Save Rural Hospitals Act of 2023

Area wage index - Save Rural Hospitals Act (S.803); Workforce - Resident Physician Shortage Reduction Act of 2023 (H.R.2389); post-acute care/inpatient rehabilitation facilities - legislation related to a Medicare post-acute care prospective payment system Disproportionate Share Hospital (DSH) and Uncompensated Care funding; Medicare reimbursement cuts; Medicare sequester; Medicaid DSH Payments; physician pay.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.803/H.R.3635, Save Rural Hospitals Act of 2023, issues related to area wage index reform. S.1302/H.R.2389, the Resident Physician Shortage Reduction Act. H.R.4758, Accelerating Kids' Access to Care Act, issues related to state provider licensing reciprocity for Medicaid services. H.R.3876/S.2323, Access to Genetic Counselor Services Act. Issues related to state Medicaid waiver approvals. Issues related to CMS telehealth policies. Issues related to Medicares hospital at home programs. Issues related to hospital outpatient reimbursement. Issues related to hospital inpatient reimbursement. Issues related to clinician payment under the Medicare Physician Fee Schedule. Issues related to so-called site-neutral cuts. Issues related to Medicare Advantage. Issues related to Medicare support for Graduate Medical Education.

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

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

S.803, Save Rural Hospitals Act; H.R.3635, Save Rural Hospitals Act of 2023; regulatory relief for low-wage hospitals; issues related to hospital reimbursement, generally.

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

Government targets: SENATE

340B Drug Pricing Program - Continued to urge action to ensure covered entities have access to 340B discounted prices through contract pharmacies. Highlighted critical importance of the 340B program for hospitals. Children's Hospital Graduate Medical Education (CHGME) - Continued to urge Congress to reauthorize CHGME program Drug shortages - Supported elements to increase transparency in prescription drug supply chain and increase reimbursement for generic prescription drugs; issues related to compounding; issues related to buffer inventory. Continued supporting passage of The Drug Shortage Prevention Act (H.R. 3008) and The Drug Origin Transparency Act (H.R. 3810) Hospital Group Purchasing - Advocated to highlight the value that hospital group purchasing organizations provide to hospitals and suppliers. Provided education on how GPOs work in the healthcare supply chain and the role they play in delivering value to healthcare providers, as well as key differences between traditional GPOs and PBMs. Monitored development of the Lower Costs, More Transparency Act (H.R. 5378) Medical Device Sterilization - Conducted education and outreach on the potential negative impact on the healthcare supply chain of pending regulations limiting the use of Ethylene Oxide as a medical device sterilant. Mental and Behavioral Health - Highlighted the need for legislation to address significant challenges to mental and behavioral health treatment, including increased demand for services, limited access to treatment, and clinician shortages. Pandemic and All Hazards Preparedness Act (PAHPA) - Encouraged the reauthorization of PAHPA Payer-mandated White Bagging - Urged support for policy updates related to payer-mandated white bagging for medications. Rural healthcare - Encouraged passage of the Save Rural Hospitals Act (S. 803) ; the Rural Hospital Closure Relief Act (S. 1571) and the Assistance for Rural Community Hospitals Act (H.R. 6430) Social Determinants of Health - Encouraged Congress and agencies to ensure tools like the Vizient Vulnerability Index are being utilized to understand and identify social drivers of health at the neighborhood level. Specifications, Standards and Ecolabels for Federal Purchasing - Responded to the Environmental Protection Agency (EPA) on EPAs Recommendations of Specifications, Standards and Ecolabels for Federal Purchasing. Encouraged EPA to use a standard, ecolabel or certification that is recognized by the Environmental Sustainability Program. Telehealth - Continued supporting passage of the CONNECT for Health Act (S. 2016/H.R. 4189). Continued to advocate for the adoption of permanent telehealth policies to extend flexibilities beyond the current 2024 expiration date. Telemedicine prescribing - Encouraged Congress to pass a two-year extension of Drug Enforcement Administration (DEA) prescribing flexibilities without requiring an in-person medical evaluation Workforce - Monitored development of the Bipartisan Primary Care and Health Workforce Act (S.2840) ; Encouraged passage of the Safety from Violence for Healthcare Employees (SAVE) Act (S. 2768/H.R. 2584) ; the Dr. Lorna Breen Health Care Provider Protection Reauthorization Act (S. 3679/H.R. 7153) ; the Healthcare Workforce Resilience Act (S.3211/H.R.6205) ; the Resident Physician Workforce Shortage Reduction Act of 2023 (S. 1302/H.R. 2389) ; and the Substance Use Disorder Workforce Act (H.R.7050)

S.803/H.R.3635, Save Rural Hospitals Act of 2023, issues related to area wage index reform. S.1302/H.R.2389, the Resident Physician Shortage Reduction Act. H.R.4758, Accelerating Kids' Access to Care Act, issues related to state provider licensing reciprocity for Medicaid services. H.R.3876/S.2323, Access to Genetic Counselor Services Act. Issues related to state Medicaid waiver approvals. Issues related to CMS telehealth policies. Issues related to Medicares hospital at home programs. Issues related to hospital outpatient reimbursement. Issues related to hospital inpatient reimbursement. Issues related to clinician payment under the Medicare Physician Fee Schedule. Issues related to so-called site-neutral cuts. Issues related to Medicare Advantage. Issues related to Medicare support for Graduate Medical Education.

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

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

General health care issues and Medicare reimbursement; S.803/H.R.3635, Save Rural Hospitals Act of 2023.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

General health care issues and Medicare reimbursement; S.803/H.R.3635, Save Rural Hospitals Act of 2023; issues concerning rural emergency hospitals.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Area wage index - Save Rural Hospitals Act (S.803); Workforce - Resident Physician Shortage Reduction Act of 2023 (H.R.2389); post-acute care/inpatient rehabilitation facilities - legislation related to a Medicare post-acute care prospective payment system Disproportionate Share Hospital and Uncompensated Care funding; Medicare reimbursement cuts; Medicare sequester; physician pay.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.803/H.R.3635, Save Rural Hospitals Act of 2023, issues related to area wage index reform. H.R.5378, Lower Costs, More Transparency Act, issues related to reimbursement cuts and administrative burdens on hospitals. S.1302/H.R.2389, the Resident Physician Shortage Reduction Act. H.R.4758, Accelerating Kids' Access to Care Act, issues related to state provider licensing reciprocity for Medicaid services. Issues related to CMS telehealth policies. Issues related to Medicares hospital at home programs. Issues related to hospital outpatient reimbursement. Issues related to hospital inpatient reimbursement. Issues related to clinician payment under the Medicare Physician Fee Schedule. Issues related to Medicare Advantage. Issues related to Medicare support for Graduate Medical Education.

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

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

S.803, Save Rural Hospitals Act; H.R.3635, Save Rural Hospitals Act of 2023; regulatory relief for low-wage hospitals; issues related to hospital reimbursement, generally.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

General health care issues and Medicare reimbursement; S.803/H.R.3635, Save Rural Hospitals Act of 2023; issues concerning rural emergency hospitals.

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

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

General health care issues and Medicare reimbursement; S.803/H.R.3635, Save Rural Hospitals Act of 2023.

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

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

H.R. 7513, Protecting America's Seniors Access to Care Act, all provisions; H.R. 468, Building Americas Health Care Workforce Act, all provisions; H.R. 8113, Transparency into State Directed Payments Act of 2024, all provisions; H.R. 8115, To amend title XIX of the Social Security Act to allow for the deferral or disallowance of portions of payments for certain managed care violations under Medicaid, all provisions; H.R. 1110, KEEP Telehealth Option Act, all provisions; H.R. 7711, Advancing Access to Telehealth Act, all provisions; H.R. 3432, Telemental Health Care Access Act, all provisions; H.R. 3875, the Expanded Telehealth Access Act, all provisions; H.R. 5611, Helping Ensure Access to Local Telehealth (HEALTH) Act of 2023, all provisions; H.R. 6033, Patient Education and Knowledge (SPEAK) Act of 2023, all provisions; H.R. 5541, the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, all provisions; H.R. 7863, To require the Secretary of Health and Human Services to issue guidance on furnishing behavioral health services via telehealth to individuals with limited English proficiency under Medicare program, all provisions; H.R. 134, To amend title XVIII of the Social Security Act to remove geographic requirements and expand originating sites for telehealth services, all provisions; H.R. 8261, The Preserving Telehealth, Hospital, and Ambulance Access Act, Issues pertaining to Telehealth, Hospital at Home, and MDH-LVA; S.4350 / H.R. 8260, Hospital Inpatient Services, Modernization Act of 2024, all provisions; H.R. 8235, Rural Physician Workforce Preservation Act, all provisions; S. 2016/ H.R. 4189, The CONNECT for Health Act of 2023, Specifically telehealth waivers, geographic restrictions, originating site requirements, in person requirement behavioral health, RHCs and FQHCs access; S. 1110, the Rural Hospital Support Act, all provisions; S. 1673 / H.R. 1666, Protecting Access to Ground Ambulance Medical Services Act of 2023, all provisions; H.R. 6430, Assistance for Rural Community Hospitals (ARCH)Act, all provisions; S. 803, Save Rural Hospitals Act, all provisions; H.R. 4968, GOLD Card Act of 2023, all provisions; H.R. 3173 / S. 4532, Improving Seniors' Timely Access to Care, all provisions; H.R. 5013/S. 3503, Value in Health Care Act, all provisions; HR 2389/ S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions; Draft Bill, Graduate Medical Education Bill, Issues pertaining to proposed changes to the Medicare Graduate Medical Education program and solutions to address workforce shortages in rural areas; H.J.Res. 139 / S.J. Res 91, A joint resolution for congressional disapproval of a rule relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting", all provisions; HR 1565, Critical Access Hospital Relief Act of 2023, all provisions; H.R. 7623, Telehealth Modernization Act, Issues pertaining to Telehealth, Hospital at Home, Unique Health Identifier; H.R.1128, Rural Health Care Access Act of 2023, all provisions; S.1571, Rural Hospital Closure Relief Act of 2023, all provisions; S. 470 / H.R. 977, The Patient Access to Higher Quality Health Care Act, all provisions; Draft Bill, Keeping Obstetrics Local Act, all provisions;H.R.5378, Lower Costs, More Transparency Act, Issues related to site neutral payment cuts, hospital price transparency, unique health identifier, 340B Program; Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule for the inpatient psychiatric facility (IPF) prospective payment system (PPS), Issues pertaining to payment policy proposals for inpatient psychiatric facilities (IPFs); Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule for skilled nursing facility prospective payment system , Issues pertaining to payment policy proposals for skilled nursing facilities (SNFs); Centers for Medicare & Medicaid Services (CMS)FY25 proposed rule for inpatient rehabilitation facility prospective payment system, Issues pertaining to payment policy proposals for inpatient rehabilitation facilities (IRFs); Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule Hospital Inpatient Prospective Payment Systems , Issues pertaining to payment policy proposals for acute-care hospitals; Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule Long-Term Care Hospital Prospective Payment System, Issues pertaining to payment policy proposals for long term acute-care hospitals; Centers for Medicare & Medicaid Services (CMS), Transforming Episode Accountability Model (TEAM), Deadline expansion and proposed mandatory alternative payment model; Centers for Medicare & Medicaid Services (CMS), Medicare Advantage Data RFI, Issues pertaining to enforcement and accountability of MA plans, prompt payment, gold carding, Standarization, penalties, and plan oversight; Centers for Medicare & Medicaid Services (CMS); Anomalous DME Spending in MSSP, accountable care models; Centers for Medicare & Medicaid Services (CMS), Accrediting Organizations (AO's), Feedback to strengthen accrediting organizations oversight; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees; Site Neutral Payments, for Q2 2024, Issues related to site neutral payment cuts for drug administration; Valued Based Care, for Q2 2024, Specifically on alternative payment models, MACRA reform, feedback on proposed TEAM model; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, and REHs; Physician Payments, Issues pertaining to proposed solutions to improve MACRA, alternative payment models, mental health of workforce; LTCH High Cost Outlier Threshold, Issues concerning High Cost Outlier in LTCH payment policy; Organ Transplant Model, Issues pertaining to Value Based Care; Rural Health Clinic Payments, Issues related to increasing payments for rural health clinics; Chronic Care Management, Issues pertaining to chronic care management for Medicare beneficiaries.

H.R. 7513, Protecting America's Seniors Access to Care Act, all provisions; H.R. 468, Building Americas Health Care Workforce Act, all provisions; H.R. 8113, Transparency into State Directed Payments Act of 2024, all provisions; H.R. 8115, To amend title XIX of the Social Security Act to allow for the deferral or disallowance of portions of payments for certain managed care violations under Medicaid, all provisions; H.R. 1110, KEEP Telehealth Option Act, all provisions; H.R. 7711, Advancing Access to Telehealth Act, all provisions; H.R. 3432, Telemental Health Care Access Act, all provisions; H.R. 3875, the Expanded Telehealth Access Act, all provisions; H.R. 5611, Helping Ensure Access to Local Telehealth (HEALTH) Act of 2023, all provisions; H.R. 6033, Patient Education and Knowledge (SPEAK) Act of 2023, all provisions; H.R. 5541, the Temporary Reciprocity to Ensure Access to Treatment (TREAT) Act, all provisions; H.R. 7863, To require the Secretary of Health and Human Services to issue guidance on furnishing behavioral health services via telehealth to individuals with limited English proficiency under Medicare program, all provisions; H.R. 134, To amend title XVIII of the Social Security Act to remove geographic requirements and expand originating sites for telehealth services, all provisions; H.R. 8261, The Preserving Telehealth, Hospital, and Ambulance Access Act, Issues pertaining to Telehealth, Hospital at Home, and MDH-LVA; S.4350 / H.R. 8260, Hospital Inpatient Services, Modernization Act of 2024, all provisions; H.R. 8235, Rural Physician Workforce Preservation Act, all provisions; S. 2016/ H.R. 4189, The CONNECT for Health Act of 2023, Specifically telehealth waivers, geographic restrictions, originating site requirements, in person requirement behavioral health, RHCs and FQHCs access; S. 1110, the Rural Hospital Support Act, all provisions; S. 1673 / H.R. 1666, Protecting Access to Ground Ambulance Medical Services Act of 2023, all provisions; H.R. 6430, Assistance for Rural Community Hospitals (ARCH)Act, all provisions; S. 803, Save Rural Hospitals Act, all provisions; H.R. 4968, GOLD Card Act of 2023, all provisions; H.R. 3173 / S. 4532, Improving Seniors' Timely Access to Care, all provisions; H.R. 5013/S. 3503, Value in Health Care Act, all provisions; HR 2389/ S. 1302, Resident Physician Shortage Reduction Act of 2023, all provisions; Draft Bill, Graduate Medical Education Bill, Issues pertaining to proposed changes to the Medicare Graduate Medical Education program and solutions to address workforce shortages in rural areas; H.J.Res. 139 / S.J. Res 91, A joint resolution for congressional disapproval of a rule relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting", all provisions; HR 1565, Critical Access Hospital Relief Act of 2023, all provisions; H.R. 7623, Telehealth Modernization Act, Issues pertaining to Telehealth, Hospital at Home, Unique Health Identifier; H.R.1128, Rural Health Care Access Act of 2023, all provisions; S.1571, Rural Hospital Closure Relief Act of 2023, all provisions; S. 470 / H.R. 977, The Patient Access to Higher Quality Health Care Act, all provisions; Draft Bill, Keeping Obstetrics Local Act, all provisions;H.R.5378, Lower Costs, More Transparency Act, Issues related to site neutral payment cuts, hospital price transparency, unique health identifier, 340B Program; Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule for the inpatient psychiatric facility (IPF) prospective payment system (PPS), Issues pertaining to payment policy proposals for inpatient psychiatric facilities (IPFs); Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule for skilled nursing facility prospective payment system , Issues pertaining to payment policy proposals for skilled nursing facilities (SNFs); Centers for Medicare & Medicaid Services (CMS)FY25 proposed rule for inpatient rehabilitation facility prospective payment system, Issues pertaining to payment policy proposals for inpatient rehabilitation facilities (IRFs); Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule Hospital Inpatient Prospective Payment Systems , Issues pertaining to payment policy proposals for acute-care hospitals; Centers for Medicare & Medicaid Services (CMS), FY25 proposed rule Long-Term Care Hospital Prospective Payment System, Issues pertaining to payment policy proposals for long term acute-care hospitals; Centers for Medicare & Medicaid Services (CMS), Transforming Episode Accountability Model (TEAM), Deadline expansion and proposed mandatory alternative payment model; Centers for Medicare & Medicaid Services (CMS), Medicare Advantage Data RFI, Issues pertaining to enforcement and accountability of MA plans, prompt payment, gold carding, Standarization, penalties, and plan oversight; Centers for Medicare & Medicaid Services (CMS); Anomalous DME Spending in MSSP, accountable care models; Centers for Medicare & Medicaid Services (CMS), Accrediting Organizations (AO's), Feedback to strengthen accrediting organizations oversight; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees; Site Neutral Payments, for Q2 2024, Issues related to site neutral payment cuts for drug administration; Valued Based Care, for Q2 2024, Specifically on alternative payment models, MACRA reform, feedback on proposed TEAM model; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, and REHs; Physician Payments, Issues pertaining to proposed solutions to improve MACRA, alternative payment models, mental health of workforce; LTCH High Cost Outlier Threshold, Issues concerning High Cost Outlier in LTCH payment policy; Organ Transplant Model, Issues pertaining to Value Based Care; Rural Health Clinic Payments, Issues related to increasing payments for rural health clinics; Chronic Care Management, Issues pertaining to chronic care management for Medicare beneficiaries.

S.803/H.R.3635, Save Rural Hospitals Act of 2023, issues related to area wage index reform. H.R.5378, Lower Costs, More Transparency Act, issues related to reimbursement cuts and administrative burdens on hospitals. S.1302/H.R.2389, the Resident Physician Shortage Reduction Act. Issues related to CMS telehealth policies. Issues related to Medicares hospital at home programs. Issues related to Medicare geographic reclassification. Issues related to hospital outpatient reimbursement. Issues related to clinician payment under the Medicare Physician Fee Schedule. Issues related to Medicare Advantage. Issues related to Medicare support for Graduate Medical Education.

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

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

Area wage index - Save Rural Hospitals Act (S.803); behavioral health; Workforce - Resident Physician Shortage Reduction Act of 2023 (H.R.2389); legislation pertaining to health care workforce resilience; legislation pertaining to academic nursing; legislation pertaining to mental and behavioral health access for health providers; rural hospital medical residency and health workforce programs - Rural America Health Corps Act (S.940/H.R.1711); post-acute care/inpatient rehabilitation facilities - legislation related to a Medicare post-acute care prospective payment system, IRF CMS Review Choice Demonstration; 340b Eligibility requirements waiver - related legislation; Disproportionate Share Hospital and Uncompensated Care funding; relief to repay payments received through the Medicare Accelerated and Advance Payments program.

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

General health care issues and Medicare reimbursement; S.803/H.R.3635, Save Rural Hospitals Act of 2023.

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

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

General health care issues and Medicare reimbursement; S.803/H.R.3635, Save Rural Hospitals Act of 2023.

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

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

S.803, Save Rural Hospitals Act; H.R.3635, Save Rural Hospitals Act of 2023; regulatory relief for low-wage hospitals; issues related to hospital reimbursement, generally.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.803/H.R.3635, Save Rural Hospitals Act of 2023, issues related to area wage index reform. H.R.5378, Lower Costs, More Transparency Act, issues related to reimbursement cuts and administrative burdens on hospitals. S.1302/H.R.2389, the Resident Physician Shortage Reduction Act. H.R.4286, the Increasing Access to Lung Cancer Screening Act. Issues related to CMS telehealth policies. Issues related to Medicares hospital at home programs. Issues related to Medicare geographic reclassification. Issues related to hospital outpatient reimbursement. Issues related to clinician payment under the Medicare Physician Fee Schedule.

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

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

Hill outreach to oppose site-neutral payment cuts; Hill outreach in support of the Acute Hospital Care at Home program; Hill outreach about streamlining prior authorization in Medicare Advantage plans; AHA Letter Comments on Medicare Payment Advisory Commission 2024 Payment Proposals; Support S. 803, Save Rural Hospitals Act of 2023, a bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments; Letter comments on three topics that were discussed during the December 2023 Medicare Payment Advisory Commission (MedPAC) public meeting: Hospital payment update recommendation to Congress, Post acute care facilities update recommendation to Congress, Physician reimbursement update recommendation to Congress; Support HR 2665, Supporting Safety Net Hospitals Act, a bill to amend title XIX of the Social Security Act to delay certain disproportionate share hospital payment reductions under the Medicaid program; Comment letter to CMS opposes the proposal to limit the inclusion of patient days for patients who are regarded as eligible for Medicaid benefits under a Section 1115 demonstration project for purposes of the Medicare DSH calculation; Comment letter to CMS regarding a proposed rule to improve access, quality and health outcomes for Medicaid programs and the proposed policies related to access, finance and quality in Medicaid and CHIP managed care programs; Support H.R. 4968 GOLD Card Act of 2023A bill to amend title XVIII of the Social Security Act to exempt qualifying physicians from prior authorization requirements under Medicare Advantage plans, and for other purposes; Monitor H.R. 5378 Lower Costs, More Transparency Act, A bill to promote price transparency in the health care sector, and for other purpose; A comment letter on the Centers for Medicare & Medicaid Services (CMS) hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule for calendar year (CY) 2024, The letter urges CMS to examine ways to account for these increased costs to ensure that beneficiaries continue to have access to quality outpatient care. It also urges the agency to reduce the productivity cut for CY 2024 as such a cut does not align with hospital and health systems public health emergency (PHE) experiences related to actual losses in productivity during the COVID-19 pandemic; Hill outreach to oppose the elimination of facility fees; Hill outreach to oppose changes that would prevent providers from negotiating contracting restrictions with commercial health insurance plans; A request letter on the Centers for Medicare & Medicaid Services (CMS) to permanently remove the regulatory waivers which ensure hospitals and health systems could leverage telehealth services to respond to a wave of unprecedented need efficiently and effectively; Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, A letter to comment on the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act; A letter to express concerns regarding CMS proposed restrictions on states use of provider-based funding sources, such as provider taxes, to finance Medicaid payments; A letter to CMS requesting that the agency correct an error in its CY 2024 final rule reimbursement rate for hyperbaric oxygen therapy (HBOT) (HCPCS code G0277)

Area wage index - Save Rural Hospitals Act (S.803); behavioral health; Workforce - Resident Physician Shortage Reduction Act of 2023 (H.R.2389); legislation pertaining to health care workforce resilience; legislation pertaining to academic nursing; legislation pertaining to mental and behavioral health access for health providers; rural hospital medical residency and health workforce programs - Rural America Health Corps Act (S.940/H.R.1711); post-acute care/inpatient rehabilitation facilities - legislation related to a Medicare post-acute care prospective payment system, IRF CMS Review Choice Demonstration; 340b Eligibility requirements waiver - related legislation; Disproportionate Share Hospital and Uncompensated Care funding; relief to repay payments received through the Medicare Accelerated and Advance Payments program.

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

General health care issues and Medicare reimbursement; S.803/H.R.3635, Save Rural Hospitals Act of 2023.

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

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

General health care issues and Medicare reimbursement; S.803/H.R.3635, Save Rural Hospitals Act of 2023.

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

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

S.803, Save Rural Hospitals Act; H.R.3635, Save Rural Hospitals Act of 2023; regulatory relief for low-wage hospitals; issues related to hospital reimbursement, generally.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Rural health care issues, generally; Medicare Area Wage Index; S.803, Save Rural Hospitals Act; H.R.3635, Save Rural Hospitals Act of 2023; issues related to 340B program, generally; issues related to hospital reimbursement, generally.

Client expense: Not reported · Firm income: Not reported

Rural health care issues, generally; Medicare Area Wage Index; S.803, Save Rural Hospitals Act; H.R.3635, Save Rural Hospitals Act of 2023; issues related to 340B program, generally; issues related to hospital reimbursement, generally.

Client expense: Not reported · Firm income: Not reported

S.803, Save Rural Hospitals Act; H.R.3635, Save Rural Hospitals Act of 2023; issues related to hospital reimbursement, generally.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S.2840 - Bipartisan Primary Care and Health Workforce Act - Re: Facility fees; contracting practices; price transparency H.R. 5378 - Lower Costs, More Transparency Act - Re: Site-neutral & hospital price transparency H.R. 2665/S. 3430 - Supporting Safety Net Hospitals Act, Better Mental Health Care Lower-Cost Drugs and Extenders Act of 2023 - Re: elimination of DSH cuts Improving Seniors' Timely Access to Care Act - Re: reforms to the Medicare Prior Authorization Process H.R. 4968 - The Gold Card Act of 2023 - Re: Reforms to the Medicare Prior Authorization Process H.R. 977 / S. 470 - Patient Access to Higher Quality Health Care Act of 2023 - Re: changing current law limiting self-referral to physician-owned hospitals S.803/ H.R. 3635 - Save Rural Hospitals Act of 2023 - Re: Area Wage Index floor S.1110/H.R. 6430 - Rural Hospital Support Act, Assistance for Rural Community Hospitals (ARCH) Act - Re: making permanent rural payment programs (LVH/MDH) IMD Exclusion Support Medicaid Directed Payment programs Support accountability and transparency in Medicare Advantage

Client expense: $543,000 · Firm income: Not reported

Medicaid Disproportionate Hospital (DSH) payment cuts - Urged Congress to avoid Medicaid Disproportionate Share Hospital (DSH) payment cuts scheduled to begin in FY 2024. Urged passage of Supporting Safety Net Hospitals Act (H.R. 2665). Supported temporary delay of Medicaid DSH cuts in continuing resolution (H.R. 6363). Lower Costs, More Transparency Act (H.R. 5378) - Opposed adoption of site-neutral payment policies for drug administration and increased fines related to price transparency requirements for hospitals. Urged Congress to redirect its focus from site-neutral payment policies to reducing administrative burdens and increasing, rather than reducing, payments for care delivery in rural areas. The Medicare Dependent Hospital (MDH) program and the Low Volume Hospital Payment Adjustment (LVA) - Supported passage of The Rural Hospital Support Act (S. 1110) Medicare Area Wage Index - Supported passage of the Save Rural Hospitals Act (S. 803/H.R. 3635) Rural health care - Responded to House Ways and Means Committees Request for Information on ways to improve healthcare in rural and underserved areas. Urged Congress to consider utilizing the Vizient Vulnerability Index to help identify key challenges different rural communities face. Supported passage of the Rural Hospital Closure Relief Act (S. 1571) and the Conrad State 30 and Physician Access Reauthorization Act (H.R. 4924/S. 665). Urged further changes to Rural Emergency Hospital designation. Proposed Medicaid Managed Care Rule - Joined several other hospital advocacy organizations in signing a letter to CMS urging the agency not to finalize proposals related to provider-supported funding in the Medicaid Managed Care Proposed Rule. Supported CMSs proposal to establish the Average Commercial Rate (ACR) as the upper payment limit for inpatient and outpatient hospital services in the context of state directed payments. Medicare-supported Graduate Medical Education - Supported passage of the Resident Physician Shortage Reduction Act (H.R. 2389/S. 1302). Medicare Home Infusion - Supported passage of the Preserving Patient Access to Home Infusion Act (S. 1976/H.R. 4104). Issues related to pharmacy benefit managers; monitoring the Modernizing and Ensuring PBM Accountability (MEPA) Act (S.2973) Issues related to hospital and provider payment

S.2840 - Bipartisan Primary Care and Health Workforce Act - Re: health care contracting practices and facility fees H.R. 5378 - Lower Costs, More Transparency Act - Site-neutral payment policies and hospital price transparency provisions H.R. 2665 - Supporting Safety Net Hospitals Act - Elimination of DSH cuts H.R. 3173 - Improving Seniors' Timely Access to Care Act - Reforms to the Medicare Prior Authorization Process H.R. 4968 - The Gold Card Act of 2023 - Reforms to the Medicare Prior Authorization Process H.R. 977 / S. 470 - Patient Access to Higher Quality Health Care Act of 2023 - Changing current law limiting self-referral to physician-owned hospitals S.803 - Save Rural Hospitals Act of 2023 - Re: Area Wage Index floor S.1110 - Rural Hospital Support Act - Re: making permanent rural payment programs (LVH/MDH) 340B eligibility

Client expense: $441,000 · Firm income: Not reported

Area wage index - Save Rural Hospitals Act (S.803); behavioral health; Workforce - Resident Physician Shortage Reduction Act of 2023 (H.R.2389); legislation pertaining to health care workforce resilience; legislation pertaining to academic nursing; legislation pertaining to mental and behavioral health access for health providers; rural hospital medical residency and health workforce programs - Rural America Health Corps Act (S.940/H.R.1711); post-acute care/inpatient rehabilitation facilities - legislation related to a Medicare post-acute care prospective payment system, IRF CMS Review Choice Demonstration; 340b Eligibility requirements waiver - related legislation; Disproportionate Share Hospital and Uncompensated Care funding; relief to repay payments received through the Medicare Accelerated and Advance Payments program.

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

Hill outreach to oppose site-neutral payment cuts; Hill outreach in support of the Acute Hospital Care at Home program; Hill outreach about streamlining prior authorization in Medicare Advantage plans; AHA Letter Comments on Medicare Payment Advisory Commission 2024 Payment Proposals; Support S. 803, Save Rural Hospitals Act of 2023, a bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments; Letter comments on three topics that were discussed during the March 2023 Medicare Payment Advisory Commission (MedPAC) public meeting: the hospital wage index, alignment of payment rates across ambulatory settings and Medicare Part B drug payments. Agrees that the current wage index system is flawed, but continues to have concerns about the use of non-hospital data in an alternative wage index system; recommends that the commission reject modifications to the current average sales price (ASP)-plus-6% methodology; and urges the commission not to recommend additional site-neutral payment cuts; Support HR 2665, Supporting Safety Net Hospitals Act, a bill to amend title XIX of the Social Security Act to delay certain disproportionate share hospital payment reductions under the Medicaid program; Comment letter to CMS opposes the proposal to limit the inclusion of patient days for patients who are regarded as eligible for Medicaid benefits under a Section 1115 demonstration project for purposes of the Medicare DSH calculation; Comment letter to CMS regarding a proposed rule to improve access, quality and health outcomes for Medicaid programs and the proposed policies related to access, finance and quality in Medicaid and CHIP managed care programs; Support H.R. 4968 GOLD Card Act of 2023A bill to amend title XVIII of the Social Security Act to exempt qualifying physicians from prior authorization requirements under Medicare Advantage plans, and for other purposes; Support H.R.5378 Lower Costs, More Transparency Act A bill to promote price transparency in the health care sector, and for other purposes; A comment letter on the Centers for Medicare & Medicaid Services (CMS) hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule for calendar year (CY) 2024, The letter urges CMS to examine ways to account for these increased costs to ensure that beneficiaries continue to have access to quality outpatient care. It also urges the agency to reduce the productivity cut for CY 2024 as such a cut does not align with hospital and health systems public health emergency (PHE) experiences related to actual losses in productivity during the COVID-19 pandemic; Hill outreach to oppose the elimination of facility fees; Hill outreach to oppose changes that would prevent providers from negotiating contracting restrictions with commercial health insurance plans; A request letter on the Centers for Medicare & Medicaid Services (CMS) to permanently remove the regulatory waivers which ensure hospitals and health systems could leverage telehealth services to respond to a wave of unprecedented need efficiently and effectively; Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, A letter to comment on the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act; A letter to express concerns regarding CMS proposed restrictions on states use of provider-based funding sources, such as provider taxes, to finance Medicaid payments; A letter to CMS requesting that the agency correct an error in its CY 2024 final rule reimbursement rate for hyperbaric oxygen therapy (HBOT) (HCPCS code G0277)

S.803/H.R.3635, Save Rural Hospitals Act of 2023, issues related to area wage index reform. H.R.5378, Lower Costs, More Transparency Act, issues related to reimbursement cuts and administrative burdens on hospitals. S.3503/H.R.5013, the Value in Healthcare Act, issues related to the Medicare Shared Savings Program and APM incent. H.R.4286, the Increasing Access to Lung Cancer Screening Act. S.1302/H.R.2389, the Resident Physician Shortage Reduction Act. Issues related to Medicaid policies for pediatric populations. Issues related to CMS telehealth policies. Issues related to hospital at home programs. Legislative proposals to improve access to behavioral health and pediatric behavioral health services, including through workforce investments.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

General health care issues and Medicare reimbursement; S.803/H.R.3635, Save Rural Hospitals Act of 2023.

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

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

General health care issues and Medicare reimbursement; S.803/H.R.3635, Save Rural Hospitals Act of 2023.

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

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

S.803, Save Rural Hospitals Act; H.R.3635, Save Rural Hospitals Act of 2023; issues related to 340B program, generally; issues related to hospital reimbursement, generally.

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

Government targets: SENATE

Medicare-funded Graduate Medical Education National Health Service Corps Public Health Infrastructure and Emergency Preparedness Mental and Behavioral Health Funding for Health Professions NIH Approaches to Diversity, Equity and Inclusion Rural Healthcare HRSA THCGME Initiative to Strengthen Primary Health Care NIH Osteopathic Funding and Representation Community-based Clinical Rotations for Medical Students Advisory Committee on Interdisciplinary Community-Based Linkages Council on Graduate Medical Education U.S. Preventive Services Task Force Fair Access in Residency Act (H.R. 751) Physicians for Underserved Areas Act (S. 703) Specialty Physicians Advancing Rural Care (SPARC) Act (S. 705, H.R. 2761) Rural Physician Workforce Production Act (H.R. 834, S. 230) Resident Physician Shortage Reduction Act (H.R. 2389, S. 1302) Restoring America's Health Care Workforce and Readiness Act (S. 862) Rural Health Innovation Act (S. 953, H.R. 1712) Rural America Health Corps Act (S. 940, H.R. 1711) Save Rural Hospitals Act (S. 803) Health Care Worker Retention Act (H.R. 1215) Care for Long COVID Act (H.R. 1616, S. 801) Indian Health Service Health Professions Tax Fairness Act of 2023 Doctors of Community (DOC) Act (H.R. 2569) Expanding Medical Education Act Medical Student Education Authorization Act (S. 1403, H.R. 3046) Advisory Committee on Training in Primary Care Medicine and Dentistry Ensuring Access to General Surgery Act of 2023 (S. 1140, H.R. 1781) Strengthening Community Care Act of 2023 (H.R. 2559) AACOM 125th Anniversary Resolution (H.Res. 498, S.Res. 283) Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023 (H.R. 3561) Sole Community Provider Hospital IME Payments FY24 IPPS Proposed Rule Graduate Medical Education Provisions Primary Care and Health Workforce Expansion Act Bipartisan Primary Care and Health Workforce Act (S. 2840) Lower Costs More Transparency Act (H.R.5378) Community Health Care Reauthorization Act (S. 2308) Medical School Preceptor Tax Credit

Medicaid Disproportionate Hospital (DSH) payment cuts - Urged Congress to avoid Medicaid Disproportionate Share Hospital (DSH) payment cuts scheduled to begin in FY 2024. Urged passage of Supporting Safety Net Hospitals Act (H.R. 2665). Supported temporary delay of Medicaid DSH cuts in continuing resolution (H.R. 5860). Lower Costs, More Transparency Act (H.R. 5378) - Supported inclusion of provision to delay Medicaid DSH payment cuts and provisions similar to those in the Improving Seniors Timely Access to Care Act to update requirements for the use of prior authorization by Medicare Advantage organizations. Opposed adoption of site-neutral payment policies for drug administration and increased fines related to price transparency requirements for hospitals. Medicare-supported Graduate Medical Education - Supported passage of the Resident Physician Shortage Reduction Act (H.R. 2389/S. 1302). Medicare Home Infusion - Supported passage of the Preserving Patient Access to Home Infusion Act (S. 1976/H.R. 4104). Rural health care - Developed and provided feedback to the House Ways and Means Committee RFI related to improving care access in rural and underserved areas. Supported passage of the SAVE Rural Hospitals Act (S. 803/H.R. 3635); the Rural Hospital Closure Relief Act (S. 1571); the Rural Hospital Support Act (S. 1110); the Conrad State 30 and Physician Access Reauthorization Act (H.R. 4924/S. 665). Urged further changes to Rural Emergency Hospital designation.

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

S.803/H.R.3635, Save Rural Hospitals Act of 2023, issues related to area wage index reform. S.2323/H.R.3876, the Access to Genetic Counselor Services Act of 2023 H.R.5378, Lower Costs, More Transparency Act, issues related to reimbursement cuts and administrative burdens on hospitals. H.R.4822, the Health Care Price Transparency Act of 2023, issues related to reimbursement cuts and administrative burdens on hospitals. S.2137/H.R.5159, Preserving Access to Home Health Act. Issues related to CMS telehealth policies, including requirements for providers to list their home addresses. Issues related to hospital at home programs. Legislative proposals to improve access to behavioral health and pediatric behavioral health services, including through workforce investments. Issues related to Tennessees Medicaid DSH allotment.

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

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

Hill outreach to oppose site-neutral payment cuts; Hill outreach in support of the Acute Hospital Care at Home program; Hill outreach about streamlining prior authorization in Medicare Advantage plans; AHA Letter Comments on Medicare Payment Advisory Commission 2024 Payment Proposals; Support S. 803, Save Rural Hospitals Act of 2023, a bill to amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments; Letter comments on three topics that were discussed during the March 2023 Medicare Payment Advisory Commission (MedPAC) public meeting: the hospital wage index, alignment of payment rates across ambulatory settings and Medicare Part B drug payments. Agrees that the current wage index system is flawed, but continues to have concerns about the use of non-hospital data in an alternative wage index system; recommends that the commission reject modifications to the current average sales price (ASP)-plus-6% methodology; and urges the commission not to recommend additional site-neutral payment cuts; Support HR 2665, Supporting Safety Net Hospitals Act, a bill to amend title XIX of the Social Security Act to delay certain disproportionate share hospital payment reductions under the Medicaid program; Comment letter to CMS opposes the proposal to limit the inclusion of patient days for patients who are regarded as eligible for Medicaid benefits under a Section 1115 demonstration project for purposes of the Medicare DSH calculation; Comment letter to CMS regarding a proposed rule to improve access, quality and health outcomes for Medicaid programs and the proposed policies related to access, finance and quality in Medicaid and CHIP managed care programs; Support H.R. 4968 GOLD Card Act of 2023A bill to amend title XVIII of the Social Security Act to exempt qualifying physicians from prior authorization requirements under Medicare Advantage plans, and for other purposes; Support H.R.5378 Lower Costs, More Transparency Act A bill to promote price transparency in the health care sector, and for other purposes; A comment letter on the Centers for Medicare & Medicaid Services (CMS) hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) payment system proposed rule for calendar year (CY) 2024. The letter urges CMS to examine ways to account for these increased costs to ensure that beneficiaries continue to have access to quality outpatient care. It also urges the agency to reduce the productivity cut for CY 2024 as such a cut does not align with hospital and health systems public health emergency (PHE) experiences related to actual losses in productivity during the COVID-19 pandemic; Hill outreach to oppose the elimination of facility fees; Hill outreach to oppose changes that would prevent providers from negotiating contracting restrictions with commercial health insurance plans.

S.2840 - Bipartisan Primary Care and Health Workforce Act - Re: health care contracting practices and facility fees H.R. 5378 - Lower Costs, More Transparency Act - Site-neutral payment policies and hospital price transparency provisions H.R. 2665 - Supporting Safety Net Hospitals Act - Elimination of DSH cuts H.R. 3173 - Improving Seniors' Timely Access to Care Act - Reforms to the Medicare Prior Authorization Process H.R. 4968 - The Gold Card Act of 2023 - Reforms to the Medicare Prior Authorization Process H.R. 977 / S. 470 - Patient Access to Higher Quality Health Care Act of 2023 - Changing current law limiting self-referral to physician-owned hospitals S.803 - Save Rural Hospitals Act of 2023 - Re: Area Wage Index floor S.1110 - Rural Hospital Support Act - Re: making permanent rural payment programs (LVH/MDH) 340B eligibility

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

Area wage index - Save Rural Hospitals Act (S.803); behavioral health; Workforce - Resident Physician Shortage Reduction Act of 2023 (H.R.2389); legislation pertaining to health care workforce resilience; legislation pertaining to academic nursing; legislation pertaining to mental and behavioral health access for health providers; rural hospital medical residency and health workforce programs - Rural America Health Corps Act (S.940/H.R.1711); post-acute care/inpatient rehabilitation facilities - legislation related to a Medicare post-acute care prospective payment system, IRF CMS Review Choice Demonstration; 340b Eligibility requirements waiver - related legislation; Disproportionate Share Hospital and Uncompensated Care funding; relief to repay payments received through the Medicare Accelerated and Advance Payments program.

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

General health care issues and Medicare reimbursement; S.803/H.R.3635, Save Rural Hospitals Act of 2023.

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

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

General health care issues and Medicare reimbursement; S.803/H.R.3635, Save Rural Hospitals Act of 2023.

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

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

Medicare-funded Graduate Medical Education National Health Service Corps Public Health Infrastructure and Emergency Preparedness Mental and Behavioral Health Funding for Health Professions NIH Approaches to Diversity, Equity and Inclusion Rural Healthcare HRSA THCGME Program Initiative to Strengthen Primary Health Care NIH Osteopathic Funding and Representation Community-based Clinical Rotations for Medical Students Advisory Committee on Interdisciplinary Community-Based Linkages Council on Graduate Medical Education U.S. Preventive Services Task Force Fair Access in Residency Act (H.R. 751) Physicians for Underserved Areas Act (S. 703) Specialty Physicians Advancing Rural Care (SPARC) Act (S. 705, H.R. 2761) Rural Physician Workforce Production Act (H.R. 834, S. 230) Resident Physician Shortage Reduction Act (H.R. 2389, S. 1302) Restoring America's Health Care Workforce and Readiness Act (S. 862) Rural Health Innovation Act (S. 953, H.R. 1712) Rural America Health Corps Act (S. 940, H.R. 1711) Save Rural Hospitals Act (S. 803) Health Care Worker Retention Act (H.R. 1215) Care for Long COVID Act (H.R. 1616, S. 801) Indian Health Service Health Professions Tax Fairness Act of 2023 Doctors of Community (DOC) Act (H.R. 2569) Expanding Medical Education Act Medical Student Education Authorization Act (S. 1403, H.R. 3046) Advisory Committee on Training in Primary Care Medicine and Dentistry Ensuring Access to General Surgery Act of 2023 (S. 1140, H.R. 1781) Strengthening Community Care Act of 2023 (H.R. 2559) AACOM 125th Anniversary Resolution (H.Res. 498, S.Res. 283) Promoting Access to Treatments and Increasing Extremely Needed Transparency (PATIENT) Act of 2023 (H.R. 3561) Sole Community Provider Hospital IME Payments FY24 IPPS Proposed Rule Graduate Medical Education Provisions Primary Care and Health Workforce Expansion Act Bipartisan Primary Care and Health Workforce Act (S. 2840) Low Cost More Transparency Act (H.R.5378) Community Health Care Reauthorization Act (S. 2308)