Conrad State 30 and Physician Access Reauthorization Act

H.R. 1, the One Big, Beautiful Bill Act H.R. 2433, Reducing Medically Unnecessary Delays in Care Act of 2025 Seniors timely access to care act (S. 1816 / H.R. 3514) Genomic Data Protection Act Tariffs S. 998, Medical Supply Chain Resiliency Act S 106 / HR 539 - Chiropractic Medicare Coverage Modernization Act PAMA reform HR 2483, Support for Patients and Communities Reauth Act HR 2484, Seniors access to Critical medications act Reducing Hereditary Cancer Act S 1399, the Health Tech Investment Act H.R. 3580, the Oversight of Medicare Billing Code Cost Act S 1830 - the Right to Treat Act S 1811 - Prohibits Graduate medical schools from receiving Federal assistance if DEI policies are in place S. 1916 - Protect Genetic information after bankruptcy S 1830 - HHS has no authority to regulate the practice of medicine S 2066, Medicare transaction Fraud prevention act LCD legislation S 1866 - National Breast and Cervical Cancer Early Detection Program S 1882 - to expand research and training on reproductive health conditions HR2389/S1302 - Resident Physician Shortage Reduction Act S2333 - Public Health Workforce Loan Repayment Act Health Workforce Resilience Act S665/HR 4942 Conrad 30 and Physician Access Reauthorization Act CLIA Waiver CURES 2.0 To prevent across-the-board direct spending cuts Cytotechnologist labor rates Remote digital telepathology S 1000/HR 2377 SALSA HR 977 - legislation that would repeal provisions prohibiting self-referrals to new or expanded POHs. HR 1202/S 704 - REDI Act HR2761/S 705 - SPARC Act HR 2764/S1229 - Green New Deal for Health HR 3248 - Diagnostic Lab Testing Transparency Act H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023 Student loan repayment for FPs HR 4527 - HEALTH DATA Act Primary Care and Health Workforce Expansion Act S 1994 Counting Veterans Cancer Act HR 4875 Doctors in our Borders Act HR 2474 - Strengthening Medicare for Patients and Providers Act Continuing Appropriations Act, 2024 and Other Extensions Act Further Continuing Appropriations and Other Extensions Act, 2024 HR 6683 - Preserving Seniors Access to Physicians Act of 2023 Gene Therapy Precision Medicine Answers for Kids Today Act S.3018/H.R.3173 the Improving Seniors Timely Access to Care Act of 2021 Dr. Lorna Breen Health Care Provider Protection Act PREVAIL HR 6371 - budget neutrality bill EDUCATE Act - Murphy DEI Bill HR 2369 - VALID Act FDA final rule on LDTs Pandemic All-Hazards Preparedness Act H.R.9747, the Continuing Appropriations and Extensions Act, 2025 S.2140/H.R. 9474, the Patent Eligibility Restoration Act of 2023 S.1451 / H.R. 3120 - Healthy Competition for Better Care Act H.R. 9572 - Enhanced Enforcement of Health Coverage Act H.R. 6025/S. 3211 - Healthcare Workforce Resilience Act Cures 2.1 H.R. 10073, Medicare patient Access and Practice Stabilization Act of 2024 S. 4935, Physician Fee Stabilization Act H.R. 5392, The Timely Access to Coverage Decisions Act of 2023 Medical Lab Personnel Shortage Relief Act H.R. 9572 Enhanced Enforcement of Health Coverage Act Sickle Cell Disease Comprehensive Care Act S. 709/H.R. 1585 - Conrad State 30 and Physician Access Reauthorization Act S. 1380 - SPARC Act S. 942/H.R. 2028 - REDI Act H.R. 879 - Medicare Patient Access and Practice Stabilization Act of 2025 H.R. 1463 - To prohibit the use of Federal funds to implement, administer, or enforce a final rule of the Food and Drug Administration relating to "Medical Devices; Laboratory Developed Tests", and for other purposes. H.R. 1968 - Continuing Resolution H.R. 1201 - Doctors in our Borders Act Issues relating to regulation of laboratory diagnostics Patent Eligibility Restoration Act

Client expense: $149,447 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Practice Support/Grants to Practice H.R. 10331, Anesthesia for All Act: prohibit time caps on reimbursement for anesthesia services H.R.1173, Patients Right to Know Their Medication Act of 2023: prescription drug labeling H.R. 9572, No Surprises Enforcement Act: strengthen compliance with the No Surprises Act H.R. 3595, Safe Prescribing Through Reporting Act of 2025: disclosure of certain records relating to substance use disorder medications to State prescription drug monitoring programs S.3548, Health Care Prices Revealed and Information to Consumers Explained Transparency Act: Ambulatory Surgical Centers H.R.6205, Healthcare Workforce Resilience Act: physician workforce H.R.7591, National Patient Safety Board Act of 2024: patient safety S.1302, Resident Physician Shortage Reduction Act of 2023: residency positions S.665, Conrad State 30 and Physician Access Reauthorization Act: Foreign physician immigration status Medical liability S. 705, Specialty Physicians Advancing Rural Care (SPARC) Act: physician shortages in rural areas Public Law No. 113-5, Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA): preparedness for public health Lorna Breen Reauthorization H.R.27, HALT Fentanyl Act: fentanyl scheduling and registration requirements H.R. 1227, Alternatives to PAIN Act of 2025: access to non-opioid pain management options S. 475, Alternatives to PAIN Act of 2025: access to non-opioid pain management options H.R. 3259, NOPAIN Act: Opioids S. 586, NOPAIN Act: Opioids S. 1292, Non-Opioid Directive Act: Opioids H.R. 7961, SAVE Act: To protect hospital personnel from violence, and for other purposes. H.R.833, Save America's Rural Hospitals: rural pass through H.R. 7725, Embracing anti-Discrimination, Unbiased Curricula, and Advancing Truth in Education (EDUCATE) Act: medical school funding H.R. 2671, Specialty Physicians Advancing Rural Care Act (the SPARC Act): student loan repayment programs to support specialty medical care in rural areas Pre-authorization; prior authorization Affordable Care Act reform efforts 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records: appropriate access to patient information essential for providing whole-person care Resident Education Deferred Interest Act (REDI Act): Student loan relief Student Loan Forgiveness for Frontline Health Workers Act: Student loan relief 21st Century Cures Initiative H.R. 4369, National Centers of Excellence in Continuous Pharmaceutical Manufacturing Act: Drug shortages DEA Scheduling Propofol Comparative Effectiveness Research - PCORI HITECH Implementation, Electronic Health Records, Final and Proposed Rules, HIT Meaningful Use HHS/OIG Anesthesia Practice Arrangements, Company Model FDA Safe Use Initiative Pain Management Anesthesia Research Funding (Pediatric and others) Scope of Practice FDA Operating Room Fires Naloxone access FDA Opioids Ketamine use by law enforcement Prescription Drug Abuse FDA Network of Experts NIH Interagency Pain Research Coordinating Committee USP - US Pharmacopeia National Pain Strategy Provider Nondiscrimination Compounding FDA Nominations to Advisory Committees (Anesthesia Drugs, Anesthesia Devices, Compounding) Agency for Healthcare Research and Quality (AHRQ) funding Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Brain health Certified Anesthesiologist Assistants Blood management Long COVID research Anesthesia workforce shortages CDC Opioid Prescribing Guideline 2024 Labor/HHS/Education appropriations bill Defense Health Agency anesthesia policy Maternal Mortality/Maternal Care Deserts Change Healthcare, Change Healthcare data breach Insurance reform, shared savings, insurer accountability NIH: Funding, Indirect Costs, Indirect Grants, Overhead

Client expense: $270,000 · Firm income: Not reported

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

Practice Support/Grants to Practice H.R. 10331, Anesthesia for All Act: prohibit time caps on reimbursement for anesthesia services H.R.1173, Patients Right to Know Their Medication Act of 2023: prescription drug labeling H.R. 9572, No Surprises Enforcement Act: strengthen compliance with the No Surprises Act S.3548, Health Care Prices Revealed and Information to Consumers Explained Transparency Act: Ambulatory Surgical Centers H.R.6205, Healthcare Workforce Resilience Act: physician workforce H.R.7591, National Patient Safety Board Act of 2024: patient safety S.1302, Resident Physician Shortage Reduction Act of 2023: residency positions S.665, Conrad State 30 and Physician Access Reauthorization Act: Foreign physician immigration status Medical liability S. 705, Specialty Physicians Advancing Rural Care (SPARC) Act: physician shortages in rural areas Public Law No. 113-5, Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA): preparedness for public health Lorna Breen Reauthorization H.R.27, HALT Fentanyl Act: fentanyl scheduling and registration requirements H.R. 1227, Alternatives to PAIN Act of 2025: access to non-opioid pain management options S. 475, Alternatives to PAIN Act of 2025: access to non-opioid pain management options H.R. 3259, NOPAIN Act: Opioids S. 586, NOPAIN Act: Opioids S. 1292, Non-Opioid Directive Act: Opioids H.R. 7961, SAVE Act: To protect hospital personnel from violence, and for other purposes. H.R.833, Save America's Rural Hospitals: rural pass through H.R. 7725, Embracing anti-Discrimination, Unbiased Curricula, and Advancing Truth in Education (EDUCATE) Act: medical school funding H.R. 2671, Specialty Physicians Advancing Rural Care Act (the SPARC Act): student loan repayment programs to support specialty medical care in rural areas Pre-authorization; prior authorization Affordable Care Act reform efforts 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records: appropriate access to patient information essential for providing whole-person care Resident Education Deferred Interest Act (REDI Act): Student loan relief Student Loan Forgiveness for Frontline Health Workers Act: Student loan relief 21st Century Cures Initiative H.R. 4369, National Centers of Excellence in Continuous Pharmaceutical Manufacturing Act: Drug shortages DEA Scheduling Propofol Comparative Effectiveness Research - PCORI HITECH Implementation, Electronic Health Records, Final and Proposed Rules, HIT Meaningful Use HHS/OIG Anesthesia Practice Arrangements, Company Model FDA Safe Use Initiative Pain Management Anesthesia Research Funding (Pediatric and others) Scope of Practice FDA Operating Room Fires Naloxone FDA Opioids Ketamine use by law enforcement Prescription Drug Abuse FDA Network of Experts NIH Interagency Pain Research Coordinating Committee USP - US Pharmacopeia National Pain Strategy Provider Nondiscrimination Compounding FDA Nominations to Advisory Committees (Anesthesia Drugs, Anesthesia Devices, Compounding) Agency for Healthcare Research and Quality (AHRQ) funding Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Brain health Certified Anesthesiologist Assistants Blood management Long COVID research Anesthesia workforce shortages CDC Opioid Prescribing Guideline 2024 Labor/HHS/Education appropriations bill Defense Health Agency anesthesia policy Maternal Mortality/Maternal Care Deserts Change Healthcare, Change Healthcare data breach Insurance reform, shared savings, insurer accountability NIH: Funding, Indirect Costs, Indirect Grants, Overhead

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), White House Office

HR2389/S1302 - Resident Physician Shortage Reduction Act S2333 - Public Health Workforce Loan Repayment Act Health Workforce Resilience Act S665/HR 4942 Conrad 30 and Physician Access Reauthorization Act CLIA Waiver CURES 2.0 To prevent across-the-board direct spending cuts Cytotechnologist labor rates Remote digital telepathology S 1000/HR 2377 SALSA HR 977 - legislation that would repeal provisions prohibiting self-referrals to new or expanded POHs. HR 1202/S 704 - REDI Act HR2761/S 705 - SPARC Act HR 2764/S1229 - Green New Deal for Health HR 3248 - Diagnostic Lab Testing Transparency Act H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023 Student loan repayment for FPs HR 4527 - HEALTH DATA Act Primary Care and Health Workforce Expansion Act S 1994 Counting Veterans Cancer Act HR 4875 Doctors in our Borders Act HR 2474 - Strengthening Medicare for Patients and Providers Act Continuing Appropriations Act, 2024 and Other Extensions Act Further Continuing Appropriations and Other Extensions Act, 2024 HR 6683 - Preserving Seniors Access to Physicians Act of 2023 Gene Therapy Precision Medicine Answers for Kids Today Act S.3018/H.R.3173 the Improving Seniors Timely Access to Care Act of 2021 Dr. Lorna Breen Health Care Provider Protection Act PREVAIL HR 6371 - budget neutrality bill EDUCATE Act - Murphy DEI Bill HR 2369 - VALID Act FDA final rule on LDTs Pandemic All-Hazards Preparedness Act H.R.9747, the Continuing Appropriations and Extensions Act, 2025 S.2140/H.R. 9474, the Patent Eligibility Restoration Act of 2023 S.1451 / H.R. 3120 - Healthy Competition for Better Care Act H.R. 9572 - Enhanced Enforcement of Health Coverage Act H.R. 6025/S. 3211 - Healthcare Workforce Resilience Act Cures 2.1 H.R. 10073, Medicare patient Access and Practice Stabilization Act of 2024 S. 4935, Physician Fee Stabilization Act H.R. 5392, The Timely Access to Coverage Decisions Act of 2023 Medical Lab Personnel Shortage Relief Act H.R. 9572 Enhanced Enforcement of Health Coverage Act Sickle Cell Disease Comprehensive Care Act S. 709/H.R. 1585 - Conrad State 30 and Physician Access Reauthorization Act S. 1380 - SPARC Act S. 942/H.R. 2028 - REDI Act H.R. 879 - Medicare Patient Access and Practice Stabilization Act of 2025 H.R. 1463 - To prohibit the use of Federal funds to implement, administer, or enforce a final rule of the Food and Drug Administration relating to "Medical Devices; Laboratory Developed Tests", and for other purposes. H.R. 1968 - Continuing Resolution H.R. 1201 - Doctors in our Borders Act Issues relating to regulation of laboratory diagnostics Patent Eligibility Restoration Act

Client expense: $217,588 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4942, Conrad State 30 and Physician Access Reauthorization Act, all provisions S. 665, Conrad State 30 and Physician Access Reauthorization Act, all provisions H.R. 6205, Healthcare Workforce Resilience Act, all provisions S. 3211, Healthcare Workforce Resilience Act, all provisions H.R. 4875, Doctors in our Borders Act, all provisions H.R. 6980, Directing Our Countrys Transfer Of Residency Slots (DOCTORS) Act, all provisions S. 2719, Directing Our Countrys Transfer Of Residency Slots (DOCTORS) Act, all provisions H.R. 6363, Further Continuing Appropriations and Other Extensions Act, 2024, provisions relating to dual intent residents H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024, provisions relating to Conrad 30 program H. Res. 1102, Further Consolidated Appropriations Act, 2024, provisions relating to Conrad 30 extension H.R. 9747, Continuing Appropriations and Extensions Act, 2025, provisions relating to continuing resolution through December 20

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4942/ S.665 - "Conrad State 30 and Physician Access Reauthorization Act"; H.R. 2584/ S. 2768 - "SAVE Act"; H.R. 2255/ S. 1024 - "Healthcare Workforce Resilience Act" - Re: Healthcare Workforce Issues H.R. 977 - "The Patient Access to Higher Quality Health Care Act" - re: Physician-Owned Hospitals S. 4322 - Rural Emergency Hospital Designation Improvement Act re: Rural health S.4054 - "Health Care Cybersecurity Improvement Act of 2024" - Re: Cybersecurity requirements H.R. 9714 / S. 5194 - Health Care Affordability Act of 2024; re: ACA enhanced tax credits H.R. 10073 - Medicare Patient Access and Practice Stabilization Act re: Physician payment updates H.R. 10515 - American Relief Act - re: Hospital payment and PAYGO Discussions re: disaster relief

Client expense: $680,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. FY2024 Defense Appropriations Act Fiscal 2024 Labor-HHS-Education Appropriations P.L. 116-136, CARES Act P.L. 113-5 Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA) S. 127 - Pharmacy Benefit Manager Transparency Act H.R. 830 - The HELP Copays Act S. 1375 - HELP Copays Act H.R. 1202 - Resident Education Deferred Interest Act, or REDI Act S. 704 - REDI Act S. 665, HR 4942 - Conrad State 30 and Physician Access Reauthorization Act H.R. 2389 - Resident Physician Shortage Reduction Act S. 1302 - Resident Physician Shortage Reduction Act H.R. 2474 - Strengthening Medicare for Patients and Providers Act S. 652, H.R. 2630 - Safe Step Act S. 1339 - Pharmacy Benefit Manager Reform Act H.R. 2670 - National Defense Authorization Act H.R. 2816 - Pharmacy Benefit Manager Sunshine and Accountability Act H.R. 2679 - Pharmacy Benefits Manager Accountability Act H.R. 2474 - The Strengthening Medicare for Patients and Providers Act H.R.6371 - Provider Reimbursement Stability Act of 2023 S. 2764 - Protecting Patient Access to Cancer and Complex Therapies Act H.R. 5391 - Protecting Patient Access to Cancer and Complex Therapies Act Appropriation legislation related to Medicare Physician Payments cuts implemented in 2024 Appropriations legislation related to the Congressionally Directed Medical Research Program Appropriations legislation related to the National Institutes of Health S. 705 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 2761 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 8702 - Improving Seniors Timely Access to Care Act of 2024 S. 4532 - Improving Seniors Timely Access to Care Act of 2024 H.R. 6664 - The Innovation in Pediatric Drugs Act S. 4349 - Electronic Prior Authorization for Prescription Drugs Act HR. 6487 - No Fees for EFTs Act S. 3805 - No Fees for EFTs Act S. 4935 - Physician Fee Stabilization Act H.R. 7623 - Telehealth Modernization Act S. 3967 - Telehealth Modernization Act H.R. 7153 - Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act S. 3679 - Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act H.R. 6545 - Physician Fee Schedule Update and Improvements Act H.R. 10545 - American Relief Act of 2025 H.R. 8774 - Department of Defense Appropriations Act, 2025 H.R. 9029 - Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2025

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. FY2024 Defense Appropriations Act Fiscal 2024 Labor-HHS-Education Appropriations P.L. 116-136, CARES Act P.L. 113-5 Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA) S. 127 - Pharmacy Benefit Manager Transparency Act H.R. 830 - The HELP Copays Act S. 1375 - HELP Copays Act H.R. 1202 - Resident Education Deferred Interest Act, or REDI Act S. 704 - REDI Act S. 665, HR 4942 - Conrad State 30 and Physician Access Reauthorization Act H.R. 2389 - Resident Physician Shortage Reduction Act S. 1302 - Resident Physician Shortage Reduction Act H.R. 2474 - Strengthening Medicare for Patients and Providers Act S. 652, H.R. 2630 - Safe Step Act S. 1339 - Pharmacy Benefit Manager Reform Act H.R. 2670 - National Defense Authorization Act H.R. 2816 - Pharmacy Benefit Manager Sunshine and Accountability Act H.R. 2679 - Pharmacy Benefits Manager Accountability Act H.R. 2474 - The Strengthening Medicare for Patients and Providers Act H.R.6371 - Provider Reimbursement Stability Act of 2023 S. 2764 - Protecting Patient Access to Cancer and Complex Therapies Act H.R. 5391 - Protecting Patient Access to Cancer and Complex Therapies Act Appropriation legislation related to Medicare Physician Payments cuts implemented in 2024 Appropriations legislation related to the Congressionally Directed Medical Research Program Appropriations legislation related to the National Institutes of Health S. 705 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 2761 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 8702 - Improving Seniors Timely Access to Care Act of 2024 S. 4532 - Improving Seniors Timely Access to Care Act of 2024 H.R. 6664 - The Innovation in Pediatric Drugs Act S. 4349 - Electronic Prior Authorization for Prescription Drugs Act HR. 6487 - No Fees for EFTs Act S. 3805 - No Fees for EFTs Act S. 4935 - Physician Fee Stabilization Act H.R. 7623 - Telehealth Modernization Act S. 3967 - Telehealth Modernization Act H.R. 7153 - Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act S. 3679 - Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act H.R. 6545 - Physician Fee Schedule Update and Improvements Act H.R. 10545 - American Relief Act of 2025 H.R. 8774 - Department of Defense Appropriations Act, 2025 H.R. 9029 - Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2025

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. FY2024 Defense Appropriations Act Fiscal 2024 Labor-HHS-Education Appropriations P.L. 116-136, CARES Act P.L. 113-5 Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA) S. 127 - Pharmacy Benefit Manager Transparency Act H.R. 830 - The HELP Copays Act S. 1375 - HELP Copays Act H.R. 1202 - Resident Education Deferred Interest Act, or REDI Act S. 704 - REDI Act S. 665, HR 4942 - Conrad State 30 and Physician Access Reauthorization Act H.R. 2389 - Resident Physician Shortage Reduction Act S. 1302 - Resident Physician Shortage Reduction Act H.R. 2474 - Strengthening Medicare for Patients and Providers Act S. 652, H.R. 2630 - Safe Step Act S. 1339 - Pharmacy Benefit Manager Reform Act H.R. 2670 - National Defense Authorization Act H.R. 2816 - Pharmacy Benefit Manager Sunshine and Accountability Act H.R. 2679 - Pharmacy Benefits Manager Accountability Act H.R. 2474 - The Strengthening Medicare for Patients and Providers Act H.R.6371 - Provider Reimbursement Stability Act of 2023 S. 2764 - Protecting Patient Access to Cancer and Complex Therapies Act H.R. 5391 - Protecting Patient Access to Cancer and Complex Therapies Act Appropriation legislation related to Medicare Physician Payments cuts implemented in 2024 Appropriations legislation related to the Congressionally Directed Medical Research Program Appropriations legislation related to the National Institutes of Health S. 705 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 2761 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 8702 - Improving Seniors Timely Access to Care Act of 2024 S. 4532 - Improving Seniors Timely Access to Care Act of 2024 H.R. 6664 - The Innovation in Pediatric Drugs Act S. 4349 - Electronic Prior Authorization for Prescription Drugs Act HR. 6487 - No Fees for EFTs Act S. 3805 - No Fees for EFTs Act S. 4935 - Physician Fee Stabilization Act H.R. 7623 - Telehealth Modernization Act S. 3967 - Telehealth Modernization Act H.R. 7153 - Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act S. 3679 - Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act H.R. 6545 - Physician Fee Schedule Update and Improvements Act H.R. 10545 - American Relief Act of 2025 H.R. 8774 - Department of Defense Appropriations Act, 2025 H.R. 9029 - Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2025

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

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

Hospital issues, including Medicare and Medicaid-related hospital issues. - H.R. 8702/S. 4518, Improving Seniors Timely Access to Care Act. - Legislation related to Support for Rural Hospitals (i.e. H.R. 1565, Critical Access Hospital Relief Act, S. 1571, Rural Hospital Closure Relief Act) - Support for extension of COVID-19 era telehealth flexibilities - Oppose Site Neutral Payment Policy Cuts - Cybersecurity - Appropriations request to support rural labor and delivery services - Workforce Issues (i.e. H.R. 2389 / S. 1302, Resident Physician Shortage Reduction Act, H.R. 6205 / S. 3211, Healthcare Workforce Resilience Act, H.R. 4942 / S. 665, Conrad State 30 and Physician Access Reauthorization Act, H.R. 7266 / S. 3770, Future Advancement of Academic Nursing Act)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2584/ S. 2768, the Safety from Violence for Healthcare Employees (SAVE) Act, all provisions; S. 3211/ H.R. 6205, Healthcare Workforce Resilience Act, all provisions; S.665 / H.R. 4942, Conrad State 30 and Physician Access Reauthorization Act, all provisions; S 3679 / H.R. 7153, Dr. Lorna Breen Health Care Provider Protection Reauthorization Act, all provisions, S. 3770/ H.R. 7266, "The Future Advancement of Academic Nursing (FAAN Act)", all provisions; S. 1176 / H.R. 2663, Workplace Violence Prevention for Health Care and Social Service Workers Act, all provisions, Draft Bill , 340B SUSTAIN Act, all provisions, H.R. 7635, The 340B PATIENTS Act, all provisions; H.R.8574, the 340B Affording Care for Communities and Ensuring a Strong Safety-net (340B ACCESS) Act, all provisions; DRAFT Senate / H.R. 5804, Mental Health Infrastructure Improvement Act, all provisions; S. 5368, End Drug Shortages Act, all provisions, H.R. 10362 / S. 5493, To prohibit pharmacy benefit managers and pharmacies from being under common ownership, and for other purposes, all provisions, H.R. 7379, Patient Matching And Transparency in Certified Health IT Act of 2024, all provisions; Health & Human Services (HHS), Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2), Interoperability, improve transparency and electronic access and exchange of electronic health records; Health & Human Services (HHS) & Drug Enforcement Agency (DEA) Telemedicine Waivers for Controlled Substances, Waiver flexibilities for prescribing controlled substances through telemedicine ; Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA), IV Fluid Shortage Impact on Sepsis and Infection Care IV Fluid Shortage Impact on Sepsis and Infection Care; Medical Debt, Issues specific to medical debt incurred by patients and hospital billing and collection practices; Price Transparency, Issues related to hospital price transparency; Rural Health Care Access, Issues to protect access to rural health care; Tax-exempt status, Issues pertaining to not-for-profit hospitals' tax exempt status; Maternal Health and Child Health, Access to maternal and child health care and addressing related workforce shortages, conditions of participation (COP) and impact of recent payment rules; Behavioral Health, Issues related to expanding access to care and reducing regulatory barriers; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay; Workforce, nurse staffing mandate, workforce development programs; Health Professions Diversity, National health service corps; centers of excellence; health careers opportunity programs; Hospital mergers and acquisitions, Issues pertaining to hospital consolidation, mergers an acquisition, physician practice acquisition; Physician Owned Hospitals Physician-owned hospitals; Supply Chain Issues, Baxter Plant / Hurricane Recovery, Issues pertaining to supply chain issues, IV Fluid Shortages, Baxter Plant, Hurricane Recovery, defense production act, national emergency declaration, Advanced Premium Tax Credits, Extension of Advanced Premium Tax Credits, Cyber Security & Resiliency, Issues pertaining to ongoing cyber risks to the health care field.

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

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Labor, Dept of (DOL), Occupational Safety & Health Administration (OSHA), SENATE, White House Office

Support for the Conrad State 30 and Physician Access Reauthorization Act (H.R. 4942/S. 665) Support for the Healthcare Workforce Resilience Act (H.R. 6025/S. 3211)

Client expense: Not reported · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Visa relief for health care providers. S. 3211/HR 6205 Healthcare Workforce Resilience Act S. 665/HR 4942 Conrad State 30 and Physician Access Reauthorization Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4942, Conrad State 30 and Physician Access Reauthorization Act, all provisions S. 665, Conrad State 30 and Physician Access Reauthorization Act, all provisions H.R. 6205, Healthcare Workforce Resilience Act, all provisions S. 3211, Healthcare Workforce Resilience Act, all provisions H.R. 4875, Doctors in our Borders Act, all provisions H.R. 6980, Directing Our Countrys Transfer Of Residency Slots (DOCTORS) Act, all provisions S. 2719, Directing Our Countrys Transfer Of Residency Slots (DOCTORS) Act, all provisions H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024, provisions relating to Conrad 30 program H. Res. 1102, Further Consolidated Appropriations Act, 2024, provisions relating to Conrad 30 extension Dual intent temporary visas

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 824 - Telehealth Benefit Expansion for Workers Act of 2023 H.R. 1202 / S. 704 - Resident Education Deferred Interest (REDI) Act H.R. 2389 - Resident Physician Shortage Reduction Act of 2023 H.R. 2400 / S. 1165 - Reentry Act of 2023 H.R. 2474 - Strengthening Medicare for Patients and Providers Act H.R. 3073 / S. 1452 - Community Mental Wellness and Resilience Act H.R. 3432 / S. 3651 - Telemental Health Care Access Act of 2023 H.R. 3946/S. 1800 - FASD Respect Act H.R. 4189 / S. 2016 - CONNECT for Health Act of 2023 H.R. 4892 / S. 3921 - Medicaid Bump Act H.R. 4933 / S. 462 - Mental Health Professionals Workforce Shortage Loan Repayment Act H.R. 4942 / S. 665 - Conrad State 30 and Physician Access Reauthorization Act H.R. 5116 / S. 2688 - Behavioral Health Information Technology (BHIT) Coordination Act H.R. 5819 / S. 1378 - COMPLETE Care Act H.R. 6683 - Preserving Seniors Access to Physicians Act of 2023 H.R. 7153 / S. 3679 - Dr. Lorna Breen Health Care Provider Protections Reauthorization Act H.R. 3305 / S. 1606 - Black Maternal Health Momnibus Act H.R. 3226 / S. 1573 - Prematurity Research Expansion and Education for Mothers who deliver Infants Early (PREEMIE) Reauthorization Act of 2023 H.R. 3312 / S. 1602 - Moms Matter Act H.R. 3838 / S. 2415 - Preventing Maternal Deaths Reauthorization Act of 2023 H.R. 7024 - Tax Relief for American Families and Workers Act of 2024 H.R. 8458 / S. 669- Increasing Mental Health Options Act of 2024 H.R. 8543 / S. 2993 - To amend the Social Security Act and the Public Health Service Act to permanently authorize certified community behavioral health clinics, and for other purposes H.R. 8680 - To authorize the Secretary of Health and Human Services, acting through the Assistant Secretary for Mental Health and Substance Use, to award grants to train community mental wellness workers H.R. 8702/ S .4532 - To amend title XVIII of the Social Security Act to establish requirements with respect to the use of prior authorization under Medicare Advantage plans H.R.8767 - To amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid program of items and services for patients in an institution for mental diseases S. 1339 - Pharmacy Benefit Reform Manager Act H.R. 7891 / S. 1409 - Kids Online Safety Act H.R. 7890 / S. 1418 - Children and Teens Online Privacy Protection Act (COPPA 2.0) H.R. 4531 / S. 3106 - SUPPORT for Patients and Communities Reauthorization Act H.R. 6663 / S. 3364 - Kid PROOF Act of 2023 S. 3430 - Better Mental Health Care, Lower-Cost Drugs, and Health Extenders Act S. 3157 - More Behavioral Health Providers Act of 2023 H.R. 7619 / S. 3158 - Expand the Behavioral Health Workforce Now Act H.R.6928 - CONNECT Act of 2024 H.R.6961 / S. 3010 - Nutrition CARE Act of 2024 H.R. 6982 / S. 3579 - Gambling Addiction, Recovery, Investment, and Treatment Act H.R. 7050 - Substance Use Disorder Workforce Act of 2024 H.Res. 1089 / S.Res.567 - Health Workforce Well-being Day of Awareness Resolution S. 2556 - Improving Coordination and Access to Resources Equitably (CARE) for Youth Act H.R. 5408 / S. 2767 - SSI Savings Penalty Elimination Act H.R.7301 - Certified Community Behavioral Health Clinic Expansion Act of 2024 H.R. 7808 - EARLY Minds Act H.R. 7265 / S. 3779 - Child Suicide Prevention and Lethal Means Act S. 3638 - Dependent Controlled Substance Transparency Act H.R. 7265 / S. 3379 Child Suicide Prevention & Lethal Means Safety Act H.R.7708 - To amend title XVIII of the Social Security Act to require MA organizations offering network-based plans to maintain an accurate provider directory, and for other purposes H.R.8575 - Michelle Alyssa Go Act H.R. 7258 / S. 3968 - A bill to amend the Public Health Service Act to provide community-based training opportunities for medical students in rural areas and medically under-served communities, and for other purposes S.4023 - Behavioral Health Network and Directory Improvement Act S.4358 - Preventing and Treating Substance Use Disorders Among Older Adults Act Sent letter to the FDA on reducing the scope of the Clozapine REMS in preparation for the Joint Committees Meeting Meeting with FDA on continued Stimulant Shortage APA met with DOL, HHS, and Treasury to Discuss Parity APA sent letter to ONC on Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule Signed onto AMA letter on Medicare physician payment reform S.4935- Physician Fee Stabilization Act H.R. 6371 - the Provider Reimbursement Stability Act H.R. 2474 - Strengthening Medicare for Patients and Providers Act H.R. 5013 / S. 3503 - Value in Health Care (VALUE) Act H.R. 1770 / S. 2477 - Equitable Community Access to Pharmacist Services Act. Signed AMA letter in opposition H.R.6664 / S. 4905- Innovation in Pediatric Drugs Act of 2023 H.R.9133 / S. 4835- The Primary and Behavioral Health Care Access Act H.R. 2630 / S. 652 - the Safe Step Act H.R. 9581 - STAR Plus Scholarship Act H.R. 8715 - NEST Act H.R. 9577- Stabilization to Prevent (STOP) Suicide Act H.R. 9656 - Career and Technical Education (CTE) Student Mental Health and Wellness Act S. 5146- Medical Graduate Investment Act of 2024 H.R. 9688 - Keep Kids Covered Act H.R. 9886/S.5271 - Broadening Utilization of Proven and Effective Treatment for Recovery Act H.R. 7858 - Telehealth Enhancement for Mental Health Act of 2024 Cover Our Care Act H.R. 3503 - NIH Clinical Trial Diversity Act of 2023 H.R. 9422 - Recovery Act H.R. 10073 - Medicare Patient Access and Practice Stabilization Act of 2024 H.R. 9457 - Transparent Telehealth Bills Act of 2024 H.R. 3838/S. 2415 - Preventing Maternal Deaths Reauthorization Act of 2023 S.5524 - Parity Enforcement Act of 2024 H.R. 10085 - Saving Lives on Campuses Act of 2024 H.R. 10280 - Strengthening Pathways to Health Professions Act

Client expense: $269,642 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Treasury, Dept of

Workforce: H.R. 731 / S. 220 the Workforce Mobility Act, which addresses issues relating to using non-compete agreements in employment contracts for certain non-exempt employees. H.R. 4942 / S.665 the Conrad State 30 and Physician Access Reauthorization Act, waives requirements for foreign physicians to reside for two years abroad after training in exchange for serving in an underserved area. H.R. 6205 / S. 3211, the Healthcare Workforce Resilience Act, would recapture unused immigrant visas. H.R. 7153/S. 3679, the Dr. Lorna Breen Health Care Provider Protection Act, would ensure continued funding for programs that address physician burnout and wellness.

Client expense: $105,404 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 2, Secure the Border Act of 2023 H.R. 16, American Dream and Promise Act of 2023 H.R. 319, Legal Workforce Act H.R. 575, Moving H-2A to United States Department of Agriculture Act of 2023 H.R. 614, Commercial Fishing and Seafood Business Act of 2023 H.R. 1325/S. 255, Asylum Seeker Work Authorization Act of 2023 H.R. 1535, Eliminating Backlogs Act of 2023 H.R. 1760, To extend the admission to Guam or the Commonwealth of the Northern Mariana Islands for certain nonimmigrant H-2B workers H.R. 1787, Carnivals are Real Entertainment Act H.R. 2393, Combating Cartels on Social Media Act of 2023 H.R. 2758, Returning Worker Accountability Act of 2023 H.R. 2827/S. 1301, Partner with Korea Act H.R. 2915, Farm Workforce Support Act of 2023 H.R. 3308/S. 874, Farm Operations Support Act H.R. 3442/S. 1667, Protecting Children of Long-Term Visa Holders Act of 2023 H.R. 3599, DIGNITY Act H.R. 3734, Essential Workers for Economic Advancement Act H.R. 3808, Afghan Allies Protection Act of 2023 H.R. 3911, Ukrainian Adjustment Act of 2023 H.R. 4048, Venezuelan Adjustment Act H.R. 4319, Farm Workforce Modernization Act of 2023 H.R. 4358, PHDs First Act H.R. 4448, Canadian Snowbird Visa Act H.R. 4627/S. 2327, Afghan Adjustment Act H.R. 4647, High-skilled Immigration Reform for Employment Act H.R. 4665/S. 2438, Department of State, Foreign Operations, and Related Programs Appropriations Act, 2024, H.R. 4708, H-2 Improvements to Relieve Employers (HIRE) Act H.R. 4942/S. 665, Conrad State 30 and Physician Access Reauthorization Act H.R. 5127, Visitor Visa Wait Time Reduction Act H.R. 5155, Temporary Family Visitation Act H.R. 5477/S. 2384, Keep STEM Talent Act of 2023 H.R. 5990, Border Enforcement, Security, and Trade (BEST) Facilitation Act of 2023 H.R. 6205, Healthcare Workforce Resilience Act H.R. 6542, Immigration Visa Efficiency and Security Act of 2023 H.R. 7046/S. 3848, Supporting Farm Operations Act of 2024 H.R. 7574, Closing the Workforce Gap Act of 2024 H.R. 8392, To Add Ireland to the E-3 Nonimmigrant Visa Program H.R. 8752, Department of Homeland Security Appropriations Act, 2025 H.R. 8771/S. 4797, Department of State, Foreign Operations, and Related Programs Appropriations Act, 2025 H.R. 9029/S. 4942, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2025 H.R. 9747, Continuing Appropriations and Extensions Act, 2025 H.R. 10007 - To amend the Immigration and Nationality Act to authorize the admission of nonimmigrant emergency medical technicians and paramedics H.R. 10027 - To establish Joint Operations Centers along the southern border of the United States, and for other purposes H.R. 10375 - To amend the Immigration and Nationality Act and the Mutual Education and Cultural Exchange Act of 1961 to strengthen the critical minerals workforce in the United States S. 156, Accountability Through Electronic Verification Act S. 243, A bill to require the Commissioner of U.S. Customs and Border Protection to establish procedures for conducting maintenance projects at ports of entry at which the Office of Field Operations conducts certain enforcement and facilitation activities S. 255, Asylum Seeker Work Authorization Act of 2023 S. 365, Dream Act of 2023 S. 387, Canadian Snowbirds Act of 2023 S. 979, H-1B and L-1 Visa Reform Act of 2023 S. 1253, Securing America's Ports of Entry Act of 2023 S. 1727, Safe Environment from Countries Under Repression and Emergency (SECURE) Act S. 1926, A bill to amend the Caribbean Basin Economic Recovery Act to make Uruguay eligible for designation as a beneficiary country under that Act, to include Uruguay in the list of foreign states whose nationals are eligible for admission into the United States as E1 and E2 nonimmigrants if nationals of the United States are treated similarly by the Government of Uruguay, and to require a report on the eligibility of Uruguay for the visa waiver program, and for other purposes S. 2278, Border Enforcement, Security, and Trade (BEST) Facilitation Act of 2023 S. 2324, Ensuring American Security and Protecting Afghan Allies Act S. 2606, Renewing Immigration Provisions of the Immigration Act of 1929 S. 2632, Visa Processing Improvement Act S. 2705, State Executive Authority for Seasonal Occupations Needing Additional Labor (SEASONAL) Act S. 2719, Directing Our Countrys Transfer Of Residency Slots (DOCTORS) Act S. 2785, Higher Wages for American Workers Act of 2023 S. 3013, A bill to permanently authorize the exemption of aliens working as fish processors from the numerical limitation on H-2B nonimmigrant visas S. 3187, Southern Border Transparency Act of 2023 S. 3211, Healthcare Workforce Resilience Act S. 3255, Temporary Family Visitation Act S. 3291, EAGLE Act of 2023 S. 4069, Affordable and Secure Food Act of 2024 S. 4361, The Border Act of 2024 S. 4591, Save Our Seafood Act S. 4638, National Defense Authorization Act for Fiscal Year 2025 S. 4888, A bill to include Czechia in the list of foreign states whose nationals are eligible for admission into the United States as E-1 nonimmigrants if United States nationals are treated similarly by the Government of Czechia H.Res. 481, Expressing the sense of the House of Representatives that BridgeUSA exchange programs are vital to the economy and national interests of the United States, and that Congress should prioritize robust support to ensure equitable opportunities for Americans and people from other countries Various issues relating to visa waiver program; H-1B Visa Program; H-1B registration rule; H-1B reform; H-2 Visa Program and temporary rule; H-2B Visa Program and cap relief; H-2A Visa Program; H-4 rule; L-1 Visa Program; J-1 Programs; BridgeUSA program; EB-5 Visa Program; E-Verify program; nonimmigrant workers in temporary or seasonal nonagricultural employment; Customs and Border Protection staffing at U.S. ports of entry; border security; immigration policy and reforms; guest worker programs; legalization concepts; visa reform; customs trade facilitation and enforcement; Deferred Action for Childhood Arrivals (DACA) program; extension of temporary protected status (TPS) designations for El Salvador, Honduras, and Haiti; administrative-regulatory efforts related to public charge, notice to appear, H-4 & OPT; delays in H-4 and L-2 Status Extensions and Employment Authorization Documents (EADs); Office of Foreign Labor Certifications Planned Implementation of Form ETA-9089, Application for Permanent Employment Certification, into DOLs Foreign Labor Application Gateway (FLAG) System; high-skilled immigration; lesser skilled immigration; temporary agricultural guest workers; temporary non-agricultural guest workers; optional practical training program; asylum and refugee programs; size and administration of employment-based immigrant visa categories; size and administration of family-based immigrant visa categories; size and administration of employment-based nonimmigrant visa categories; expansion of the use of the E-Verify system; I-9 employment verification; interior enforcement; increased vetting of visa applicants; unfair immigration related employment practices; international travel; trusted traveler programs; biometric entry-exit; increasing the number of ICE officers, border patrol agents and Customs and Border Protection officers; aerial security enhancements; EB-5 Regional Center Program and the Implementation of the EB-5 Reform and Integrity Act of 2022, P.L. 117-103, Division BB; State Department policies extending consular interview waiver eligibility for various classifications of nonimmigrants; regulatory proposals that would restrict applicant eligibility for the H-1B program; regulatory proposals that would drastically change how prevailing wage levels are determined for the purposes of obtaining certain employment-based nonimmigrant and immigrant visas; proposals that would significantly change how cap-subject H-1B petitions will be chosen in the future; regulatory proposals that would change how the period of admission for student visa holders and exchange visa holders is determined; regulatory proposals that will temporarily raise the annual quota for H-2B visas; regulatory proposals reopening and expanding consular operations; recapturing unused immigrant visas from prior years; creating exemptions to the current immigrant visa caps proposals that would expand consular interview waivers for prospective immigrant and nonimmigrant visa applicants abroad; proposals that would provide relief for displaced Afghan nationals; expanding the eligibility for stateside renewal of work visas; implementation of electronic visa foils in passports; consular service delays; USCIS processing delays; DOL processing delays; visa relief for long term foreign national workers laid off by their employers while waiting for their green cards in the immigrant visa backlogs; improving wait times for CBP Processing at Ports of Entry; expanding and implementing new CBP preclearance facilities abroad; reforms to the use of parole authority; extending the validity period for employment authorization documents; reforms to the State Departments Visa Bulletin; implementation of the new optional I-9 document verification procedures; expanded mandatory detention of unauthorized aliens in the U.S.; expansion of expulsion/removal authorities; changes to the legal standard for credible fear interviews for asylum applicants; modifying asylum eligibility requirements; expanding availability of special immigrant visas for Afghan nationals; reforms to the adjudication process for inadmissibility waivers; regulatory proposals that change how the H-2A program will be administered; proposals that will adjust what types of foreign nationals are eligible for obtaining employment authorization and advance parole documents; expanding E visa eligibility; expanding and updating the J-1 Exchange Visitor Skill List

Client expense: $22,410,000 · Firm income: Not reported

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

H.R. 4942/S. 665, Conrad State 30 and Physician Access Reauthorization

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

Government targets: Bureau of Citizenship & Immigration Services (BCIS), HOUSE OF REPRESENTATIVES, SENATE

Practice Support/Grants to Practice H.R. 10331, Anesthesia for All Act: prohibit time caps on reimbursement for anesthesia services H.R.1173, Patients Right to Know Their Medication Act of 2023: prescription drug labeling H.R. 9572, No Surprises Enforcement Act: strengthen compliance with the No Surprises Act S.3548, Health Care Prices Revealed and Information to Consumers Explained Transparency Act: Ambulatory Surgical Centers H.R.6205, Healthcare Workforce Resilience Act: physician workforce H.R.7591, National Patient Safety Board Act of 2024: patient safety S.1302, Resident Physician Shortage Reduction Act of 2023: residency positions S.665, Conrad State 30 and Physician Access Reauthorization Act: Foreign physician immigration status Medical liability H.Res. 734: Expressing support for the designation of October 1 as "National Latino and Latina Physician Day" S. 705, Specialty Physicians Advancing Rural Care (SPARC) Act: physician shortages in rural areas Public Law No. 113-5, Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA): preparedness for public health Lorna Breen Reauthorization H.R. 3259, NOPAIN Act: Opioids S. 586, NOPAIN Act: Opioids S. 1292, Non-Opioid Directive Act: Opioids H.R. 7961, SAVE Act: To protect hospital personnel from violence, and for other purposes. H.R.833, Save America's Rural Hospitals: rural pass through H.R. 7725, Embracing anti-Discrimination, Unbiased Curricula, and Advancing Truth in Education (EDUCATE) Act: medical school funding H.R. 2671, Specialty Physicians Advancing Rural Care Act (the SPARC Act): student loan repayment programs to support specialty medical care in rural areas Pre-authorization; prior authorization Affordable Care Act reform efforts 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records: appropriate access to patient information essential for providing whole-person care Resident Education Deferred Interest Act (REDI Act): Student loan relief Student Loan Forgiveness for Frontline Health Workers Act: Student loan relief 21st Century Cures Initiative H.R. 4369, National Centers of Excellence in Continuous Pharmaceutical Manufacturing Act: Drug shortages DEA Scheduling Propofol Comparative Effectiveness Research - PCORI HITECH Implementation, Electronic Health Records, Final and Proposed Rules, HIT Meaningful Use HHS/OIG Anesthesia Practice Arrangements, Company Model FDA Safe Use Initiative Pain Management Anesthesia Research Funding (Pediatric and others) Scope of Practice FDA Operating Room Fires Naloxone FDA Opioids Ketamine use by law enforcement Prescription Drug Abuse FDA Network of Experts NIH Interagency Pain Research Coordinating Committee USP - US Pharmacopeia National Pain Strategy Nondiscrimination Compounding FDA Nominations to Advisory Committees (Anesthesia Drugs, Anesthesia Devices, Compounding) Agency for Healthcare Research and Quality (AHRQ) funding Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Brain health Certified Anesthesiologist Assistants Blood management Long COVID research Anesthesia workforce shortages CDC Opioid Prescribing Guideline 2024 Labor/HHS/Education appropriations bill Defense Health Agency anesthesia policy Maternal Mortality/Maternal Care Deserts Change Healthcare, Change Healthcare data breach Insurance reform, shared savings, insurer accountability

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

Government targets: Agency for Healthcare Research & Quality (AHRQ), Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Justice, Dept of (DOJ), Natl Institutes of Health (NIH), Occupational Safety & Health Administration (OSHA), Office of Management & Budget (OMB), SENATE, Veterans Affairs, Dept of (VA), 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. 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)

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

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

HR2389/S1302 - Resident Physician Shortage Reduction Act S2333 - Public Health Workforce Loan Repayment Act Health Workforce Resilience Act S665/HR 4942 Conrad 30 and Physician Access Reauthorization Act CLIA Waiver CURES 2.0 To prevent across-the-board direct spending cuts Cytotechnologist labor rates Remote digital telepathology S 1000/HR 2377 SALSA HR 977 - legislation that would repeal provisions prohibiting self-referrals to new or expanded POHs. HR 1202/S 704 - REDI Act HR2761/S 705 - SPARC Act HR 2764/S1229 - Green New Deal for Health HR 3248 - Diagnostic Lab Testing Transparency Act H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023 Student loan repayment for FPs HR 4527 - HEALTH DATA Act Primary Care and Health Workforce Expansion Act S 1994 Counting Veterans Cancer Act HR 4875 Doctors in our Borders Act HR 2474 - Strengthening Medicare for Patients and Providers Act Continuing Appropriations Act, 2024 and Other Extensions Act Further Continuing Appropriations and Other Extensions Act, 2024 HR 6683 - Preserving Seniors Access to Physicians Act of 2023 Gene Therapy Precision Medicine Answers for Kids Today Act S.3018/H.R.3173 the Improving Seniors Timely Access to Care Act of 2021 Dr. Lorna Breen Health Care Provider Protection Act PREVAIL HR 6371 - budget neutrality bill EDUCATE Act - Murphy DEI Bill HR 2369 - VALID Act FDA final rule on LDTs Pandemic All-Hazards Preparedness Act H.R.9747, the Continuing Appropriations and Extensions Act, 2025 S.2140/H.R. 9474, the Patent Eligibility Restoration Act of 2023 S.1451 / H.R. 3120 - Healthy Competition for Better Care Act H.R. 9572 - Enhanced Enforcement of Health Coverage Act H.R. 6025/S. 3211 - Healthcare Workforce Resilience Act Cures 2.1 H.R. 10073, Medicare patient Access and Practice Stabilization Act of 2024 S. 4935, Physician Fee Stabilization Act H.R. 5392, The Timely Access to Coverage Decisions Act of 2023 Medical Lab Personnel Shortage Relief Act H.R. 9572 Enhanced Enforcement of Health Coverage Act Sickle Cell Disease Comprehensive Care Act

Client expense: $126,566 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Incentivizing domestic manufacturing of critical medical supplies Issues related to health care costs and transparency Electronic prior authorization and administrative simplification Health care supply chain resiliency 340B Drug discount program Reauthorization of Pandemic and All Hazards Preparedness Act Hospital finance issues Healthcare workforce issues (graduate medical education, health professional training, recruitment and retention, minimum staffing requirements) Medicare payment policies Alternative payment models and related policies Medicare home infusion policy Reauthorization of Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act Expanding access to interoperable health tech in long term and post-acute care settings Maternal and infant health Health care workplace violence and worker safety S. 148 Stop STALLING Act S. 150 Affordable Prescriptions for Patients Act Medicaid Disproportionate Hospital Share cuts S. 2115, H.R. 4307 Medical Supply Chain Resiliency Act H.R. 4104, S. 1976 Preseving Patients Access to Home Infusion Act H.R. 2584, S. 2768 SAVE Act H.R. 3577 Medical and Health Stockpile Accountability Act H.R. 2665 Supporting Safety Net Hospitals Act H.R. 2389, S. 1302 Resident Physician Shortage Reduction Act H.R. 3346 IMPACT to Save Moms Act H.R. 5378 Lower Costs, More Transparency Act S. 2840 Bipartisan Primary Care and Health Workforce Act H.R. 5013, S. 3503 Value in Health Care Act H.R. 4942, S. 665 Conrad State 30 and Physician Access Reauthorization Act Artificial intelligence in healthcare H.R.766, S. 114 Preventive Health Savings Act H.R. 6205, S. 3211 Healthcare Workforce Resilience Act H.R. 7050 Substance Use Disorder Workforce Act H.R. 8702, S. 4532 Improving Seniors' Timely Access to Care Act H.R. 7855 Rural Residency Planning and Development Act

Client expense: $180,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

(S. 665) Conrad 30 and Physician Access Act (S. 2719) Directing Our Country's Transfer of Residency Slots (H.R. 6298/S. 3247) Stop Shackling and Detaining Pregnant Women Act (H.R. 6205/S.3211) Healthcare Workforce Resilience Act

Client expense: $1,072,997 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Advocate for proposals to provide direct financial support to safety net hospitals with Congressional staff. Discuss opposition to Medicare site-neutral payment policies with Congressional staff. Educate Congressional staff on hospital price transparency federal rule (84 FR 65602). Oppose changes to NPIs for hospital outpatient departments (H.R. 7623, H.R. 4509, H.R. 7623 as amended, H.R. 4822). Meet with Congressional staff to discuss H.R. 5378, the Lower Costs, More Transparency Act of 2023, and comment on following proposals in bill: support for delay of Medicaid DSH cut, codification and expansion of Federal price transparency rule, oppose National Provider Identifier (NPI) requirements for hospital outpatient departments, oppose changes to 340B drug pricing program, support reauthorization of Community Health Centers, support reauthorization of National Health Service Corps, support reauthorization of Teaching Health Center Graduate Medical Education funding. Discuss hospital and health provisions in CAA, 2024 (H.R. 4366) with HHS staff and Congressional staff: support public health extenders and elimination of Medicaid DSH cut. Discuss support for the 340B Drug Pricing Program with Congressional staff and discuss certain changes: oppose 340B ACCESS Act (H.R. 7635), comment on SUSTAIN 340B Act discussion draft, support PATIENTS Act (H.R. 7635); oppose back-end rebate proposals. Discuss legislative proposals with Congressional staff to stabilize long-term care and post-acute care providers: establish a temporary per diem Medicare payment to ease capacity issues and address financial challenges from slow discharges (support); make permanent three-day hospital stay waiver (support) and other COVID-19 PHE regulatory flexibilities. Discuss Medicare Graduate Medical Education (GME) provisions in the Consolidated Appropriations Act (CAA), 2021 and CAA, 2023 with HHS staff. Discuss with Congressional staff support for Medicare GME expansion and changes to GME program: the Resident Physician Shortage Reduction Act, the Pathway to Practice Act of 2021, the Substance Use Disorder Workforce Act (H.R. 7050); additional GME slots in CAA, 2021 and CAA, 2023; Rural Residency Planning and Development Act (H.R. 7855); concerns on Rural Physician Workforce Preservation Act and opposition to modifications to ongoing slot distribution; Senate Finance Committee draft proposals to increase GME slots. Discuss with HHS staff and Congressional staff recommendations to address workforce shortages for nursing and ancillary health care workforce: faculty recruitment and retention, additional financial support for supervision and precepting students, Medicare payment for nursing and allied health, testing new workforce models, establishing incentives and early recruitment strategies, providing funding for clinical training site, and immigration reforms that expedite entry for foreign health care workers. Support passage of the Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 2584/S.2768). Support revisions to Conrad 30 waiver program to increase the number of foreign physicians that may remain in the US after completing GME: S.665/H.R.4942, S.2719/H.R.6980, H.R. 4875. Discuss expiring COVID-19 Public Health Emergency Medicare flexibilities with Congressional staff and HHS staff and support legislative proposals to extend PHE telehealth flexibilities and Acute Hospital Care at Home Waiver: H.R. 7623. Oppose legislative proposals to impose financial penalties on hospitals relating to minimum cybersecurity standards (S.5218). Discuss legislative proposals to regulate the use of artificial intelligence in health care delivery with Congressional staff. Discuss FEMA COVID-19 Public Assistance payouts with Congressional staff. Support Improving Seniors Timely Access to Care Act (S. 4532/H.R. 8702). Discuss legislative proposals on consumer medical debt with Congressional staff. Outreach to HHS Assistant Secretary for Preparedness and Response urging certain regulatory flexibilities to alleviate IV fluid shortages.

Client expense: $350,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Federal Emergency Management Agency (FEMA), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), SENATE, White House Office

S.652 - Safe Step Act H.R.830 - HELP Copays Act S.665 - Conrad State 30 and Physician Access Reauthorization Act CDC Chronic Disease Education and Awareness

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

Government targets: Centers For Disease Control & Prevention (CDC), HOUSE OF REPRESENTATIVES, Natl Institutes of Health (NIH), SENATE

Department of Veterans Affairs appropriations and its delivery of benefits and services to veterans, their dependents and survivors: HR 10000, HR 1001, HR 10012, HR 1003, HR 10038, HR 10106, HR 10142, HR 10148, HR 10153, HR 10369, HR 10381, HR 104, HR 1078, HR 1083, HR 1089, HR 1139, HR 1144, HR 1166, HR 1169, HR 1179, HR 1182, HR 1191, HR 1226, HR 1278, HR 1282, HR 1311, HR 1315, HR 1329, HR 1378, HR 1402, HR 1529, HR 1530, HR 1554, HR 1606, HR 1609, HR 1616, HR 1639, HR 1659, HR 1669, HR 1753, HR 1767, HR 1774, HR 1786, HR 1799, HR 1815, HR 196, HR 228, HR 232, HR 234, HR 236, HR 2410, HR 2413, HR 2414, HR 2441, HR 2447, HR 2469, HR 2472, HR 2499, HR 251, HR 2518, HR 2525, HR 2526, HR 2530, HR 2543, HR 2733, HR 2768, HR 2809, HR 2818, HR 2830, HR 2846, HR 2896, HR 2911, HR 2932, HR 2971, HR 3023, HR 303, HR 3040, HR 3075, HR 3084, HR 3110, HR 3128, HR 3157, HR 3186, HR 3192, HR 3214, HR 3225, HR 3303, HR 3326, HR 333, HR 3363, HR 3368, HR 3450, HR 3489, HR 3499, HR 3504, HR 3511, HR 3581, HR 3584, HR 3600, HR 3601, HR 3603, HR 3644, HR 3648, HR 3649, HR 3651, HR 3676, HR 3677, HR 3698, HR 3718, HR 3720, HR 3722, HR 3738, HR 3790, HR 3811, HR 3816, HR 3848, HR 3870, HR 3874, HR 3895, HR 3898, HR 3933, HR 394, HR 395, HR 3956, HR 3981, HR 4016, HR 4047, HR 4060, HR 4061, HR 41, HR 411, HR 4150, HR 4155, HR 4157, HR 4171, HR 4190, HR 4225, HR 4249, HR 4262, HR 4264, HR 4278, HR 4325, HR 4400, HR 4401, HR 4424, HR 4461, HR 4518, HR 4566, HR 4569, HR 4670, HR 4886, HR 4906, HR 491, HR 492, HR 4921, HR 5002, HR 5014, HR 5147, HR 5153, HR 516, HR 522, HR 523, HR 5247, HR 5259, HR 5365, HR 5377, HR 5416, HR 542, HR 543, HR 544, HR 5470, HR 5492, HR 5530, HR 5559, HR 5610, HR 5633, HR 5697, HR 5702, HR 5785, HR 5794, HR 5870, HR 5890, HR 5891, HR 5904, HR 5914, HR 592, HR 5938, HR 5956, HR 6023, HR 6179, HR 6197, HR 6225, HR 6294, HR 6300, HR 6315, HR 6324, HR 6330, HR 6331, HR 6333, HR 6338, HR 6340, HR 6345, HR 6360, HR 6361, HR 6362, HR 6373, HR 6374, HR 6380, HR 645, HR 6452, HR 6492, HR 6507, HR 6524, HR 6531, HR 6538, HR 6551, HR 6656, HR 6800, HR 6833, HR 6873, HR 6874, HR 6916, HR 693, HR 6949, HR 6995, HR 7097, HR 7136, HR 7150, HR 728, HR 7323, HR 733, HR 7347, HR 7365, HR 7401, HR 7434, HR 746, HR 7480, HR 7490, HR 7504, HR 7514, HR 7543, HR 7596, HR 7613, HR 7643, HR 7653, HR 7654, HR 7657, HR 7703, HR 7732, HR 7773, HR 7777, HR 7793, HR 7816, HR 7860, HR 7884, HR 7895, HR 7896, HR 7917, HR 7919, HR 7920, HR 7971, HR 8009, HR 8017, HR 8025, HR 8048, HR 808, HR 8136, HR 8165, HR 8167, HR 8168, HR 8223, HR 8312, HR 8340, HR 8347, HR 8371, HR 8381, HR 8418, HR 8442, HR 8454, HR 8481, HR 8511, HR 8514, HR 854, HR 8560, HR 8562, HR 8567, HR 8580, HR 8592, HR 8627, HR 8646, HR 8661, HR 885, HR 8851, HR 8874, HR 8879, HR 8880, HR 8881, HR 8896, HR 894, HR 9029, HR 903, HR 9050, HR 9052, HR 9057, HR 9094, HR 9107, HR 9146, HR 9161, HR 9179, HR 9276, HR 9324, HR 9328, HR 9404, HR 9415, HR 9449, HR 9468, HR 9478, HR 9484, HR 9510, HR 9511, HR 9525, HR 9575, HR 9583, HR 9643, HR 9773, HR 9788, HR 9806, HR 9819, HR 9854, HR 984, HR 9924, HR 9930, HR 9934, HR 9948, HR 9996, S 10, S 1028, S 1037, S 106, S 1090, S 1113, S 1119, S 1125, S 1172, S 1266, S 1267, S 1299, S 1309, S 1314, S 132, S 1330, S 1360, S 141, S 1436, S 1469, S 1515, S 1590, S 1612, S 1635, S 1678, S 1739, S 1792, S 1828, S 185, S 1877, S 1910, S 1954, S 1972, S 1975, S 1994, S 2014, S 2026, S 2083, S 2084, S 2146, S 216, S 2174, S 2181, S 2183, S 2212, S 2256, S 2259, S 2263, S 2276, S 2294, S 2315, S 24, S 2422, S 2431, S 2465, S 2503, S 2513, S 2516, S 263, S 2679, S 2745, S 2757, S 2778, S 2795, S 280, S 2801, S 2803, S 2863, S 2888, S 291, S 296, S 2975, S 30, S 302, S 3126, S 3243, S 3256, S 326, S 3274, S 3282, S 3284, S 3288, S 3290, S 3295, S 3341, S 3352, S 344, S 3452, S 3466, S 350, S 3524, S 3526, S 3546, S 3560, S 3598, S 3614, S 3636, S 3728, S 3746, S 3751, S 3768, S 38, S 3834, S 3841, S 3873, S 3885, S 3886, S 3911, S 3958, S 3970, S 3979, S 4009, S 4047, S 4061, S 4074, S 4109, S 4111, S 414, S 42, S 4226, S 4246, S 4284, S 4357, S 4372, S 4396, S 4423, S 4445, S 449, S 4556, S 4748, S 4750, S 4879, S 4922, S 4929, S 495, S 498, S 4997, S 5035, S 5138, S 5141, S 5210, S 528, S 5301, S 531, S 5325, S 592, S 622, S 656, S 665, S 680, S 740, S 748, S 774, S 777, S 853, S 897, S 928

Client expense: $141,405 · Firm income: Not reported

Government targets: Defense, Dept of (DOD), HOUSE OF REPRESENTATIVES, Labor, Dept of (DOL), Office of Management & Budget (OMB), SENATE, Small Business Administration (SBA), U.S. Postal Service (USPS), Veterans Affairs, Dept of (VA), Veterans Employment & Training Service

H.R. 6980/S.2719 - Directing Our Countrys Transfer of Residency Slots (DOCTORS) Act Issue: Educate Congress on policies related to amending the Immigration and Nationality Act to provide for the reallocation of unused waivers of the foreign residency requirement for certain J visa holders. H.R.4942/S.665 - Conrad State 30 and Physician Access Reauthorization Act Issue: Support expansion of the Conrad 30 program and improvements to physician immigration. H.R.4875 - Doctors in our Borders Act Issue: Support expansion of the Conrad 30 program and improvements to physician immigration. Educate Congress on policies allowing undocumented students to attend U.S. medical schools and graduate medical education. H.R.6205/S.3211 - Healthcare Workforce Resilience Act Issue: Support reduction of green card backlogs for health professionals. Issue: Support permanent protections for Deferred Action for Childhood Arrivals (DACA) recipients.

Client expense: $632,324 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Expand Patient Access and Telehealth: Urged Congress to pass H.R.2630/S. 652, the Safe Step Act, which requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. The bill lays out five exceptions to fail first protocols and requires that a group health plan grant an exemption. Pharmacy Benefit Managers (PBMs) and group health insurers have developed a series of price management tools to curb the rising cost of prescription drugs. Supported H.R. 2829, the Chronic Care Management Improvement Act of 2023, that would remove the co-pay charged to patients who utilize chronic care management services. It would waive the beneficiary coinsurance to manage chronic care conditions and improve patients health. Supported the Protecting Rural Telehealth Access Act, H.R. 3440 and S. 1636. This bipartisan legislation would ensure rural and underserved community healthcare providers can permanently offer telehealth services, including audio-only telehealth appointments, that are set to expire in December 2024. The legislation would: 1) allow payment parity for audio-only health services for clinically appropriate appointments; 2) permanently waive the geographic restriction allowing patients to be treated from their homes; 3) permanently allow rural health clinics and Federally Qualified Health Centers to serve as distance sites for providing telehealth services; 4) lift the restrictions on store and forward technologies for telehealth; and 5) allow Critical Access Hospitals (CAHs) to directly bill for telehealth services. Supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. Also supported the Protecting Rural Telehealth Access Act, H.R. 3440, and the Telehealth Modernization Act of 2024, H.R. 7623, which facilitate access to care via telehealth permanently. Supported CONNECT for Health Act of 2023, H.R. 4189 and S. 2016, to permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites. That legislation would: 1) help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and remote patient monitoring (RPM) without most of the 42 U.S.C. Section 1834(m) telehealth restrictions; 2) allow telehealth and RPM to be used by qualifying participants in alternative payment models, without most of the 1834(m) restrictions; 3) permit the use of remote patient monitoring for certain patients with chronic conditions; 4) allow, as originating sites, telestroke evaluation and management sites, Native American health service facilities, and dialysis facilities for home dialysis patients in certain cases; and 5) permit further telehealth and RPM in community health centers and rural health clinics. Medicare Payments to Physicians (H.R. 2474): Urged Congress to pass H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which preserves access to care for Medicare beneficiaries by providing an annual inflation update equal to the Medicare Economic Index (MEI) for Medicare physician payments. Unlike other health care sectors, Medicare payment rates for physicians have not been updated based on the MEI. As a result, from 2001 to 2021, Medicare physician payments have decreased by 20 percent when adjusted for inflation. Supported H.R. 6545, the Physician Fee Schedule Update and Improvements Act before the House Energy and Commerce Committee. This bill includes an important provision that would allocate 3 percent to the 2024 Medicare conversion factor, which would represent a 1.75 percent increase to the approved level. H.R. 6545 also includes several provisions from H.R. 6371, the Provider Reimbursement Stability Act of 2023, that ACP supports. It would raise the budget neutrality threshold to $53 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every five years afterwards. Supported H.R. 6683, the Preserving Seniors Access to Physicians Act of 2023. That bill averts a 3.4 percent across-the-board cut to physician payment for 2024. ACP supports a similar bill, S. 5035, introduced by Sen. Boozman. ACP supported extending the work geographic practice costs index to improve the accuracy of geographic adjustment factors. Supported H.R. 6366 that would extend the work geographic practice costs index for another year to 1.00 for any locality where the index would be less than 1.00. We support aspects of legislation recently introduced by Senators Whitehouse and Cassidy, the Pay Primary Care Physicians (PCPs) Act, S. 4338, that would expand and accelerate the adoption of a hybrid per member per month (PMPM) payment model outside of the PFS. We believe this type of model can enhance innovation and improve the delivery of chronic care in primary care practices. ACP supported Dr. Michael C. Burgess Preventive Health Savings Act, H.R. 766, to enable CBO to capture cost-savings associated with preventive health care legislation beyond existing 10-year window, for two additional 10-year periods. Support Value-Based Care: Urged support of the Value in Health Care Act of 2023. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that are scheduled to expire at the end of the year. It also gives the Centers for Medicare & Medicaid Services (CMS) authority to adjust APM qualifying thresholds so that the current one-size-fits-all approach does not serve as a disincentive to including rural, underserved, primary care or specialty practices in APMs. The bill removes revenue-based distinctions that disadvantage rural and safety net providers, which is critical to improving access to care and improving health equity. The bill also improves financial benchmarks so that APM participants are not penalized for their own success. To allow more clinicians to continue the transition to value, the bill establishes a voluntary track for accountable care organizations (ACOs) in the Medicare Shared Savings Program to take on higher levels of risk and provides technical assistance for clinicians new to APMs. Lastly, the bill seeks to provide parity between APMs and the Medicare Advantage (MA) program by studying ways to increase alignment that will ease burdens on physicians and ensure that both APMs and MA are attractive and sustainable options. ACP supports extending incentive payments for participation in eligible alternative payment models through 2026. This approach would help to maintain incentives that support physicians transition from a volume-based fee-for-service health care system to one that is based on the value and quality outcomes of health care delivered to the patient. Supported H.R. 6369 by Rep. Kim Schrier to extend incentive payments for participation in eligible alternative payment models. ACP supports H.R. 5395, the SURS Extension Act, which would extend the Quality Payment Program-Small Practice, Underserved, and Rural Support (QPP-SURS) program for fiscal years 2024-2029. This program was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and has provided direct assistance to eligible clinicians required to participate in MIPS. ACP supports efforts to streamline the number of quality measures physicians must report on and enhance stakeholder engagement. Supported the Fewer Burdens for Better Care Act of 2023, which would emphasize multi-stakeholder input, with a 30-day comment period for stakeholders to comment on the removal of measures from the Medicare program. Pricing Transparency/Consolidation: Supported several provisions of H.R. 5378, Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This bill brings together H.R. 4822, Health Care Price Transparency Act of 2023, H.R. 3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023 and other related bills reported out of Ways and Means, Energy and Commerce and Education and Workforce Committees. Supported requiring disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promote price transparency among hospitals, health plans and pharmacy benefit managers and promote site neutrality for Medicare and Medicare beneficiaries. We further supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps. Supported Section 4 of H.R. 2880, the Protecting Patients Against PBM Abuses Act, which aims to increase PBM data reporting to enhance transparency for Medicare Part D. Specifically, it would set out new requirements for PBMs to report data on rebates and administrative fees to HHS. It would also require that HHS deidentify the data and make it publicly available so that policy makers and the public will have a better understanding of how rebates and administrative fees impact the costs of drug plans. The Affordable Care Act (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported H.R. 1692, the Health Care Affordability Act of 2023, by Rep. Underwood to permanently extend the premium tax credit subsidies under the ACA. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Supportive of S. 8, Improving Health Insurance Affordability Act to expand the eligibility of taxpayers for the refundable tax credit for coverage under a qualified health plan and increase cost-sharing subsidies under the ACA. We support similar legislation introduced by Sen. Shaheen in the Senate. FY2025 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2025 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2025 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Urged Congress to support year-end Continuing Resolution (CR) that contained PBM reform, averting Medicare physician payment cuts by 2.5%, provided bonus payment to physicians participating in APMs, and extended telehealth flexibilities adopted during the COVID-19 pandemic for 2 years. Also advocated that streamlined prior authorization process for Medicare Advantage plans be included in the CR. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2389, the Resident Physician Shortage Reduction Act of 2023, which increases the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years; Support efforts of the bipartisan Senate Working Group to add 10,000 GME slots in legislation; Cosponsor and pass S. 665, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R. 1202/S. 704, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2024 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Supported H.R.4986/S. 2577, which would refinance the interest rate for all existing federal student loans to zero percent. Further, it would cap interest rates for future student loan borrowers, while considering their financial needs. Prescription Drug Reform: Reviewed proposals to implement guidance by HHS for implementation of Inflation Reduction Act's prescription drug negotiation provisions. Supported H.R. 4895, the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029. Supported H.R. 5385, the Medicare PBM Accountability Act. This legislation aims to lower the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans. It would require PBMs to submit annual reports to the Secretary of HHS on PBMs cost savings incurred from rebates, discounts, and price concessions. Supported H.R. 1352, the Increasing Access to Biosimilars Act of 2023. This legislation would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B. Supported H.R. 5386, the Cutting Copays Act. This legislation would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs. Supported H.R. 3009/S. 2362, the Drug Shortage Prevention Act of 2023, to require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. Social Determinants of Healthcare/DEI: Opposed the Educate Act, H.R. 7725/S. 4115, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Firearm Safety: (S.117): Urged Congress to support the Handgun Permit to Purchase Act (S. 117), legislation that would authorize grants to states to support handgun purchaser licensing programs. To qualify for the grants, states must require gun purchasers to be at least the age of 2I and be subject to a criminal background check. Urged Congress to support the Bipartisan Background Checks Act, H.R. 715, and the Background Check Expansion Act, S. 494 and Ethans Law, H.R. 660 and S. 173, requiring gun owners to safely and securely store their firearms. Supported the Keep Americans Safe Act, H.R. 625 and S. 298, which would ban the importation, sale, manufacture, transfer, or possession of high-capacity gun magazines that hold more than fifteen rounds. Supported the Extreme Risk Protection Order Expansion Act, H.R. 768 and S. 247 empowering family members and law enforcement to prevent gun violence by petitioning a court to temporarily separate an at-risk individual from firearms. Supported the FY2024 funding gun violence prevention research contained in FY24 Senate Labor-HHS-Ed appropriations bill for inclusion in any final FY24 appropriations bills. Administrative Burden: Urged Congress to codify many of these proposed improvements to the prior authorization process in the reintroduced the Improving Seniors' Timely Access to Care Act, S.4532. This legislation was passed by the House in the last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Urged members of Congress to cosponsor and pass H.R.2630/S. 652, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Data Privacy: Supported American Privacy Rights Act, H.R. 8818, nations first comprehensive federal consumer data privacy framework. Bill was considered by House Energy and Commerce and would expand data privacy protections to entities not currently subject to HIPAA privacy protections. ACP asked for provisions enabling consumers to opt-out of allowing companies to use algorithms based on their personal data, allow states to further protect their residents and fully inform subjects of the nature and risks of the research. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, H.R. 1770/ S. 2477, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Healthcare Worker Safety: Supported H.R. 6364, the Medicare Telehealth Privacy Act of 2023. This bill would ensure that HHS will not publicly post the addresses of participating telehealth practitioners to provide privacy protections for physicians so that they can effectively treat and care for patients via telehealth. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

Client expense: $242,106 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA)

Expand Patient Access and Telehealth: Urged Congress to pass H.R.2630/S. 652, the Safe Step Act, which requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol. The bill lays out five exceptions to fail first protocols and requires that a group health plan grant an exemption. Pharmacy Benefit Managers (PBMs) and group health insurers have developed a series of price management tools to curb the rising cost of prescription drugs. Supported H.R. 2829, the Chronic Care Management Improvement Act of 2023, that would remove the co-pay charged to patients who utilize chronic care management services. It would waive the beneficiary coinsurance to manage chronic care conditions and improve patients health. Supported the Protecting Rural Telehealth Access Act, H.R. 3440 and S. 1636. This bipartisan legislation would ensure rural and underserved community healthcare providers can permanently offer telehealth services, including audio-only telehealth appointments, that are set to expire in December 2024. The legislation would: 1) allow payment parity for audio-only health services for clinically appropriate appointments; 2) permanently waive the geographic restriction allowing patients to be treated from their homes; 3) permanently allow rural health clinics and Federally Qualified Health Centers to serve as distance sites for providing telehealth services; 4) lift the restrictions on store and forward technologies for telehealth; and 5) allow Critical Access Hospitals (CAHs) to directly bill for telehealth services. Supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. Also supported the Protecting Rural Telehealth Access Act, H.R. 3440, and the Telehealth Modernization Act of 2024, H.R. 7623, which facilitate access to care via telehealth permanently. Supported CONNECT for Health Act of 2023, H.R. 4189 and S. 2016, to permanently remove all geographic restrictions on telehealth services and expand originating sites to include the home and other sites. That legislation would: 1) help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and remote patient monitoring (RPM) without most of the 42 U.S.C. Section 1834(m) telehealth restrictions; 2) allow telehealth and RPM to be used by qualifying participants in alternative payment models, without most of the 1834(m) restrictions; 3) permit the use of remote patient monitoring for certain patients with chronic conditions; 4) allow, as originating sites, telestroke evaluation and management sites, Native American health service facilities, and dialysis facilities for home dialysis patients in certain cases; and 5) permit further telehealth and RPM in community health centers and rural health clinics. Medicare Payments to Physicians (H.R. 2474): Urged Congress to pass H.R. 2474, the Strengthening Medicare for Patients and Providers Act, which preserves access to care for Medicare beneficiaries by providing an annual inflation update equal to the Medicare Economic Index (MEI) for Medicare physician payments. Unlike other health care sectors, Medicare payment rates for physicians have not been updated based on the MEI. As a result, from 2001 to 2021, Medicare physician payments have decreased by 20 percent when adjusted for inflation. Supported H.R. 6545, the Physician Fee Schedule Update and Improvements Act before the House Energy and Commerce Committee. This bill includes an important provision that would allocate 3 percent to the 2024 Medicare conversion factor, which would represent a 1.75 percent increase to the approved level. H.R. 6545 also includes several provisions from H.R. 6371, the Provider Reimbursement Stability Act of 2023, that ACP supports. It would raise the budget neutrality threshold to $53 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every five years afterwards. Supported H.R. 6683, the Preserving Seniors Access to Physicians Act of 2023. That bill averts a 3.4 percent across-the-board cut to physician payment for 2024. ACP supports a similar bill, S. 5035, introduced by Sen. Boozman. ACP supported extending the work geographic practice costs index to improve the accuracy of geographic adjustment factors. Supported H.R. 6366 that would extend the work geographic practice costs index for another year to 1.00 for any locality where the index would be less than 1.00. We support aspects of legislation recently introduced by Senators Whitehouse and Cassidy, the Pay Primary Care Physicians (PCPs) Act, S. 4338, that would expand and accelerate the adoption of a hybrid per member per month (PMPM) payment model outside of the PFS. We believe this type of model can enhance innovation and improve the delivery of chronic care in primary care practices. ACP supported Dr. Michael C. Burgess Preventive Health Savings Act, H.R. 766, to enable CBO to capture cost-savings associated with preventive health care legislation beyond existing 10-year window, for two additional 10-year periods. Support Value-Based Care: Urged support of the Value in Health Care Act of 2023. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that are scheduled to expire at the end of the year. It also gives the Centers for Medicare & Medicaid Services (CMS) authority to adjust APM qualifying thresholds so that the current one-size-fits-all approach does not serve as a disincentive to including rural, underserved, primary care or specialty practices in APMs. The bill removes revenue-based distinctions that disadvantage rural and safety net providers, which is critical to improving access to care and improving health equity. The bill also improves financial benchmarks so that APM participants are not penalized for their own success. To allow more clinicians to continue the transition to value, the bill establishes a voluntary track for accountable care organizations (ACOs) in the Medicare Shared Savings Program to take on higher levels of risk and provides technical assistance for clinicians new to APMs. Lastly, the bill seeks to provide parity between APMs and the Medicare Advantage (MA) program by studying ways to increase alignment that will ease burdens on physicians and ensure that both APMs and MA are attractive and sustainable options. ACP supports extending incentive payments for participation in eligible alternative payment models through 2026. This approach would help to maintain incentives that support physicians transition from a volume-based fee-for-service health care system to one that is based on the value and quality outcomes of health care delivered to the patient. Supported H.R. 6369 by Rep. Kim Schrier to extend incentive payments for participation in eligible alternative payment models. ACP supports H.R. 5395, the SURS Extension Act, which would extend the Quality Payment Program-Small Practice, Underserved, and Rural Support (QPP-SURS) program for fiscal years 2024-2029. This program was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and has provided direct assistance to eligible clinicians required to participate in MIPS. ACP supports efforts to streamline the number of quality measures physicians must report on and enhance stakeholder engagement. Supported the Fewer Burdens for Better Care Act of 2023, which would emphasize multi-stakeholder input, with a 30-day comment period for stakeholders to comment on the removal of measures from the Medicare program. Pricing Transparency/Consolidation: Supported several provisions of H.R. 5378, Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This bill brings together H.R. 4822, Health Care Price Transparency Act of 2023, H.R. 3561, Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023 or the PATIENT Act of 2023 and other related bills reported out of Ways and Means, Energy and Commerce and Education and Workforce Committees. Supported requiring disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promote price transparency among hospitals, health plans and pharmacy benefit managers and promote site neutrality for Medicare and Medicare beneficiaries. We further supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps. Supported Section 4 of H.R. 2880, the Protecting Patients Against PBM Abuses Act, which aims to increase PBM data reporting to enhance transparency for Medicare Part D. Specifically, it would set out new requirements for PBMs to report data on rebates and administrative fees to HHS. It would also require that HHS deidentify the data and make it publicly available so that policy makers and the public will have a better understanding of how rebates and administrative fees impact the costs of drug plans. The Affordable Care Act (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported H.R. 1692, the Health Care Affordability Act of 2023, by Rep. Underwood to permanently extend the premium tax credit subsidies under the ACA. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Supportive of S. 8, Improving Health Insurance Affordability Act to expand the eligibility of taxpayers for the refundable tax credit for coverage under a qualified health plan and increase cost-sharing subsidies under the ACA. We support similar legislation introduced by Sen. Shaheen in the Senate. FY2025 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2025 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2025 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Urged Congress to support year-end Continuing Resolution (CR) that contained PBM reform, averting Medicare physician payment cuts by 2.5%, provided bonus payment to physicians participating in APMs, and extended telehealth flexibilities adopted during the COVID-19 pandemic for 2 years. Also advocated that streamlined prior authorization process for Medicare Advantage plans be included in the CR. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to cosponsor and pass H.R. 2389, the Resident Physician Shortage Reduction Act of 2023, which increases the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years; Support efforts of the bipartisan Senate Working Group to add 10,000 GME slots in legislation; Cosponsor and pass S. 665, the Conrad State 30 and Physician Access Reauthorization Act, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement; Cosponsor and pass H.R. 1202/S. 704, the Resident Education Deferred Interest (REDI) Act, to make it possible for residents to defer interest on their loans; Support inclusion in FY2024 appropriations legislation funding for Title VII Primary Care and Training Enhancement (PCTE) at $71 million to support and expand the pipeline for individuals training in primary care. Supported H.R.4986/S. 2577, which would refinance the interest rate for all existing federal student loans to zero percent. Further, it would cap interest rates for future student loan borrowers, while considering their financial needs. Prescription Drug Reform: Reviewed proposals to implement guidance by HHS for implementation of Inflation Reduction Act's prescription drug negotiation provisions. Supported H.R. 4895, the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029. Supported H.R. 5385, the Medicare PBM Accountability Act. This legislation aims to lower the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans. It would require PBMs to submit annual reports to the Secretary of HHS on PBMs cost savings incurred from rebates, discounts, and price concessions. Supported H.R. 1352, the Increasing Access to Biosimilars Act of 2023. This legislation would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B. Supported H.R. 5386, the Cutting Copays Act. This legislation would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs. Supported H.R. 3009/S. 2362, the Drug Shortage Prevention Act of 2023, to require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. Social Determinants of Healthcare/DEI: Opposed the Educate Act, H.R. 7725/S. 4115, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Firearm Safety: (S.117): Urged Congress to support the Handgun Permit to Purchase Act (S. 117), legislation that would authorize grants to states to support handgun purchaser licensing programs. To qualify for the grants, states must require gun purchasers to be at least the age of 2I and be subject to a criminal background check. Urged Congress to support the Bipartisan Background Checks Act, H.R. 715, and the Background Check Expansion Act, S. 494 and Ethans Law, H.R. 660 and S. 173, requiring gun owners to safely and securely store their firearms. Supported the Keep Americans Safe Act, H.R. 625 and S. 298, which would ban the importation, sale, manufacture, transfer, or possession of high-capacity gun magazines that hold more than fifteen rounds. Supported the Extreme Risk Protection Order Expansion Act, H.R. 768 and S. 247 empowering family members and law enforcement to prevent gun violence by petitioning a court to temporarily separate an at-risk individual from firearms. Supported the FY2024 funding gun violence prevention research contained in FY24 Senate Labor-HHS-Ed appropriations bill for inclusion in any final FY24 appropriations bills. Administrative Burden: Urged Congress to codify many of these proposed improvements to the prior authorization process in the reintroduced the Improving Seniors' Timely Access to Care Act, S.4532. This legislation was passed by the House in the last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Urged members of Congress to cosponsor and pass H.R.2630/S. 652, the Safe Step Act, to ensure patient access to appropriate treatments based on clinical decision-making and medical necessity rather than arbitrary step therapy protocols. Data Privacy: Supported American Privacy Rights Act, H.R. 8818, nations first comprehensive federal consumer data privacy framework. Bill was considered by House Energy and Commerce and would expand data privacy protections to entities not currently subject to HIPAA privacy protections. ACP asked for provisions enabling consumers to opt-out of allowing companies to use algorithms based on their personal data, allow states to further protect their residents and fully inform subjects of the nature and risks of the research. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, H.R. 1770/ S. 2477, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Healthcare Worker Safety: Supported H.R. 6364, the Medicare Telehealth Privacy Act of 2023. This bill would ensure that HHS will not publicly post the addresses of participating telehealth practitioners to provide privacy protections for physicians so that they can effectively treat and care for patients via telehealth. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

Client expense: $124,919 · Firm income: Not reported

Government targets: Centers For Disease Control & Prevention (CDC), Centers For Medicare and Medicaid Services (CMS), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Homeland Security, Dept of (DHS), President of the U.S., SENATE, State, Dept of (DOS), Veterans Affairs, Dept of (VA)

H.R. 4942/ S.665 - "Conrad State 30 and Physician Access Reauthorization Act"; H.R. 2584/ S. 2768 - "SAVE Act"; H.R. 2255/ S. 1024 - "Healthcare Workforce Resilience Act" - Re: Healthcare Workforce Issues H.R. 977 - "The Patient Access to Higher Quality Health Care Act" - re: Physician-Owned Hospitals S.4054 - "Health Care Cybersecurity Improvement Act of 2024" - Re: Cybersecurity requirements H.R. 9714 / S. 5194 - Health Care Affordability Act of 2024; re: ACA enhanced tax credits Discussions re: tariff on Chinese manufactured health care goods Discussions re: drug shortages Physician payment updates Discussions re: Medical debt S. 2840 Bipartisan Primary Care and Health Workforce Act; H.R. 3120 Healthy Competition for Better Care Act; H.R. 9457 - Transparent Telehealth Bills Act - re: Hospital payment and contracting practices Discussions regarding independent dispute resolution process- Re: No Surprises Act Implementation

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Hospital issues, including Medicare and Medicaid-related hospital issues. - H.R. 8702/S. 4518, Improving Seniors Timely Access to Care Act. - Legislation related to Support for Rural Hospitals (i.e. H.R. 1565, Critical Access Hospital Relief Act, S. 1571, Rural Hospital Closure Relief Act) - Support for extension of COVID-19 era telehealth flexibilities - Oppose Site Neutral Payment Policy Cuts - Cybersecurity - Appropriations request to support rural labor and delivery services - Workforce Issues (i.e. H.R. 2389 / S. 1302, Resident Physician Shortage Reduction Act, H.R. 6205 / S. 3211, Healthcare Workforce Resilience Act, H.R. 4942 / S. 665, Conrad State 30 and Physician Access Reauthorization Act, H.R. 7266 / S. 3770, Future Advancement of Academic Nursing Act)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. FY2024 Defense Appropriations Act Fiscal 2024 Labor-HHS-Education Appropriations P.L. 116-136, CARES Act P.L. 113-5 Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA) S. 127 - Pharmacy Benefit Manager Transparency Act H.R. 830 - The HELP Copays Act S. 1375 - HELP Copays Act H.R. 1202 - Resident Education Deferred Interest Act, or REDI Act S. 704 - REDI Act S. 665, HR 4942 - Conrad State 30 and Physician Access Reauthorization Act H.R. 2389 - Resident Physician Shortage Reduction Act S. 1302 - Resident Physician Shortage Reduction Act H.R. 2474 - Strengthening Medicare for Patients and Providers Act S. 652, H.R. 2630 - Safe Step Act S. 1339 - Pharmacy Benefit Manager Reform Act H.R. 2670 - National Defense Authorization Act H.R. 2816 - Pharmacy Benefit Manager Sunshine and Accountability Act H.R. 2679 - Pharmacy Benefits Manager Accountability Act H.R. 2474 - The Strengthening Medicare for Patients and Providers Act H.R.6371 - Provider Reimbursement Stability Act of 2023 S. 2764 - Protecting Patient Access to Cancer and Complex Therapies Act H.R. 5391 - Protecting Patient Access to Cancer and Complex Therapies Act Appropriation legislation related to Medicare Physician Payments cuts implemented in 2024 Appropriations legislation related to the Congressionally Directed Medical Research Program Appropriations legislation related to the National Institutes of Health S. 705 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 2761 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 8702 - Improving Seniors Timely Access to Care Act of 2024 S. 4532 - Improving Seniors Timely Access to Care Act of 2024 H.R. 6664 - The Innovation in Pediatric Drugs Act S. 4349 - Prior Authorization for Prescription Drugs Act HR. 6487 - No Fees for EFTs Act S. 3805 - No Fees for EFTs Act S. 4935 - Physician Fee Stabilization Act H.R. 7623 - Telehealth Modernization Act S. 3967 - Telehealth Modernization Act H.R. 7153 - Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act S. 3679 - Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act H.R. 6545 - Physician Fee Schedule Update and Improvements Act

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. FY2024 Defense Appropriations Act Fiscal 2024 Labor-HHS-Education Appropriations P.L. 116-136, CARES Act P.L. 113-5 Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA) S. 127 - Pharmacy Benefit Manager Transparency Act H.R. 830 - The HELP Copays Act S. 1375 - HELP Copays Act H.R. 1202 - Resident Education Deferred Interest Act, or REDI Act S. 704 - REDI Act S. 665, HR 4942 - Conrad State 30 and Physician Access Reauthorization Act H.R. 2389 - Resident Physician Shortage Reduction Act S. 1302 - Resident Physician Shortage Reduction Act H.R. 2474 - Strengthening Medicare for Patients and Providers Act S. 652, H.R. 2630 - Safe Step Act S. 1339 - Pharmacy Benefit Manager Reform Act H.R. 2670 - National Defense Authorization Act H.R. 2816 - Pharmacy Benefit Manager Sunshine and Accountability Act H.R. 2679 - Pharmacy Benefits Manager Accountability Act H.R. 2474 - The Strengthening Medicare for Patients and Providers Act H.R.6371 - Provider Reimbursement Stability Act of 2023 S. 2764 - Protecting Patient Access to Cancer and Complex Therapies Act H.R. 5391 - Protecting Patient Access to Cancer and Complex Therapies Act Appropriation legislation related to Medicare Physician Payments cuts implemented in 2024 Appropriations legislation related to the Congressionally Directed Medical Research Program Appropriations legislation related to the National Institutes of Health S. 705 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 2761 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 8702 - Improving Seniors Timely Access to Care Act of 2024 S. 4532 - Improving Seniors Timely Access to Care Act of 2024 H.R. 6664 - The Innovation in Pediatric Drugs Act S. 4349 - Prior Authorization for Prescription Drugs Act HR. 6487 - No Fees for EFTs Act S. 3805 - No Fees for EFTs Act S. 4935 - Physician Fee Stabilization Act H.R. 7623 - Telehealth Modernization Act S. 3967 - Telehealth Modernization Act H.R. 7153 - Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act S. 3679 - Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act H.R. 6545 - Physician Fee Schedule Update and Improvements Act

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

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

Monitor federal issues and legislation associated with health care policy. Monitor federal and legislative activity related to Medicare reimbursement. Monitor federal and legislative activity related to drug pricing. Monitoring and outreach on legislative activity related to the COVID-19 pandemic and the federal governments response. FY2024 Defense Appropriations Act Fiscal 2024 Labor-HHS-Education Appropriations P.L. 116-136, CARES Act P.L. 113-5 Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA) S. 127 - Pharmacy Benefit Manager Transparency Act H.R. 830 - The HELP Copays Act S. 1375 - HELP Copays Act H.R. 1202 - Resident Education Deferred Interest Act, or REDI Act S. 704 - REDI Act S. 665, HR 4942 - Conrad State 30 and Physician Access Reauthorization Act H.R. 2389 - Resident Physician Shortage Reduction Act S. 1302 - Resident Physician Shortage Reduction Act H.R. 2474 - Strengthening Medicare for Patients and Providers Act S. 652, H.R. 2630 - Safe Step Act S. 1339 - Pharmacy Benefit Manager Reform Act H.R. 2670 - National Defense Authorization Act H.R. 2816 - Pharmacy Benefit Manager Sunshine and Accountability Act H.R. 2679 - Pharmacy Benefits Manager Accountability Act H.R. 2474 - The Strengthening Medicare for Patients and Providers Act H.R.6371 - Provider Reimbursement Stability Act of 2023 S. 2764 - Protecting Patient Access to Cancer and Complex Therapies Act H.R. 5391 - Protecting Patient Access to Cancer and Complex Therapies Act Appropriation legislation related to Medicare Physician Payments cuts implemented in 2024 Appropriations legislation related to the Congressionally Directed Medical Research Program Appropriations legislation related to the National Institutes of Health S. 705 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 2761 - Specialty Physicians Advancing Rural Care (SPARC) Act H.R. 8702 - Improving Seniors Timely Access to Care Act of 2024 S. 4532 - Improving Seniors Timely Access to Care Act of 2024 H.R. 6664 - The Innovation in Pediatric Drugs Act S. 4349 - Prior Authorization for Prescription Drugs Act HR. 6487 - No Fees for EFTs Act S. 3805 - No Fees for EFTs Act S. 4935 - Physician Fee Stabilization Act H.R. 7623 - Telehealth Modernization Act S. 3967 - Telehealth Modernization Act H.R. 7153 - Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act S. 3679 - Dr. Lorna Breen Healthcare Provider Protection Reauthorization Act H.R. 6545 - Physician Fee Schedule Update and Improvements Act

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

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

Draft Bill , 340B SUSTAIN Act, Issues pertaining to 340B Program access; H.R.9412 , Healthcare Cybersecurity Act of 2024, Issues pertaining to cyber security for health care field; Draft Bill , Strengthening Pathways to Healthcare Professions Act of 2024, Strengthening HRSA health workforce programs; H.R.8574, the 340B Affording Care for Communities and Ensuring a Strong Safety-net (340B ACCESS) Act, Issues pertaining to 340B Program access; H.R. 2584/ S. 2768, the Safety from Violence for Healthcare Employees (SAVE) Act, all provisions; S. 3211/ H.R. 6205, Healthcare Workforce Resilience Act, all provisions; S.665 / H.R. 4942, Conrad State 30 and Physician Access Reauthorization Act, all provisions; S 3679 / H.R. 7153, Dr. Lorna Breen Health Care Provider Protection Reauthorization Act, all provisions; H.R. 7635, The 340B PATIENTS Act, all provisions; S. 4289, Medical Debt Cancellation Act , all provisions; H.R. 3120, Healthy Competition for Better Care Act, all provisions; H.R. 9457, Transparent Telehealth Bills Act of 2024, all provisions; S. 3770/ H.R. 7266, The Future Advancement of Academic Nursing (FAAN Act), all provisions; S. 1176 / H.R. 2663 , Workplace Violence Prevention for Health Care and Social Service Workers Act, all provisions; S. 5025 , the SEPSIS Act , all provisions; Draft Bill , Rural 340B Access Act, Issues pertaining 340B Program access; Draft Bill , Draft Bill , Freestanding Emergency Departments; Cybersecurity and Infrastructure Security Agency (CISA) - Dept. Homeland Sec., Cyber Incident Reporting for Critical Infrastructure Act (CIRCIA) Reporting Requirements, Feedback on reporting requirements for cybersecurity incidents under CIRCIA; Occupational Safety and Health Administration (OSHA)Occupational Safety and Health Administrations (OSHA) proposed emergency response standard, Feedback to strengthen OSHA's emergency response standard for hospitals and health systems and their workforce; Health Resources Services Administration (HRSA), J&J Rebate Model for 340B Program, Feedback on Johnson & Johnson rebate model for 340B Program; Medical Debt, Issues specific to medical debt incurred by patients and hospital billing and collection practices; Price Transparency, STMT to Committee on Aging, Issues related to hospital price transparency; Cyber Security, Issues pertaining to ongoing cyber risks to the health care field. Change Health Care cyber-attack, breach notifications CrowdStrike, OneBlood, health records; Rural Health Care Access, Issues to protect access to rural health care; Tax-exempt status, Issues pertaining to not-for-profit hospitals' tax exempt status; Maternal Health and Child Health, Access to maternal and child health care and addressing related workforce shortages, conditions of participation (COP) and impact of recent payment rules; Behavioral Health, Issues related to expanding access to care and reducing regulatory barriers; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay; Drug Prices, Included in Cost of Healthcare Hearing , Issues related to prescription drug prices; Physician Owned Hospitals, Hill meetings, Physician-owned hospitals; 340B Program, Hill Letter, Johnson and Johnson 340B Proposal; DEA Telehealth Waivers, Telemedicine prescribing of controlled substances; Workforce, nurse staffing mandate, workforce development programs; Health Professions Diversity, National health service corps; centers of excellence; health careers opportunity programs; Hospital mergers and acquisitions, Issues pertaining to hospital consolidation, mergers an acquisitions, physician practice acquisition; Supply Chain Issues, HHS Calls, Issues pertaining to supply chain issues for medical devices and blood shortages; Rural 340B Access Act , Hill visit, Hill discussion about the Rural 340B Access Act (House and Senate); Outstanding COVID reimbursement for hospitals, Check in with FEMA, FEMA outreach about outstanding COVID reimbursement for hospitals.

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

Government targets: Drug Enforcement Administration (DEA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Homeland Security, Dept of (DHS), Justice, Dept of (DOJ), Labor, Dept of (DOL), Occupational Safety & Health Administration (OSHA), SENATE, White House Office

Incentivizing domestic manufacturing of critical medical supplies Issues related to health care costs and transparency Electronic prior authorization and administrative simplification Health care supply chain resiliency 340B Drug discount program Reauthorization of Pandemic and All Hazards Preparedness Act Hospital finance issues Healthcare workforce issues (graduate medical education, health professional training, recruitment and retention, minimum staffing requirements) Medicare payment policies Alternative payment models and related policies Medicare home infusion policy Reauthorization of Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act Expanding access to interoperable health tech in long term and post-acute care settings Maternal and infant health Health care workplace violence and worker safety S. 148 Stop STALLING Act S. 150 Affordable Prescriptions for Patients Act Medicaid Disproportionate Hospital Share cuts S. 2115, H.R. 4307 Medical Supply Chain Resiliency Act H.R. 4104, S. 1976 Preseving Patients Access to Home Infusion Act H.R. 2584, S. 2768 SAVE Act H.R. 3577 Medical and Health Stockpile Accountability Act H.R. 2665 Supporting Safety Net Hospitals Act H.R. 2389, S. 1302 Resident Physician Shortage Reduction Act H.R. 3346 IMPACT to Save Moms Act H.R. 5378 Lower Costs, More Transparency Act S. 2840 Bipartisan Primary Care and Health Workforce Act H.R. 5013, S. 3503 Value in Health Care Act H.R. 4942, S. 665 Conrad State 30 and Physician Access Reauthorization Act Artificial intelligence in healthcare H.R.766, S. 114 Preventive Health Savings Act H.R. 6205, S. 3211 Healthcare Workforce Resilience Act H.R. 7050 Substance Use Disorder Workforce Act H.R. 8702, S. 4532 Improving Seniors' Timely Access to Care Act H.R. 7855 Rural Residency Planning and Development Act

Client expense: $173,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Workforce: H.R. 731 / S. 220 the Workforce Mobility Act, which addresses issues relating to using non-compete agreements in employment contracts for certain non-exempt employees. H.R. 4942 / S.665 the Conrad State 30 and Physician Access Reauthorization Act, waives requirements for foreign physicians to reside for two years abroad after training in exchange for serving in an underserved area. H.R. 6205 / S. 3211, the Healthcare Workforce Resilience Act, would recapture unused immigrant visas. H.R. 7153/S. 3679, the Dr. Lorna Breen Health Care Provider Protection Act, would ensure continued funding for programs that address physician burnout and wellness.

Client expense: $157,711 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4942/S. 665, Conrad State 30 and Physician Access Reauthorization;

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

Government targets: Bureau of Citizenship & Immigration Services (BCIS), HOUSE OF REPRESENTATIVES, SENATE

H.R. 2, Secure the Border Act of 2023 H.R. 16, American Dream and Promise Act of 2023 H.R. 319, Legal Workforce Act H.R. 575, Moving H-2A to United States Department of Agriculture Act of 2023 H.R. 614, Commercial Fishing and Seafood Business Act of 2023 H.R. 1325/S. 255, Asylum Seeker Work Authorization Act of 2023 H.R. 1535, Eliminating Backlogs Act of 2023 H.R. 1760, To extend the admission to Guam or the Commonwealth of the Northern Mariana Islands for certain nonimmigrant H-2B workers H.R. 1778, Better Agriculture Resources Now (BARN) Act H.R. 1787, To amend the Immigration and Nationality Act to provide nonimmigrant status to mobile entertainment workers, and for other purposes H.R. 2393, Combating Cartels on Social Media Act of 2023 H.R. 2758, Returning Worker Accountability Act of 2023 H.R. 2827/S. 1301, Partner with Korea Act H.R. 2915, Farm Workforce Support Act of 2023 H.R. 3308/S. 874, Farm Operations Support Act H.R. 3442/S. 1667, Protecting Children of Long-Term Visa Holders Act of 2023 H.R. 3599, DIGNITY Act H.R. 3734, Essential Workers for Economic Advancement Act H.R. 3808, Afghan Allies Protection Act of 2023 H.R. 3911, Ukrainian Adjustment Act of 2023 H.R. 4048, Venezuelan Adjustment Act H.R. 4319, Farm Workforce Modernization Act of 2023 H.R. 4358, PHDs First Act H.R. 4448, Canadian Snowbird Visa Act H.R. 4627/S. 2327, Afghan Adjustment Act H.R. 4647, High-skilled Immigration Reform for Employment Act H.R. 4665/S. 2438, Department of State, Foreign Operations, and Related Programs Appropriations Act, 2024, H.R. 4708, H-2 Improvements to Relieve Employers (HIRE) Act H.R. 4942/S. 665, Conrad State 30 and Physician Access Reauthorization Act H.R. 5127, Visitor Visa Wait Time Reduction Act H.R. 5155, Temporary Family Visitation Act H.R. 5477/S. 2384, Keep STEM Talent Act of 2023 H.R. 5990, Border Enforcement, Security, and Trade (BEST) Facilitation Act of 2023 H.R. 6205, Healthcare Workforce Resilience Act H.R. 6542, Immigration Visa Efficiency and Security Act of 2023 H.R. 7046/S. 3848, Supporting Farm Operations Act of 2024 H.R. 7574, Closing the Workforce Gap Act of 2024 H.R. 8392, To Add Ireland to the E-3 Nonimmigrant Visa Program H.R. 8752, Department of Homeland Security Appropriations Act, 2025 H.R. 8771/S. 4797, Department of State, Foreign Operations, and Related Programs Appropriations Act, 2025 H.R. 9029/S. 4942, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2025 H.R. 9747, Continuing Appropriations and Extensions Act, 2025 S. 156, Accountability Through Electronic Verification Act S. 243, A bill to require the Commissioner of U.S. Customs and Border Protection to establish procedures for conducting maintenance projects at ports of entry at which the Office of Field Operations conducts certain enforcement and facilitation activities S. 255, Asylum Seeker Work Authorization Act of 2023 S. 365, Dream Act of 2023 S. 387, Canadian Snowbirds Act of 2023 S. 979,H-1B and L-1 Visa Reform Act of 2023 S. 1253, Securing America's Ports of Entry Act of 2023 S. 1727, Safe Environment from Countries Under Repression and Emergency (SECURE) Act S. 1926, A bill to amend the Caribbean Basin Economic Recovery Act to make Uruguay eligible for designation as a beneficiary country under that Act, to include Uruguay in the list of foreign states whose nationals are eligible for admission into the United States as E1 and E2 nonimmigrants if nationals of the United States are treated similarly by the Government of Uruguay, and to require a report on the eligibility of Uruguay for the visa waiver program, and for other purposes S. 2278, Border Enforcement, Security, and Trade (BEST) Facilitation Act of 2023 S. 2324, Ensuring American Security and Protecting Afghan Allies Act S. 2606, Renewing Immigration Provisions of the Immigration Act of 1929 S. 2632, Visa Processing Improvement Act S. 2705, State Executive Authority for Seasonal Occupations Needing Additional Labor (SEASONAL) Act S. 2719, Directing Our Countrys Transfer Of Residency Slots (DOCTORS) Act S. 2785, Higher Wages for American Workers Act of 2023 S. 3013, A bill to permanently authorize the exemption of aliens working as fish processors from the numerical limitation on H-2B nonimmigrant visas S. 3187, Southern Border Transparency Act of 2023 S. 3211, Healthcare Workforce Resilience Act S. 3255, Temporary Family Visitation Act S. 3291, EAGLE Act of 2023 S. 4069, Affordable and Secure Food Act of 2024 S. 4361, The Border Act of 2024 S. 4591, A bill to permanently authorize the exemption of aliens working as fish processors from the numerical limitation on H-2B nonimmigrant visas S.4638, National Defense Authorization Act for Fiscal Year 2025 S. 4888, A bill to include Czechia in the list of foreign states whose nationals are eligible for admission into the United States as E-1 nonimmigrants if United States nationals are treated similarly by the Government of Czechia H.Res. 481, Expressing the sense of the House of Representatives that BridgeUSA exchange programs are vital to the economy and national interests of the United States, and that Congress should prioritize robust support to ensure equitable opportunities for Americans and people from other countries Various issues relating to visa waiver program; H-1B Visa Program; H-1B registration rule; H-1B reform; H-2 Visa Program and temporary rule; H-2B Visa Program and cap relief; H-2A Visa Program; H-4 rule; L-1 Visa Program; J-1 Programs; Bridge USA program; EB-5 Visa Program; E-Verify program; nonimmigrant workers in temporary or seasonal nonagricultural employment; Customs and Border Protection staffing at U.S. ports of entry; border security; immigration policy and reforms; guest worker programs; legalization concepts; visa reform; customs trade facilitation and enforcement; Deferred Action for Childhood Arrivals (DACA) program; extension of temporary protected status (TPS) designations for El Salvador, Honduras, and Haiti; administrative-regulatory efforts related to public charge, notice to appear, H-4 & OPT; delays in H-4 and L-2 Status Extensions and Employment Authorization Documents (EADs); Office of Foreign Labor Certifications Planned Implementation of Form ETA-9089, Application for Permanent Employment Certification, into DOLs Foreign Labor Application Gateway (FLAG) System; high-skilled immigration; lesser skilled immigration; temporary agricultural guest workers; temporary non-agricultural guest workers; optional practical training program; asylum and refugee programs; size and administration of employment-based immigrant visa categories; size and administration of family-based immigrant visa categories; size and administration of employment-based nonimmigrant visa categories; expansion of the use of the E-Verify system; I-9 employment verification; interior enforcement; increased vetting of visa applicants; unfair immigration related employment practices; international travel; trusted traveler programs; biometric entry-exit; increasing the number of ICE officers, border patrol agents and Customs and Border Protection officers; aerial security enhancements; EB-5 Regional Center Program and the Implementation of the EB-5 Reform and Integrity Act of 2022, P.L. 117-103, Division BB; State Department policies extending consular interview waiver eligibility for various classifications of nonimmigrants; USCIS Fee Schedule; regulatory proposals that would restrict applicant eligibility for the H-1B program; regulatory proposals that would drastically change how prevailing wage levels are determined for the purposes of obtaining certain employment-based nonimmigrant and immigrant visas; proposals that would significantly change how cap-subject H-1B petitions will be chosen in the future; regulatory proposals that would change how the period of admission for student visa holders and exchange visa holders is determined; regulatory proposals that will temporarily raise the annual quota for H-2B visas; regulatory proposals reopening and expanding consular operations; recapturing unused immigrant visas from prior years; creating exemptions to the current immigrant visa caps; proposals that would expand consular interview waivers for prospective immigrant and nonimmigrant visa applicants abroad; proposals that would provide relief for Afghan nationals; expanding the eligibility for stateside renewal of work visas; implementation of electronic visa foils in passports; consular service delays; USCIS processing delays; DOL processing delays; visa relief for long term foreign national workers laid off by their employers while waiting for their green cards in the immigrant visa backlogs; improving wait times for CBP Processing at Ports of Entry; expanding and implementing new CBP preclearance facilities abroad; reforms to the use of parole authority; extending the validity period for employment authorization documents; reforms to the State Departments Visa Bulletin; implementation of the new optional I-9 document verification procedures; expanded mandatory detention of unauthorized aliens in the U.S.; expansion of expulsion/removal authorities; changes to the legal standard for credible fear interviews for asylum applicants; modifying asylum eligibility requirements; expanding availability of special immigrant visas for Afghan nationals; providing additional visas for foreign nationals to work in the U.S. on Defense Department Projects (FORTRESS Act Amendment); reforms to the adjudication process for inadmissibility waivers; regulatory proposals that change how the H-2A program will be administered; proposals that will adjust what types of foreign nationals are eligible for obtaining employment authorization and advance parole documents; expanding E visa eligibility; expanding and updating the J-1 Exchange Visitor Skill List

Client expense: $14,750,000 · Firm income: Not reported

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

S. 3211/HR 6205 Healthcare Workforce Resilience Act S. 665/HR 4942 Conrad State 30 and Physician Access Reauthorization Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6980/S.2719 - Directing Our Countrys Transfer of Residency Slots (DOCTORS) Act Issue: Educate Congress on policies related to mending the Immigration and Nationality Act to provide for the reallocation of unused waivers of the foreign residency requirement for certain J visa holders. H.R.4942/S.665 - Conrad State 30 and Physician Access Reauthorization Act Issue: Support expansion of the Conrad 30 program and improvements to physician immigration. H.R.4875 - Doctors in our Borders Act Issue: Support expansion of the Conrad 30 program and improvements to physician immigration. Educate Congress on policies allowing undocumented students to attend U.S. medical schools and graduate medical education. H.R.6205/S.3211 - Healthcare Workforce Resilience Act Issue: Support reduction of green card backlogs for health professionals.

Client expense: $617,103 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 6980/S.2719 - Directing Our Countrys Transfer of Residency Slots (DOCTORS) Act Issue: Educate Congress on policies related to mending the Immigration and Nationality Act to provide for the reallocation of unused waivers of the foreign residency requirement for certain J visa holders. H.R.4942/S.665 - Conrad State 30 and Physician Access Reauthorization Act Issue: Support expansion of the Conrad 30 program and improvements to physician immigration. H.R.4875 - Doctors in our Borders Act Issue: Support expansion of the Conrad 30 program and improvements to physician immigration. Educate Congress on policies allowing undocumented students to attend U.S. medical schools and graduate medical education. H.R.6205/S.3211 - Healthcare Workforce Resilience Act Issue: Support reduction of green card backlogs for health professionals.

Client expense: $617,103 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 4942, Conrad State 30 and Physician Access Reauthorization Act, all provisions S. 665, Conrad State 30 and Physician Access Reauthorization Act, all provisions H.R. 6205, Healthcare Workforce Resilience Act, all provisions S. 3211, Healthcare Workforce Resilience Act, all provisions H.R. 4875, Doctors in our Borders Act, all provisions H.R. 6980, Directing Our Countrys Transfer Of Residency Slots (DOCTORS) Act, all provisions S. 2719, Directing Our Countrys Transfer Of Residency Slots (DOCTORS) Act, all provisions H.R. 6363, Further Continuing Appropriations and Other Extensions Act, 2024, provisions relating to dual intent residents H.R. 7463, Extension of Continuing Appropriations and Other Matters Act, 2024, provisions relating to Conrad 30 program H. Res. 1102, Further Consolidated Appropriations Act, 2024, provisions relating to Conrad 30 extension H.R. 9747, Continuing Appropriations and Extensions Act, 2025, provisions relating to continuing resolution through December 20

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE