changes PL 117-169 Inflation Reduction Act - amendments to the IRC and other changes HR 25 Fair Tax Act - imposes a national sales tax on the use or consumption in the United States of taxable property or services in lieu of the current income taxes S 234 New Markets Tax Credit Extension Act - makes the new markets tax credit permanent S 866 American Innovation and Jobs Act - enhance tax benefits for research activities HR 2811 Limit, Save, and Grow Act of 2023 - bill increases the federal debt limit and decreases spending HR 2673/S 866American Innovation and R&D Competitiveness Act of 2023 -- eliminates the five-year amortization requirement for research and experimental expenditures HR 3936 Tax Cuts for Working Families Act -- rename the standard deduction the guaranteed deduction, and to add a bonus amount to the guaranteed deduction HR 3937 Small Business Jobs Act -- to promote the establishment and growth of small businesses HR 3938 Build It In America Act --amend the Internal Revenue Code of 1986 to encourage economic growth HR 5707 Secure Family Futures Act of 2023--to apply ordinary tax treatment to certain investments S.470 Secure Family Futures Act of 2024--to apply ordinary tax treatment to certain investments

Client expense: $580,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

HR 977/S 470: Patient Access to Higher Quality Health Act of 2023 Rep. Michael Burgess, MD (R-TX); Sen. James Lankford (R-OK) This bill repeals provisions under the Stark Law (i.e., the Physician Self-Referral Law) that limit, for purposes of Medicare participation, self-referrals by newly constructed or expanded physician-owned hospitals HR 2630/S 652: Safe Step Act Reps. Brad Wenstrup, DPM (R-OH); Raul Ruiz, MD (D-CA); Mariannette Miller-Meeks, MD (R-IA) Sens. Lisa Murkowski (R-AK); Maggie Hassan (D-NH); Roger Marshall, MD (R-KS) Requires group health plans to establish a clear and transparent process to request an exception to step therapy protocols in specified cases. Support reforming prior authorization Advocate for prior authorization policies that are more seamless, automated, and transparent for physicians and their patients. HR: 6545: Physician Fee Schedule Update and Improvements Act Reps. Mariannette Miller-Meeks (R-IA); Larry Bucshon ,MD (R-IN); Kim Schrier, MD (D-WA); Robin Kelly (D-IL), Michael Burgess, MD (R-TX); Greg Murphy, MD (R-NC), Brad Wenstrup, ,DPM (R-OH), Ami Bera, MD (D-CA), Tony Cardenas (D-CA); Raul Ruiz, MD (D-CA): Increases the budget neutrality from $20 million to $53 million would allow for greater flexibility in determining pricing adjustments for services without leading to harmful payment cuts for doctors.

Client expense: $518,655 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Behavioral Health H. 8526, Elementary and Secondary School Counseling Act Childcare Issues related to childcare - no specific bill Gun Safety Issues related to gun safety - no specific bill H.R. 4283, Gun Violence Prevention and Community Safety Act Health Care S. 4503, A bill to prevent exploitative private equity practices, and for other purposes Issues related to health care/universal access to quality, equitable, affordable coverage - no specific bill Issues related to mental and behavioral health care - no specific bill Issues related to Private Equity/Healthcare - no specific bill H.R. 9001, Physician Led and Rural Access to Quality Care Act Health Care Workforce Issues related to health care workforce shortages - no specific bill Issues related to the affordability of medical education and federal loan programs - no specific bill Issues related to scope of practice - no specific bill Issues related to the Department of Veterans Affairs Federal Supremacy Project - no specific bill Demographic data collection - no specific bill H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act H.R. 2389/S. 1302, the Resident Physician Shortage Reduction Act H.R. 6205/S. 3211, the Healthcare Workforce Resilience Act HIV/AIDS Presidents Emergency Plan for AIDS Relief (PEPFAR) Immigration Issues related to Immigration - no specific bill H.R. 4942/ S. 665, the Conrad State 30 and Physician Access Reauthorization Act Protecting Immigrant Families (PIF) Campaign Infrastructure Issues related to broadband access - no specific bill Issues related to the Build Back Better framework - no specific bill Interoperability/ONC Issues related to interoperability and information blocking - no specific bill Maternal Health and Reproductive Health S. 4381, Right to Contraception Act S. 4368, IVF Protection Act S.4304/H.R.8317MAMAS First Act Issues related to maternal health - no specific bill S. 712, The Connected Maternal Online Monitoring (MOM) Act Medical Education Issues related to the affordability of medical education - no specific bill Issues related to student loan forgiveness - no specific bill Support for physicians, residents and medical students - no specific bill Medicare/Medicaid S. 4532 / H.R. 8702, Seniors Timely Access to Care Act Cigna Modifier 25 Budget neutrality rules in the Medicare Physician Fee Schedule - no specific bill H.R. 6445 / S. 2377, Medicare Audiology Access Improvement Act H.R. 2474 the Strengthening Medicare for Patients and Providers Act H.R. 6545 Physician Fee Schedule Update and Improvements Act H.R. 6683 Preserving Seniors Access to Physicians Act of 2023 H.R.2173 the Improving Care and Access to Nurses Act H.R.2670 - National Defense Authorization Act for Fiscal Year 2024 H.R. 6371, the Provider Reimbursement Stability Act H.R. 5013/S. 3503, the Value in Health Care (VALUE) Act S. 4935, Physician Fee Stabilization Act H.R.10073, Medicare Patient Access and Practice Stabilization Act of 2024 H.R. 8816, the American Medical Innovation and Investment Act of 2024 H.R. 2474, the Strengthening Medicare for Patients and Providers Act Issues related to Medicare physician payment - no specific bill Issues related to Medicare/Medicaid - no specific bill Issues related to prior authorization and administrative simplification - no specific bill Issues related to Medicare Advantage - no specific bill Nutrition Issues related to nutrition and food security - no specific bill Issues related to SNAP funding - - no specific bill Opioids/ Substance Use Disorder LABEL Opioids Act of 2023 MATE ACT Adds New Education Mandate for 8 Hours of Continuing Education on Opioid Treatment S.1785, STOP Fentanyl Overdoses Act of 2023 H.R. 4531/S.3393 Support for Patients and Communities Reauthorization Act S. 644 - the Modernizing Opioid Treatment Access Act (MOTAA) S. 3418 Comprehensive Addiction Resources Emergency (CARE) Act Issues related to opioids and substance use disorder - no specific bill Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act Racial Justice/Health Equity Issues related to racial justice/health care equity - no specific bill Health disparities and protecting vulnerable populations - no specific bill Issues related to equitable policies around blood, tissue donations - no specific bill Surprise Billing Issues related to surprise billing - no specific bill Issues related to the implementation of the No Surprises Act - no specific bill Telehealth H.R.8261, the Preserving Telehealth, Hospital, and Ambulance Access Act H.R.4189, the CONNECT for Health Act of 2023 H.R.7623, the Telehealth Modernization Act of 2024 H.R.1843, the Telehealth Expansion Act of 2023 Issues related to telehealth - no specific bill Issues related to telebehavioral health access - no specific bill Issues related to physician licensing - no specific bill Issues related to telehealth PHE flexibilities/waivers - no specific bill Tobacco Issues related to prohibiting sale of menthol cigarettes and flavored cigars - no specific bill Issues related to increasing awareness about lung cancer screening on cigarette packages - no specific bill Vaccines Issues related to vaccines - no specific bill Regulatory FDA's proposed rule to eliminate menthol cigarettes Issues related to Medicare physician payment Issues related to implementation of the No Surprises Act Issues related to telehealth Issues related to Medicare Advantage Star Rating Health Equity Index calculation HIPAA-related Reporting Requirements Involving the Change Healthcare Cyber Incident

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

Behavioral Health H. 8526, Elementary and Secondary School Counseling Act Childcare Issues related to childcare - no specific bill Gun Safety Issues related to gun safety - no specific bill H.R. 4283, Gun Violence Prevention and Community Safety Act Health Care S. 4503, A bill to prevent exploitative private equity practices, and for other purposes Issues related to health care/universal access to quality, equitable, affordable coverage - no specific bill Issues related to mental and behavioral health care - no specific bill Issues related to Private Equity/Healthcare - no specific bill H.R. 9001, Physician Led and Rural Access to Quality Care Act Health Care Workforce Issues related to health care workforce shortages - no specific bill Issues related to the affordability of medical education and federal loan programs - no specific bill Issues related to scope of practice - no specific bill Issues related to the Department of Veterans Affairs Federal Supremacy Project - no specific bill Demographic data collection - no specific bill H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act H.R. 2389/S. 1302, the Resident Physician Shortage Reduction Act H.R. 6205/S. 3211, the Healthcare Workforce Resilience Act HIV/AIDS Presidents Emergency Plan for AIDS Relief (PEPFAR) Immigration Issues related to Immigration - no specific bill H.R. 4942/ S. 665, the Conrad State 30 and Physician Access Reauthorization Act Protecting Immigrant Families (PIF) Campaign Infrastructure Issues related to broadband access - no specific bill Issues related to the Build Back Better framework - no specific bill Interoperability/ONC Issues related to interoperability and information blocking - no specific bill Maternal Health and Reproductive Health S. 4381, Right to Contraception Act S. 4368, IVF Protection Act S.4304/H.R.8317MAMAS First Act Issues related to maternal health - no specific bill S. 712, The Connected Maternal Online Monitoring (MOM) Act Medical Education Issues related to the affordability of medical education - no specific bill Issues related to student loan forgiveness - no specific bill Support for physicians, residents and medical students - no specific bill Medicare/Medicaid S. 4532 / H.R. 8702, Seniors Timely Access to Care Act Cigna Modifier 25 Budget neutrality rules in the Medicare Physician Fee Schedule - no specific bill H.R. 6445 / S. 2377, Medicare Audiology Access Improvement Act H.R. 2474 the Strengthening Medicare for Patients and Providers Act H.R. 6545 Physician Fee Schedule Update and Improvements Act H.R. 6683 Preserving Seniors Access to Physicians Act of 2023 H.R.2173 the Improving Care and Access to Nurses Act H.R.2670 - National Defense Authorization Act for Fiscal Year 2024 H.R. 6371, the Provider Reimbursement Stability Act H.R. 5013/S. 3503, the Value in Health Care (VALUE) Act S. 4935, Physician Fee Stabilization Act H.R.10073, Medicare Patient Access and Practice Stabilization Act of 2024 H.R. 8816, the American Medical Innovation and Investment Act of 2024 H.R. 2474, the Strengthening Medicare for Patients and Providers Act Issues related to Medicare physician payment - no specific bill Issues related to Medicare/Medicaid - no specific bill Issues related to prior authorization and administrative simplification - no specific bill Issues related to Medicare Advantage - no specific bill Nutrition Issues related to nutrition and food security - no specific bill Issues related to SNAP funding - - no specific bill Opioids/ Substance Use Disorder LABEL Opioids Act of 2023 MATE ACT Adds New Education Mandate for 8 Hours of Continuing Education on Opioid Treatment S.1785, STOP Fentanyl Overdoses Act of 2023 H.R. 4531/S.3393 Support for Patients and Communities Reauthorization Act S. 644 - the Modernizing Opioid Treatment Access Act (MOTAA) S. 3418 Comprehensive Addiction Resources Emergency (CARE) Act Issues related to opioids and substance use disorder - no specific bill Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act Publications Open access to information based on publicly funded research - no specific bill Request for Information for NIH Plan to Enhance Public Access to the Results of NIH-Supported Research Issues related to scholarly and scientific publishing and public access - no specific bill H.R. 9378, Sunshine Act of 2023 Racial Justice/Health Equity Issues related to racial justice/health care equity - no specific bill Health disparities and protecting vulnerable populations - no specific bill Issues related to equitable policies around blood, tissue donations - no specific bill Surprise Billing Issues related to surprise billing - no specific bill Issues related to the implementation of the No Surprises Act - no specific bill Telehealth H.R.8261, the Preserving Telehealth, Hospital, and Ambulance Access Act H.R.4189, the CONNECT for Health Act of 2023 H.R.7623, the Telehealth Modernization Act of 2024 H.R.1843, the Telehealth Expansion Act of 2023 Issues related to telehealth - no specific bill Issues related to telebehavioral health access - no specific bill Issues related to physician licensing - no specific bill Issues related to telehealth PHE flexibilities/waivers - no specific bill Tobacco Issues related to prohibiting sale of menthol cigarettes and flavored cigars - no specific bill Issues related to increasing awareness about lung cancer screening on cigarette packages - no specific bill Vaccines Issues related to vaccines - no specific bill Regulatory FDA's proposed rule to eliminate menthol cigarettes Issues related to Medicare physician payment Issues related to implementation of the No Surprises Act Issues related to telehealth Issues related to Medicare Advantage Star Rating Health Equity Index calculation HIPAA-related Reporting Requirements Involving the Change Healthcare Cyber Incident

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Science & Technology Policy (OSTP), SENATE, Veterans Affairs, Dept of (VA)

Q4 Lobbying Report (Oct.1 -Dec. 31) HCR Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program Resident Physician Shortage Act of 2023 (H.R. 2389) No Surprises Act regulations Food and Drug Amendments No Surprise Bills for New Moms Act (H.R. 3387) Securing the U.S. Organ Procurement and Transplantation Network Act (H.R. 2544) Promoting Access to Treatments and Increasing Extremely Needed Transparency Act (H.R. 3561) Medicaid VBPs for Patients (MVP) Act (H.R. 2666) Providers and Payers COMPETE Act (H.R. 3284) To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program (H.R. 3290) Transparent PRICE Act (H.R. 3281/H.R. 2691)) Resident Physician Shortage Reduction (S. 1302) Medical Student Education Authorization Act (H.R. 3046) Save Americas Rural Hospitals Act (H.R. 833) Chronic Care Management Improvement Act (H.R. 2829) Safety From Violence for Healthcare Employees Act (H.R. 2584) Supporting Safety Net Hospitals Act (H.R. 2665) Patient Access to Higher Quality Health Care Act (H.R. 977/S.470) FEMA re: COVID-19 related reimbursement Public Health Guidance Transparency and Accountability Act of 2023 (H.R. 4529) Public Health Emergency Congressional Review Act (H.R. 4381) CDC Leadership Accountability Act of 2023 (H.R. 3813) Preparing for All Hazards and Pathogens Reauthorization Act (H.R. 4421) Preparedness and Response Reauthorization Act (H.R. 4420) Childrens Hospital GME Support Reauthorization Act of 2023 (H.R. 3887) Health Care Price Transparency Act of 2023 (H.R. 4822) Providers and Payers COMPETE Act (H.R. 3284) Lower Costs, More Transparency Act (H.R. 5378 Transparency in Coverage Act (H.R. 4507) GOLD Card Act of 2023 (H.R. 4968) No Fees for EFTs Act (H.R.6487) Rural Health Care Facilities Revitalization Act (H.R. 5989) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (H.R. 7153) To amend title XVIII of the Social Security Act to establish a definition of essential health system in statute (H.R. 7397) Substance Use Disorder Workforce Act (H.R. 7050) 340B PATIENTS Act (H.R. 7635) The 340B Affording Care for Communities and Ensuring a Strong Safety-net (ACCESS) Act (H.R. 8574) Improving Seniors Access to Timely Care Act (H.R. 8702/S.4532) The Preserving Emergency Access in Key Sites (PEAKS) Act (H.R. 7931) Rural Health Care Facilities Revitalization Act (H.R. 5989) MMM Accelerated and Advance Payment Program repayment flexibility Graduate Medical Education (GME) funding Telehealth flexibilities and payment Annual Prospective Payment System Rules Organ acquisition payment policies Californias Medicaid Hospital Quality Assurance Fee Program Medicare Advantage BUD FY 2025 Appropriations bills Nursing and allied health workforce funding FY 2025 budget request Further Continuing Appropriations and Other Extensions Act (H.R. 6363) Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act (H.R. 5894) Tax Relief for American Families and Workers Act of 2024 (H.R. 7024) Extension of Continuing Appropriations and Other Matters Act, 2024 (H.R. 7463) Submitted Comments Regulatory Comment Letters SUBJECT: CMS-10913, Medicare Part C Utilization Management Annual Data Submission and Audit Protocol Data Request; Notice, Agency Information Collection Activities: Proposed Collection; Comment Request; Federal Register (Vol 89, No 145), September 10, 2024

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

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Social Security Administration (SSA)

Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program (H.R. 3290) Rural health care innovation (PA Rural Health Model) Public Health Emergency designation SAVE Act (H.R. 2584) Fairness for Rural Teaching Hospitals Act (H.R.2433) Public Service Loan Forgiveness program/physician federal loan forgiveness Healthcare Workforce Behavioral health PATIENT Act of 2023 (H.R.3561) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (S.1113, H.R.2530) CHGME Youth behavioral health Electronic health records Pandemic and All-Hazards Preparedness Reauthorization Act Nursing and allied health education (NAHE) program Bipartisan Primary Care and Health Workforce Act (S.2840) Transparent PRICE Act (H.R.3281) Save Americas Rural Hospitals Act (H.R.833) Supporting Safety Net Hospitals Act (H.R.2665) Patient Access to Higher Quality Care Act (H.R.977/S.470) FEMA Covid-19 reimbursement Health Care Price Transparency Act (H.R.4822) Providers and Payers Compete Act (H.R.3284) Lower Costs, More Transparency Act (H.R.5378) Health Care Prices Revealed and Information to Consumers Explained Transparency Act (S.3548) Medical and Nurse Licensure Compact Health care consolidation, mergers and acquisitions Accelerating Kids Access to Care Act (H.R. 4758, S.2372)

Client expense: $60,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.5378, Lower Costs, More Transparency Act, Issues related to site neutral payment cuts, hospital price transparency, unique health identifier, 340B Program; H.R. 3173 / S. 4532, Improving Seniors' Timely Access to Care, all provisions; S.4350 / H.R. 8260, Hospital Inpatient Services Modernization Act of 2024, all provisions; Draft Bill, Issues pertaining to proposed changes to the Medicare Graduate Medical Education program and solutions to address workforce shortages in rural areas; S.4338, the Pay PCPs Act , Feedback to improve physician reimbursement and value-based primary care; S. 1110, the Rural Hospital Support Act, all provisions; H.R. 6430, Assistance for Rural Community Hospitals (ARCH)Act, all provisions; H.R. 7711, Advancing Access to Telehealth Act,all provisions; H.R. 3432, Telemental Health Care Access Act, all provisions; H.R. 3875, the Expanded Telehealth Access Act, all provisions; H.R. 5611, Helping Ensure Access to Local Telehealth (HEALTH) Act of 2023, all provisions; H.R. 6033, Supporting Patient Education and Knowledge (SPEAK) Act of 2023, all provisions; Draft Bill, To amend title XVIII of the Social Security Act to adjust long-term care hospital payment rates under the Medicare program, Issues related to LTCH payment policy reforms; S. 5236, A bill to amend titles XIX and XXI of the Social Security Act to enhance financial support for rural and safety net hospitals providing maternity, labor, and delivery services to vulnerable populations, and for other purposes, Reimbursements to rural and safety net hospitals providing maternity, labor, and delivery services; H.R. 7623, Telehealth Modernization Act, Issues pertaining to Telehealth, Hospital at Home, Unique Health Identifier; H. Jes Res 139 / S.J. Res 91, A joint resolution for congressional disapproval of a rule relating to "Medicare and Medicaid Programs, Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting", All provisions; S. 2016/ H.R. 4189, The CONNECT for Health Act of 2023, Specifically telehealth waivers, geographic restrictions, originating site requirements, in person requirement behavioral health, RHCs and FQHCs access; H.R. 1110, KEEP Telehealth Option Act, All provisions; H.R. 5541, the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, All provisions; HR 2389/ S. 1302, Resident Physician Shortage Reduction Act of 2023, All provisions; H.R. 977/S. 470, Patient Access to Higher Quality Care Act, all provisions; Draft Bill, Obstetric care in Critical Access Hospitals (CAH); Centers for Medicare & Medicaid Services (CMS), Medicare Drug Price Negotiation Program Draft Guidance, Issues pertaining to the implementation of the Medicare drug price negotiation program; Centers for Medicare & Medicaid Services (CMS), Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model, Issues pertaining to Value Based Care and feedback on proposed IOTA model; Centers for Medicare & Medicaid Services (CMS), FY 2025 Inpatient Prospective Payment Systems for Acute Care Hospitals; Disproportionate Share Hospital Payments, Issues pertaining to the FY2025 Inpatient Prospective Payment Systems Rule and Disproportionate Share Hospital Payments Changes in FY25 IPPS Rule; Medicare Payment Advisory Commission (MedPAC), 2025 Priorities, Issues pertaining to 340B Drug Pricing Program, inpatient rehabilitation facility (IRF) payments, the physician fee schedule (PFS) and telehealth in the new cycle; Centers for Medicare & Medicaid Services (CMS), Calendar Year (CY) 2025 Home Health Prospective; Payment System (HH PPS) Rate Update, Issues pertaining to the CY25 Home Health Proposed Rule; Centers for Medicare & Medicaid Services (CMS), Physician fee schedule (PFS) proposed rule for calendar year (CY) 2025, Issues pertaining to physician fee schedule; Centers for Medicare & Medicaid Services (CMS), Outpatient Prospective Payment System (OPPS) Proposed rule for Calendar Year (CY2025), Issues pertaining to outpatient and ambulatory surgery center prospective payment system, conditions of participation for maternal health; Health & Human Services (HHS), Letter to HHS, Medicare Advantage Organizations' Use of Prior Authorization for Post-Acute Care; Centers for Medicare & Medicaid Services (CMS), Significant, Anomalous and Highly Suspect (SAHS) billing in Medicare Shared Savings Program (MSSP) in Calendar Year 2023, Issues pertaining to proposed rule to mitigate the impact of significant, anomalous and highly suspect (SAHS) billing activity within the Medicare Shared Savings Program (MSSP) in calendar year (CY) 2023; Site Neutral Payments, Issues related to site neutral payment cuts for drug administration; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees, DSH cuts; Medicaid Disproportionate Share Hospital (DSH) program, Medicaid DSH program; LTCH High Cost Outlier Threshold, SFC / W&M Meeting / CMS Meeting , Issues concerning High Cost Outlier in LTCH payment policy; National Provider Identifier (NPI), Included in E&C markup statement in September , Unique identifiers for off-campus Hospital Outpatient Departments (HOPDs); Access to inpatient rehabilitation care, Letter to CMS / Supported Hill Led Effort, Access to inpatient rehabilitation care for MA enrollees; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, and REHs; Physician Payments, Issues pertaining to proposed solutions to improve MACRA, alternative payment models, mental health of workforce; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay and cost-based reimbursement for critical access hospitals under Medicare Advantage.

Client expense: $5,450,000 · Firm income: Not reported

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

S.470/H.R.977, Patient Access to Higher Quality Health Care Act: To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. S.4532/H.R. 8702), Improving Seniors Timely Access to Care Act: To streamline prior authorization in the Medicare Advantage program. H.R.2389, Resident Physician Shortage Reduction Act: To provide for the distribution of additional residency positions H.R. 2474, Strengthening Medicare for Patients and Providers Act: To provide an update to a single conversion factor under the Medicare physician fee schedule that is based on the Medicare economic index. H.R. 4968, the GOLD CARD Act of 2023: Prior authorization reform in Medicare Advantage H.R. 9001, Physician Led and Rural Access to Quality Care Act: To amend title XVIII of the Social Security Act to revise certain physician self-referral exemptions relating to physician-owned hospitals and allow physician ownership of rural hospitals H.R.9805, Access to Claims Data Act: To require the Secretary of Health and Human Services to establish a process to expand access to claims data under certain Federal health plans in order to facilitate research and quality improvement. No bill: Graduate medical education policy reform ideas. No bill: Medicare physician payment reform policy ideas, need for legislation to prevent Medicare physician payment cuts and adopt an inflation-based payment update for 2025, modifications to Medicare's budget neutrality rules, increasing surgical global codes to incorporate increased RVUs for follow-up care w/in the global period, and improvements to value-based care payment models

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.470/H.R.977, Patient Access to Higher Quality Health Care Act: To repeal changes made by health care reform laws to the Medicare exception to the prohibition on certain physician referrals for hospitals. S.4532/H.R. 8702), Improving Seniors Timely Access to Care Act: To streamline prior authorization in the Medicare Advantage program. H.R.2389, Resident Physician Shortage Reduction Act: To provide for the distribution of additional residency positions H.R. 2474, Strengthening Medicare for Patients and Providers Act: To provide an update to a single conversion factor under the Medicare physician fee schedule that is based on the Medicare economic index. H.R. 4968, the GOLD CARD Act of 2023: Prior authorization reform in Medicare Advantage H.R. 9001, Physician Led and Rural Access to Quality Care Act: To amend title XVIII of the Social Security Act to revise certain physician self-referral exemptions relating to physician-owned hospitals and allow physician ownership of rural hospitals H.R.9805, Access to Claims Data Act: To require the Secretary of Health and Human Services to establish a process to expand access to claims data under certain Federal health plans in order to facilitate research and quality improvement. No bill: Graduate medical education policy reform ideas. No bill: Medicare physician payment reform policy ideas, need for legislation to prevent Medicare physician payment cuts and adopt an inflation-based payment update for 2025, modifications to Medicare's budget neutrality rules, increasing surgical global codes to incorporate increased RVUs for follow-up care w/in the global period, and improvements to value-based care payment models

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR977/S470, Patient Access to Higher Quality Health Care Act of 2023; HR5378, Lower Costs, More Transparency Act; HR3561, PATIENT Act of 2023; S3394, Rural Emergency Hospital Adjustment Act;

Client expense: $430,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR977/S470, Patient Access to Higher Quality Health Care Act of 2023; HR5378, Lower Costs, More Transparency Act; HR3561, PATIENT Act of 2023; S3394, Rural Emergency Hospital Adjustment Act;

Client expense: $430,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Discussions pertaining to CMS hospital directed payment program Discussions pertaining to reductions to the Medicaid disproportionate share hospital (DSH) program S 470 Patient Access to Higher Quality Health Care Act of 2023 (all sections of full text)(oppose) HR 977 Patient Access to Higher Quality Health Care Act of 2023 (all sections of full text) (oppose) HR 8246 Second Chances for Rural Hospitals Act (all sections of full text)(oppose) S 1869 Site-based Invoicing and Transparency Enhancement (SITE) Act (all sections of full text) Discussions relating to site neutral payment reform Discussions pertaining to prior authorization Monitored Medicare Advantage reform legislation on CMS action

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6645, Medicare Audiology Access Improvement Act of 2023, all provisions S. 2377, Medicare Audiology Access Improvement Act of 2023, all provisions H.R. 1610, Chiropractic Medicare Coverage Modernization Act of 2023, all provisions S. 799, Chiropractic Medicare Coverage Modernization Act of 2023, all provisions H.R. 4189, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023, all provisions S. 2016, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2023, all provisions H.R. 8532, Connected MOM Act, all provisions S. 712, Connected MOM Act, all provisions H.R. 1770, Equitable Community Access to Pharmacist Services Act, all provisions S. 2477, Equitable Community Access to Pharmacist Services Act, all provisions H.R. 751, Fair Access In Residency (FAIR) Act, all provisions H.R. 4968, Getting Over Lengthy Delays in Care As Required by Doctors (GOLD CARD) Act of 2023, all provisions H.R. 2713, Improving Care and Access to Nurses (I CAN) Act, all provisions S. 2418, Improving Care and Access to Nurses (I CAN) Act, all provisions H.R. 2583, Increasing Access to Quality Cardiac Rehabilitation Care Act of 2023, all provisions H.R. 6487, No Fees for EFTs Act, all provisions S. 3805, No Fees for EFTs Act, all provisions H.R. 977, Patient Access to Higher Quality Health Care Act of 2023, all provisions S. 470, Patient Access to Higher Quality Health Care Act of 2023, all provisions H.R. 2389, Resident Physician Shortage Reduction Act of 2023, all provisions S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions H.R. 7050, Substance Use Disorder Workforce Act, all provisions H.R. 7623, Telehealth Modernization Act of 2024, all provisions H.R. 2474, Strengthening Medicare for Patients and Providers Act, all provisions H.R. 830, Help Ensure Lower Patient (HELP) Copays Act, all provisions S. 1375, Help Ensure Lower Patient (HELP) Copays Act, all provisions H.R. 6371, Provider Reimbursement Stability Act of 2023, all provisions H.R. 6545, Physician Fee Schedule Update and Improvements Act, all provisions H.R. 5378, Lower Costs, More Transparency Act, all provisions H.R. 6683, Preserving Seniors Access to Physicians Act of 2023, all provisions H.R. 5013, Value in Health Care Act of 2023, all provisions S. 3503, Value in Health Care Act of 2023, all provisions H.R. 8702, Improving Seniors Timely Access to Care Act of 2024, all provisions S. 4532, Improving Seniors Timely Access to Care Act of 2024, all provisions S. 4518, Improving Seniors Timely Access to Care Act of 2024, all provisions S. 4935, Physician Fee Stabilization Act, all provisions H.R. 6366, To amend title XVIII of the Social Security Act with respect to the work geographic index for physician payments under the Medicare program, and to revise the phase-in of clinical laboratory test payment changes under such program, all provisions H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024, provisions relating to Medicare payments H.R. 7931, Preserving Emergency Access in Key Sites (PEAKS) Act, all provisions S. 4338, Pay PCPs Act of 2024, all provisions H.R. 8563, Preserving Access To Care in Hawaii (PATCH) Act, all provisions S. 4395, Protecting Access To Care in Hawaii (PATCH) Act, all provisions H.R. 6369, To amend title XVIII of the Social Security Act to extend incentive payments for participation in eligible alternative payment models, all provisions H.R. 7665, ACO Assignment Improvement Act of 2024, all provisions S. 3939, ACO Assignment Improvement Act of 2024, all provisions H.R. 8404, Radiation Oncology Case Rate (ROCR) Value Based Program Act of 2024, all provisions S. 4330, Radiation Oncology Case Rate (ROCR) Value Based Program Act of 2024, all provisions H.R. 4829, Physical Therapist Workforce and Patient Access Act of 2023, all provisions H.R. 8235, Rural Physician Workforce Preservation Act, all provisions H.R. 1745, Medicare Fraud Detection and Deterrence Act of 2023, all provisions H.R. 1746, Preventing Medicare Telefraud Act, all provisions H.R. 8261, Preserving Telehealth, Hospital, and Ambulance Access Act, all provisions S. 1491, Pharmacy and Medically Underserved Areas Enhancement Act, all provisions S. 669, Increasing Mental Health Options Act of 2023, all provisions H.R. 7618, Stopping Addiction and Falls for the Elderly (SAFE) Act, all provisions H.R. 3730, Rural Health Clinic Burden Reduction Act, all provisions H.R. 7279, Remove Duplicative Unnecessary Clerical Exchanges (REDUCE) Act, all provisions H.R. 7708, Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act, all provisions S. 3508, Requiring Enhanced & Accurate Lists of (REAL) Health Providers Act, all provisions H.R. 9001, Physician Led and Rural Access to Quality Care Act, all provisions S. 5218, A bill to amend titles XI and XVIII of the Social Security Act to strengthen, increase oversight of, and compliance with, security standards for health information, and for other purposes, all provisions S. 4054, Health Care Cybersecurity Improvement Act of 2024, all provisions H.R. 8588, Linking Seniors to Needed Legal Services Act of 2024, all provisions H.R. 5526, Seniors Access to Critical Medications Act of 2024, all provisions H.R. 9129, Patient Debt Relief Act, all provisions Fewer Burdens for Better Care Act/draft MACRA/MIPS program reform legislation/draft FY 2025 Medicare physician payment increase/draft Medical Chaperones in Medicare/draft Medicare program: No Surprises Act implementation Medicare program: 21st Century Cures Act implementation Medicare program: FY 2025 Physician payment cut Medicare program: Information Blocking Disincentives Medicare program: Merit-based Incentive Payment System (MIPS) reform Medicare program: Medicare Economic Index (MEI) Medicare program: Medicare Access and CHIP Reauthorization Act (MACRA) reform Medicare program: Budget neutrality reforms/Inflationary update Medicare program: G2211 Inherent complexity code Medicare program: Protecting Access to Medicare Act (PAMA 2014) lab cut reform Medicare program: High-cost disposable services payment Medicare program: Medicare Administrative Contractor/local-coverage determinations Medicare program: Making Care Primary alternative payment models (APM) Medicare program: Rural physicians APM Medicare program: Site neutral payment Medicare program: Physician-owned hospitals Medicare program: Graduate Medical Education (GME) funding Medicare program: Audio-visual supervision of residents/permanent expansion Medicare program: Conditions of Participation (COP)/Obstetrical service Medicare program: MACRA/physician burdens Medicare program: Health Information Technology/physician burdens Medicare program: Prior authorization/Medicare Advantage plans Medicare program: Interoperability/data sharing/information blocking/provider disincentives Medicare program: Promoting interoperability reporting Medicare program: Trusted exchange framework/common agreement Medicare program: Data segmentation Medicare program: Quality payment program Medicare program: Medicare Shared Savings Program/Advanced APM Medicare program: Public health reporting and data exchange Medicare program: Accountable Care Organizations/APM flexibilities Medicare program: Certified Electronic Health Record (EHR) Technology Medicare program: Physician Practice Information (PPI) survey/practice expense Medicare program: MIPS Value Pathways (MVPs)/APMs Medicare program: Telehealth flexibilities Medicare and Medicaid programs: Data Privacy and Cybersecurity Medicare and Medicaid programs: Health Insurance Portability and Accountability Act (HIPAA)/electronic records

Client expense: $5,330,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Health Resources & Services Administration (HRSA), Medicare Payment Advisory Commission (MedPAC), Office of Science & Technology Policy (OSTP), SENATE, Veterans Affairs, Dept of (VA)

Repeal Section 6001 of the Affordable Care Act - section 6001 prohibits expansion of physician-led hospitals - including related provisions in H.R. 977/S. 470, the Patient Access to Higher Quality Care Act; and in H.R. 9001, the Physician Led and Rural Access to Quality Care Act, to revise certain physician self-referral exemptions relating to physician-owned hospitals in rural areas; and related issues regarding hospital competition and consolidation. Center for Medicare & Medicaid Innovation demonstration to expand patient access to physician-led hospitals. Reform Medicare Advantage prior authorization, including related provisions in: H.R. 4968, the GOLD Card Act; H.R. 4822, the Health Care Price Transparency Act; H.R. 5378, the Lower Costs, More Transparency Act; and S. 4518/S. 4532/H.R. 8702, to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. Advocacy related to H.R. 8246, Second Chances for Rural Hospitals Act, and access to physician-led entities.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Behavioral Health H. 8526, Elementary and Secondary School Counseling Act Childcare Issues related to childcare - no specific bill Health Care S. 4503, A bill to prevent exploitative private equity practices, and for other purposes Issues related to health care/universal access to quality, equitable, affordable coverage - no specific bill Issues related to mental and behavioral health care - no specific bill Issues related to Private Equity/Healthcare - no specific bill S. 1655/H.R. 3421, Medicare for All Act of 2023 H.R. 9001, Physician Led and Rural Access to Quality Care Act Health Care Workforce Issues related to health care workforce shortages - no specific bill Issues related to the affordability of medical education and federal loan programs - no specific bill Issues related to scope of practice - no specific bill Issues related to the Department of Veterans Affairs Federal Supremacy Project - no specific bill Demographic data collection - no specific bill H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act H.R. 2389 The Resident Physician Shortage Reduction Act H.R. 2389/S. 1302, the Resident Physician Shortage Reduction Act H.R. 6205/S. 3211, the Healthcare Workforce Resilience Act HIV/AIDS Presidents Emergency Plan for AIDS Relief (PEPFAR) Immigration Issues related to Immigration - no specific bill H.R. 4942/ S. 665, the Conrad State 30 and Physician Access Reauthorization Act Protecting Immigrant Families (PIF) Campaign H.R. 2389 The Resident Physician Shortage Reduction Act Infrastructure Issues related to broadband access - no specific bill Issues related to the Build Back Better framework - no specific bill Maternal Health and Reproductive Health S. 4381, Right to Contraception Act S. 4368, IVF Protection Act S.4304/H.R.8317MAMAS First Act Issues related to maternal health - no specific bill S. 712, The Connected Maternal Online Monitoring (MOM) Act Medical Education Issues related to the affordability of medical education - no specific bill Issues related to student loan forgiveness - no specific bill Support for physicians, residents and medical students - no specific bill Medicare/Medicaid S. 4532 / H.R. 8702, Seniors Timely Access to Care Act Cigna Modifier 25 Budget neutrality rules in the Medicare Physician Fee Schedule - no specific bill H.R. 6445 / S. 2377, Medicare Audiology Access Improvement Act H.R. 2474 the Strengthening Medicare for Patients and Providers Act H.R. 6545 Physician Fee Schedule Update and Improvements Act H.R. 6683 Preserving Seniors Access to Physicians Act of 2023 H.R.2173 the Improving Care and Access to Nurses Act H.R.2670 - National Defense Authorization Act for Fiscal Year 2024 H.R. 6371, the Provider Reimbursement Stability Act H.R. 5013/S. 3503, the Value in Health Care (VALUE) Act S. 4935, Physician Fee Stabilization Act Issues related to Medicare physician payment - no specific bill Issues related to Medicare/Medicaid - no specific bill Issues related to prior authorization and administrative simplification - no specific bill Issues related to Medicare Advantage - no specific bill Nutrition Issues related to nutrition and food security - no specific bill Issues related to SNAP funding - - no specific bill Opioids/ Substance Use Disorder LABEL Opioids Act of 2023 MATE ACT Adds New Education Mandate for 8 Hours of Continuing Education on Opioid Treatment S.1785, STOP Fentanyl Overdoses Act of 2023 H.R. 4531/S.3393 Support for Patients and Communities Reauthorization Act S. 644 - the Modernizing Opioid Treatment Access Act (MOTAA) S. 3418 Comprehensive Addiction Resources Emergency (CARE) Act Issues related to opioids and substance use disorder - no specific bill Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act Issues related to scholarly and scientific publishing and public access - no specific bill H.R. 9378, Sunshine Act of 2023 Racial Justice/Health Equity Issues related to racial justice/health care equity - no specific bill Health disparities and protecting vulnerable populations - no specific bill Issues related to equitable policies around blood, tissue donations - no specific bill Surprise Billing Issues related to surprise billing - no specific bill Issues related to the implementation of the No Surprises Act - no specific bill Telehealth H.R.8261, the Preserving Telehealth, Hospital, and Ambulance Access Act H.R. 4189/S.2016 the CONNECT for Health Act and H.R.7623/S.3967 the Telehealth Modernization Act Issues related to telehealth - no specific bill Issues related to telebehavioral health access - no specific bill Issues related to physician licensing - no specific bill Issues related to telehealth PHE flexibilities/waivers - no specific bill Vaccines Issues related to vaccines - no specific bill Regulatory Issues related to Medicare physician payment Issues related to implementation of the No Surprises Act Issues related to telehealth HIPAA-related Reporting Requirements Involving the Change Healthcare Cyber Incident File Code CMS-1807-P. Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Advantage; Medicare and Medicaid Provider and Supplier Enrollment Policies; and Basic Health Program

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE, Veterans Affairs, Dept of (VA)

Behavioral Health H. 8526, Elementary and Secondary School Counseling Act Childcare Issues related to childcare - no specific bill Gun Safety Issues related to gun safety - no specific bill H.R. 4283, Gun Violence Prevention and Community Safety Act Health Care S. 4503, A bill to prevent exploitative private equity practices, and for other purposes Issues related to health care/universal access to quality, equitable, affordable coverage - no specific bill Issues related to mental and behavioral health care - no specific bill Issues related to Private Equity/Healthcare - no specific bill S. 1655/H.R. 3421, Medicare for All Act of 2023 H.R. 9001, Physician Led and Rural Access to Quality Care Act Health Care Workforce Issues related to health care workforce shortages - no specific bill Issues related to the affordability of medical education and federal loan programs - no specific bill Issues related to scope of practice - no specific bill Issues related to the Department of Veterans Affairs Federal Supremacy Project - no specific bill Demographic data collection - no specific bill H.R. 1667, Dr. Lorna Breen Health Care Provider Protection Act H.R. 2389 The Resident Physician Shortage Reduction Act H.R. 2389/S. 1302, the Resident Physician Shortage Reduction Act H.R. 6205/S. 3211, the Healthcare Workforce Resilience Act HIV/AIDS Presidents Emergency Plan for AIDS Relief (PEPFAR) Immigration Issues related to Immigration - no specific bill H.R. 4942/ S. 665, the Conrad State 30 and Physician Access Reauthorization Act Protecting Immigrant Families (PIF) Campaign H.R. 2389 The Resident Physician Shortage Reduction Act Infrastructure Issues related to broadband access - no specific bill Issues related to the Build Back Better framework - no specific bill Interoperability/ONC Issues related to interoperability and information blocking - no specific bill Maternal Health and Reproductive Health S. 4381, Right to Contraception Act S. 4368, IVF Protection Act S.4304/H.R.8317MAMAS First Act Issues related to maternal health - no specific bill S. 712, The Connected Maternal Online Monitoring (MOM) Act Medical Education Issues related to the affordability of medical education - no specific bill Issues related to student loan forgiveness - no specific bill Support for physicians, residents and medical students - no specific bill Medicare/Medicaid S. 4532 / H.R. 8702, Seniors Timely Access to Care Act Cigna Modifier 25 Budget neutrality rules in the Medicare Physician Fee Schedule - no specific bill H.R. 6445 / S. 2377, Medicare Audiology Access Improvement Act H.R. 2474 the Strengthening Medicare for Patients and Providers Act H.R. 6545 Physician Fee Schedule Update and Improvements Act H.R. 6683 Preserving Seniors Access to Physicians Act of 2023 H.R.2173 the Improving Care and Access to Nurses Act H.R.2670 - National Defense Authorization Act for Fiscal Year 2024 H.R. 6371, the Provider Reimbursement Stability Act H.R. 5013/S. 3503, the Value in Health Care (VALUE) Act S. 4935, Physician Fee Stabilization Act Issues related to Medicare physician payment - no specific bill Issues related to Medicare/Medicaid - no specific bill Issues related to prior authorization and administrative simplification - no specific bill Issues related to Medicare Advantage - no specific bill Nutrition Issues related to nutrition and food security - no specific bill Issues related to SNAP funding - - no specific bill Opioids/ Substance Use Disorder LABEL Opioids Act of 2023 MATE ACT Adds New Education Mandate for 8 Hours of Continuing Education on Opioid Treatment S.1785, STOP Fentanyl Overdoses Act of 2023 H.R. 4531/S.3393 Support for Patients and Communities Reauthorization Act S. 644 - the Modernizing Opioid Treatment Access Act (MOTAA) S. 3418 Comprehensive Addiction Resources Emergency (CARE) Act Issues related to opioids and substance use disorder - no specific bill Prescription Drug Pricing Issues related to prescription drug pricing - no specific bill S. 470/HR 977, The Patient Access to Higher Quality Health Care Act Publications Open access to information based on publicly funded research - no specific bill Request for Information for NIH Plan to Enhance Public Access to the Results of NIH-Supported Research Issues related to scholarly and scientific publishing and public access - no specific bill H.R. 9378, Sunshine Act of 2023 Racial Justice/Health Equity Issues related to racial justice/health care equity - no specific bill Health disparities and protecting vulnerable populations - no specific bill Issues related to equitable policies around blood, tissue donations - no specific bill Surprise Billing Issues related to surprise billing - no specific bill Issues related to the implementation of the No Surprises Act - no specific bill Telehealth H.R.8261, the Preserving Telehealth, Hospital, and Ambulance Access Act H.R. 4189/S.2016 the CONNECT for Health Act and H.R.7623/S.3967 the Telehealth Modernization Act Issues related to telehealth - no specific bill Issues related to telebehavioral health access - no specific bill Issues related to physician licensing - no specific bill Issues related to telehealth PHE flexibilities/waivers - no specific bill Tobacco Issues related to prohibiting sale of menthol cigarettes and flavored cigars - no specific bill Issues related to increasing awareness about lung cancer screening on cigarette packages - no specific bill Vaccines Issues related to vaccines - no specific bill Regulatory FDA's proposed rule to eliminate menthol cigarettes Issues related to Medicare physician payment Issues related to implementation of the No Surprises Act Issues related to telehealth HIPAA-related Reporting Requirements Involving the Change Healthcare Cyber Incident File Code CMS-1807-P. Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Advantage; Medicare and Medicaid Provider and Supplier Enrollment Policies; and Basic Health Program

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

Government targets: Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Natl Institutes of Health (NIH), Office of Science & Technology Policy (OSTP), SENATE, Veterans Affairs, Dept of (VA)

Q3 Lobbying Report (July 1-Sept. 10) HCR Transparency (surprise medical bills; public posting of hospital charges) 340B Drug Pricing Program Resident Physician Shortage Act of 2023 (H.R. 2389) No Surprises Act regulations Food and Drug Amendments No Surprise Bills for New Moms Act (H.R. 3387) Securing the U.S. Organ Procurement and Transplantation Network Act (H.R. 2544) Promoting Access to Treatments and Increasing Extremely Needed Transparency Act (H.R. 3561) Medicaid VBPs for Patients (MVP) Act (H.R. 2666) Providers and Payers COMPETE Act (H.R. 3284) To amend title III of the Public Health Service Act to ensure transparency and oversight of the 340B drug discount program (H.R. 3290) Transparent PRICE Act (H.R. 3281/H.R. 2691)) Resident Physician Shortage Reduction (S. 1302) Medical Student Education Authorization Act (H.R. 3046) Save Americas Rural Hospitals Act (H.R. 833) Chronic Care Management Improvement Act (H.R. 2829) Safety From Violence for Healthcare Employees Act (H.R. 2584) Supporting Safety Net Hospitals Act (H.R. 2665) Patient Access to Higher Quality Health Care Act (H.R. 977/S.470) FEMA re: COVID-19 related reimbursement Public Health Guidance Transparency and Accountability Act of 2023 (H.R. 4529) Public Health Emergency Congressional Review Act (H.R. 4381) CDC Leadership Accountability Act of 2023 (H.R. 3813) Preparing for All Hazards and Pathogens Reauthorization Act (H.R. 4421) Preparedness and Response Reauthorization Act (H.R. 4420) Childrens Hospital GME Support Reauthorization Act of 2023 (H.R. 3887) Health Care Price Transparency Act of 2023 (H.R. 4822) Providers and Payers COMPETE Act (H.R. 3284) Lower Costs, More Transparency Act (H.R. 5378 Transparency in Coverage Act (H.R. 4507) GOLD Card Act of 2023 (H.R. 4968) No Fees for EFTs Act (H.R.6487) Rural Health Care Facilities Revitalization Act (H.R. 5989) Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (H.R. 7153) To amend title XVIII of the Social Security Act to establish a definition of essential health system in statute (H.R. 7397) Substance Use Disorder Workforce Act (H.R. 7050) 340B PATIENTS Act (H.R. 7635) The 340B Affording Care for Communities and Ensuring a Strong Safety-net (ACCESS) Act (H.R. 8574) Improving Seniors Access to Timely Care Act (H.R. 8702/S.4532) The Preserving Emergency Access in Key Sites (PEAKS) Act (H.R. 7931) Rural Health Care Facilities Revitalization Act (H.R. 5989) MMM Accelerated and Advance Payment Program repayment flexibility Graduate Medical Education (GME) funding Telehealth flexibilities and payment Annual Prospective Payment System Rules Organ acquisition payment policies Californias Medicaid Hospital Quality Assurance Fee Program Medicare Advantage BUD FY 2024 Appropriations bills Nursing and allied health workforce funding FY 2024 budget request Further Continuing Appropriations and Other Extensions Act (H.R. 6363) Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act (H.R. 5894) Tax Relief for American Families and Workers Act of 2024 (H.R. 7024) Extension of Continuing Appropriations and Other Matters Act, 2024 (H.R. 7463) Submitted Comments Regulatory Comment Letters SUBJECT: CMS-1809-P, Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, including the Hospital Inpatient Quality Reporting Program; Health and Safety Standards for Obstetrical Services in Hospitals and Critical Access Hospitals; Prior Authorization; Requests for Information; Medicaid and CHIP Continuous Eligibility; Medicaid Clinic Services Four Walls Exceptions; Individuals Currently or Formerly in Custody of Penal Authorities; Revision to Medicare Special Enrollment Period for Formerly Incarcerated Individuals; and All-Inclusive Rate Add-On Payment for High-Cost Drugs Provided by Indian Health Service and Tribal Facilities, (Vol 89, No 140), July 22, 2024 SUBJECT: CMS-1803-P, Medicare Program; Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin (IVIG) Items and Services Rate Update; and Other Medicare Policies, Federal Register (Vol. 89, No. 128), July 3, 2024 SUBJECT: CMS-5535-P, Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model, Federal Register (Vol. 89, No. 97), May 17, 2024 Legislative Comment Letters Letter to HHS on Johnson & Johnson's Proposed Changes to 340B Drug Discount Program, Sept. 19, 2024

Client expense: $380,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), SENATE, Social Security Administration (SSA)

HR 977/S 470: Patient Access to Higher Quality Health Act of 2023 Rep. Michael Burgess, MD (R-TX); Sen. James Lankford (R-OK) This bill repeals provisions under the Stark Law (i.e., the Physician Self-Referral Law) that limit, for purposes of Medicare participation, self-referrals by newly constructed or expanded physician-owned hospitals HR 2630/S 652: Safe Step Act Reps. Brad Wenstrup, DPM (R-OH); Raul Ruiz, MD (D-CA); Mariannette Miller-Meeks, MD (R-IA) Sens. Lisa Murkowski (R-AK); Maggie Hassan (D-NH); Roger Marshall, MD (R-KS) Requires group health plans to establish a clear and transparent process to request an exception to step therapy protocols in specified cases. Support reforming prior authorization Advocate for prior authorization policies that are more seamless, automated, and transparent for physicians and their patients. HR: 6545: Physician Fee Schedule Update and Improvements Act Reps. Mariannette Miller-Meeks (R-IA); Larry Bucshon ,MD (R-IN); Kim Schrier, MD (D-WA); Robin Kelly (D-IL), Michael Burgess, MD (R-TX); Greg Murphy, MD (R-NC), Brad Wenstrup, ,DPM (R-OH), Ami Bera, MD (D-CA), Tony Cardenas (D-CA); Raul Ruiz, MD (D-CA): Increases the budget neutrality from $20 million to $53 million would allow for greater flexibility in determining pricing adjustments for services without leading to harmful payment cuts for doctors.

Client expense: $393,590 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

PL 115-97 Tax Cuts and Jobs Act - amendments to the IRC and other changes PL 117-169 Inflation Reduction Act - amendments to the IRC and other changes HR 25 Fair Tax Act - imposes a national sales tax on the use or consumption in the United States of taxable property or services in lieu of the current income taxes S 234 New Markets Tax Credit Extension Act - makes the new markets tax credit permanent S 866 American Innovation and Jobs Act - enhance tax benefits for research activities HR 2811 Limit, Save, and Grow Act of 2023 - bill increases the federal debt limit and decreases spending HR 2673/S 866American Innovation and R&D Competitiveness Act of 2023 -- eliminates the five-year amortization requirement for research and experimental expenditures HR 3936 Tax Cuts for Working Families Act -- rename the standard deduction the guaranteed deduction, and to add a bonus amount to the guaranteed deduction HR 3937 Small Business Jobs Act -- to promote the establishment and growth of small businesses HR 3938 Build It In America Act --amend the Internal Revenue Code of 1986 to encourage economic growth HR 5707 Secure Family Futures Act of 2023--to apply ordinary tax treatment to certain investments S.470 Secure Family Futures Act of 2024--to apply ordinary tax treatment to certain investments

Client expense: $700,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE, Treasury, Dept of

issues relating to hospitals and healthcare H.R.1129 To direct the Secretary of Health and Human Services to revise regulations to remove the requirement under the Medicare program that an off-campus facility or organization shall be located within a 35-mile radius of a hospital or critical access hospital; S.468 Hospital Transparency Compliance Enforcement Act; H.R.990,S 407 SAFE Hospitals Act of 2023; H.R.1565 Critical Access Hospital Relief Act of 2023; H.R.2530 & S1113 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act; H.R.977-S.470 Patient Access to Higher Quality Health Care Act of 2023; H.R.1475 Hospital Adoption Education Act of 2023; H.R.410 Health Care PRICE Transparency Act; H.R.3417 FAIR Act; HR 2859 Holding Nonprofit Hospitals Accountable Act; H.R.5007, S2657 GREEN Hospitals Act.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR 977/S470: Patient Access to Higher Quality Health Act of 2023. Rep. Michael Burgess (R-TX) Sen. James Lankford (R-OK). This bill repeals provisions under the Stark Law (i.e., the Physician Self-Referral Law) that limit, for purposes of Medicare participation, self-referrals by newly constructed or expanded physician-owned hospitals. HR 2630/S 652: Safe Step Act. Reps. Brad Wenstrup, DPM (R-OH); Raul Ruiz, MD (D-CA); Mariannette Miller-Meeks, MD (R-IA) Sens. Lisa Murkowski (R-AK); Maggie Hassan (D-NH); Roger Marshall, MD (R-KS). Requires group health plans to establish a clear and transparent process to request an exception to step therapy protocols in specified cases. Support reforming prior authorization. Advocate for prior authorization policies that are more seamless, automated, and transparent for physicians and their patients. HR: 6545: Physician Fee Schedule Update and Improvements Act. Reps. Mariannette Miller-Meeks (R-IA): Larry Bucshon, MD (R-IN); Kim Schrier, MD (D-WA); Robin Kelly (D-IL); Michael Burgess, MD (R-TX); Greg Murphy, MD (R-NC); Brad Wenstrup, DPM (R-OH); Ami Bera, MD (D-CA); Tony Cardenas (D-CA); Raul Ruiz, MD (D-CA). Increases the budget neutrality from $20 million to $53 million would allow for greater flexibility in determining pricing adjustments for services without leading to harmful payment cuts for doctors.

Client expense: $424,674 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 7513, Protecting America's Seniors Access to Care Act, all provisions; H.R. 468, Building Americas Health Care Workforce Act, all provisions; H.R. 8113, Transparency into State Directed Payments Act of 2024, all provisions; 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, all provisions; H.R. 1110, KEEP Telehealth Option Act, all provisions; H.R. 7711, Advancing Access to Telehealth Act, all provisions; H.R. 3432, Telemental Health Care Access Act, all provisions; H.R. 3875, the Expanded Telehealth Access Act, all provisions; H.R. 5611, Helping Ensure Access to Local Telehealth (HEALTH) Act of 2023, all provisions; H.R. 6033, Patient Education and Knowledge (SPEAK) Act of 2023, all provisions; H.R. 5541, the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, all provisions; 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, all provisions; H.R. 134, To amend title XVIII of the Social Security Act to remove geographic requirements and expand originating sites for telehealth services, all provisions; H.R. 8261, The Preserving Telehealth, Hospital, and Ambulance Access Act, Issues pertaining to Telehealth, Hospital at Home, and MDH-LVA; S.4350 / H.R. 8260, Hospital Inpatient Services, Modernization Act of 2024, all provisions; H.R. 8235, Rural Physician Workforce Preservation Act, all provisions; S. 2016/ H.R. 4189, The CONNECT for Health Act of 2023, Specifically telehealth waivers, geographic restrictions, originating site requirements, in person requirement behavioral health, RHCs and FQHCs access; S. 1110, the Rural Hospital Support Act, all provisions; S. 1673 / H.R. 1666, Protecting Access to Ground Ambulance Medical Services Act of 2023, all provisions; H.R. 6430, Assistance for Rural Community Hospitals (ARCH)Act, all provisions; S. 803, Save Rural Hospitals Act, all provisions; H.R. 4968, GOLD Card Act of 2023, all provisions; H.R. 3173 / S. 4532, Improving Seniors' Timely Access to Care, all provisions; H.R. 5013/S. 3503, Value in Health Care Act, all provisions; HR 2389/ S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions; Draft Bill, Graduate Medical Education Bill, Issues pertaining to proposed changes to the Medicare Graduate Medical Education program and solutions to address workforce shortages in rural areas; H.J.Res. 139 / S.J. Res 91, A joint resolution for congressional disapproval of a rule relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting", all provisions; HR 1565, Critical Access Hospital Relief Act of 2023, all provisions; H.R. 7623, Telehealth Modernization Act, Issues pertaining to Telehealth, Hospital at Home, Unique Health Identifier; H.R.1128, Rural Health Care Access Act of 2023, all provisions; S.1571, Rural Hospital Closure Relief Act of 2023, all provisions; S. 470 / H.R. 977, The Patient Access to Higher Quality Health Care Act, all provisions; Draft Bill, Keeping Obstetrics Local Act, all provisions;H.R.5378, Lower Costs, More Transparency Act, Issues related to site neutral payment cuts, hospital price transparency, unique health identifier, 340B Program; Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule for the inpatient psychiatric facility (IPF) prospective payment system (PPS), Issues pertaining to payment policy proposals for inpatient psychiatric facilities (IPFs); Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule for skilled nursing facility prospective payment system , Issues pertaining to payment policy proposals for skilled nursing facilities (SNFs); Centers for Medicare & Medicaid Services (CMS)FY25 proposed rule for inpatient rehabilitation facility prospective payment system, Issues pertaining to payment policy proposals for inpatient rehabilitation facilities (IRFs); Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule Hospital Inpatient Prospective Payment Systems , Issues pertaining to payment policy proposals for acute-care hospitals; Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule Long-Term Care Hospital Prospective Payment System, Issues pertaining to payment policy proposals for long term acute-care hospitals; Centers for Medicare & Medicaid Services (CMS), Transforming Episode Accountability Model (TEAM), Deadline expansion and proposed mandatory alternative payment model; Centers for Medicare & Medicaid Services (CMS), Medicare Advantage Data RFI, Issues pertaining to enforcement and accountability of MA plans, prompt payment, gold carding, Standarization, penalties, and plan oversight; Centers for Medicare & Medicaid Services (CMS); Anomalous DME Spending in MSSP, accountable care models; Centers for Medicare & Medicaid Services (CMS), Accrediting Organizations (AO's), Feedback to strengthen accrediting organizations oversight; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees; Site Neutral Payments, for Q2 2024, Issues related to site neutral payment cuts for drug administration; Valued Based Care, for Q2 2024, Specifically on alternative payment models, MACRA reform, feedback on proposed TEAM model; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, and REHs; Physician Payments, Issues pertaining to proposed solutions to improve MACRA, alternative payment models, mental health of workforce; LTCH High Cost Outlier Threshold, Issues concerning High Cost Outlier in LTCH payment policy; Organ Transplant Model, Issues pertaining to Value Based Care; Rural Health Clinic Payments, Issues related to increasing payments for rural health clinics; Chronic Care Management, Issues pertaining to chronic care management for Medicare beneficiaries.

Client expense: $6,080,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Natl Drug Control Policy (NDCP), SENATE, White House Office