Rural Hospital Support Act

Medicare and Medicaid payment issues, alternative payment models, value-based healthcare/Medicare shared savings program; Health care workforce; Health care pricing transparency; Site Neutral; 340B Program and Drug Pricing; MA prior authorization (S. 1816 / H.R. 3514); Telehealth and digital health; Home health / Hospice; Rural health and Rural Hospital Support Act (S. 335); Graduate medical education; Artificial intelligence; The Affordable Care Act; RESULTS Act (H.R. 5269 / S. 2761); Equitable Community Access to Pharmacist Services (ECAPS) Act (H.R. 3164 / S. 2426); 340B PATIENTS Act (H.R. 4581 / S. 2372); CONNECT for Health Act (H.R. 4206 / S. 1261); H.R. 1708 / S. 1087 Rebuild America's Healthcare Schools Act of 2025; Medicare Physician Reimbursement/MACRA.

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

(S.335) - The Rural Hospital Support Act - Expressed support for the Rural Hospital Support Act. This legislation would provide assistance to rural hospitals through the Medicare program, including making the Medicare-dependent Hospital Program permanent.

Client expense: $116,445 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), HOUSE OF REPRESENTATIVES, President of the U.S., SENATE

Issues relating to Medicare reimbursement for rural referral centers (RRCs), sole community hospitals (SCHs) and Medicare dependent hospitals(MDHs), including the Rural Hospital Support Act (S.335) and the Assistance for Rural Community Hospitals Act (H.R.1805).

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

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

Transparency FEMA COVID Assistance Funds Save Healthcare Workers Act, H.R.3178 Behavioral health CHGME Health care consolidation, mergers and acquisition H1-B Visas H.R. 9393, Lower Costs, More Transparency Act of 2026 H.R. 9390, Prices on the Wall Act Critical Access Hospital Relief Act (H.R. 538) Rural Hospital Support Act (S. 335) Medicare Advantage Prompt Pay Act (H.R.5454) Protect Our Hospitals Act (H.R. 4807) Resident Physician Shortage Reduction Act of 2025 (H.R. 4731/S.2439) H-1Bs for Physicians and the Healthcare Workforce Act (H.R. 7961) Tax Exempt Hospital Transparency Act (H.R. 9504)

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

S. 2761 / H.R. 5269, the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act, all provisions; H.R. 5142, The Home Health Stabilization Act, all provisions; S. 1261 / H.R. 4206, CONNECT for Health Act of 2025, all provisions; H.R. 1805, Assistance for Rural Community Hospitals (ARCH) Act, all provisions; H.R. 2191, Physician Led and Rural Access to Quality Care Act, all provisions; S. 335, Rural Hospital Support Act, all provisions; S.1816 / H.R.3514, Improving Seniors Timely Access to Care Act, all provisions; S. 502, Rural Hospital Closure Relief Act, all provisions; S. 2439 / H.R. 4731, Resident Physician Shortage Reduction Act of 2025, all provisions; H.R. 4002, Patient Access to Higher Quality Health Care Act, all provisions; H.R. 5454/S. 2879, the Medicare Advantage Prompt Pay Act, all provisions; H.R. 6240, Rural Hospital Closure Relief Act of 2025, all provisions; DRAFT, Rural Teaching Hospital Relief, all provisions; S. 2793, Ensuring Access to Essential Providers, all provisions; H.R. 8375/ S. 4384, Medicare Advantage Improvement Act, all provisions; H.R. 8967 / S. 4460, Rural Community Hospital Demonstration Program Reauthorization, all provisions; H.R. 9468, Saving Today's Acute Care Resources (STAR) Act, all provisions; H.R. 8261, Chronic Care Management Improvement Act, all provisions; DRAFT, HCA Mission Act, all provisions; DRAFT, To amend title XVIII of the Social Security Act to require the inclusion of certain information in Medicare Advantage Encounter Data, all provisions; DRAFT, To amend title XVIII of the Social Security Act to limit the compensation that may be paid to agents and brokers by Medicare Advantage (MA) organizations, all provisions; DRAFT, Preserving Patient Access Act, all provisions; H.R. 8891, Rural Maternity Options for Medial Support (Rural MOMS) Act, all provisions; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to Medicare Part C & D Reporting Requirements; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the FY2027 proposed rule for the hospital inpatient prospective payment system; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the proposed Comprehensive Care for Joint Replacement Expanded Model (CJR-X); Centers for Medicare & Medicaid Services (CMS) & Department of Health & Human Services (HHS), Issues pertaining to the interoperability standards and prior authorization for drugs; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the FY2027 proposed rule for the long-term care hospital prospective payment system; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to hospital food and nutrition; Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the FY2027 proposed rule for skilled nursing facilities (SNFs); Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the FY2027 proposed rule for inpatient rehabilitation facilities (IRFs); Centers for Medicare & Medicaid Services (CMS), Issues pertaining to the FY2027 proposed rule for inpatient psychiatric facilities (IPFs); Medicaid Program, Issues pertaining to Medicaid program and how states finance programs, reimburse providers, and determine beneficiary eligibility, and implementation and mitigation of H.R. 1 provisions related to state directed payments, provider taxes and community engagement requirements; Site Neutral Payments, Issues related to site neutral payment cuts and facility fees; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, REH's, implementation of Rural Health Transformation Program, rural reclassification policy; Physician Payments, Issues pertaining to alternative payment models, mental health of workforce, physician reimbursement cuts, Medicare Access & CHIP Reauthorization (MACRA) Reforms; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay and cost-based reimbursement for critical access hospitals under Medicare Advantage, Wasteful and Inappropriate Services Reduction (WISeR) model, transparency in plan denial signatures, inappropriate downcoding, reducing administrative burdens; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees; Post Acute Care, Issues pertaining to expanding patients' access to crucial services provided by long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, hospital at home, and home health agencies.

Q2 Lobbying Report (April 1-June 30) HCR FEMA re: COVID-19 related reimbursement Critical Access Hospital Relief Act (H.R. 538) Rural Hospital Support Act (S. 335) Expanding Medical Education Act (H.R. 2106) Preserving Emergency Access in Key Sites Act (H.R. 3778/S.1860) Improving Seniors Timely Access to Care Act (H.R. 3514/S.1816) Prompt and Fair Pay Act (H.R. 4559) Medicare Advantage Prompt Pay Act (H.R.5454) Apples to Apples Comparison Act of 2025 (H.R. 4093) Protect Our Hospitals Act (H.R. 4807) Resident Physician Shortage Reduction Act of 2025 (H.R. 4731/S.2439) H-1Bs for Physicians and the Healthcare Workforce Act (H.R. 7961) Tax Exempt Hospital Transparency Act (H.R. 9504) MMM Graduate Medical Education (GME) funding Telehealth flexibilities and payment Californias Medicaid Hospital Quality Assurance Fee Program Medicaid 340B Restoring Rural Health Act (S. 3047) Rural Hospital Fairness Act (H.R. 5821) Defend Rural Health Act of 2026 (H.R.7409) BUD FY 2025 budget FY 2026 appropriations One Big Beautiful Bill Act (H.R. 1)

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

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

Urged the Centers for Medicare & Medicaid Services (CMS) to promptly fill the vacant Chief Dental Officer (CDO) position and to ensure that this role remains housed within the Office of the Administrator. Maintaining a senior, agency-wide oral health leader is essential to sustaining CMSs progress with integrating dental care with medical care and supporting innovation that recognizes the connection between oral health and overall health. Urged Congress to address the Medicaid disproportionate share hospital (DSH) program reductions scheduled to begin on Oct. 1, 2025. The Medicaid DSH program supports hospitals that serve disproportionately high numbers of low-income and uninsured patients. These funds help alleviate both Medicaid underpayment and uncompensated care costs, ensuring patients have access to critical services in their community, including trauma care, burn units, maternal care, and high-risk neonatal care. (S.335) - The Rural Hospital Support Act - Expressed support for the Rural Hospital Support Act. This legislation would provide assistance to rural hospitals through the Medicare program, including making the Medicare-dependent Hospital Program permanent.

Client expense: $240,651 · Firm income: Not reported

Medicare and Medicaid payment issues, alternative payment models, value-based healthcare/Medicare shared savings program; Health care workforce; Health care pricing transparency; Site Neutral; 340B Program and Drug Pricing; MA prior authorization (S. 1816 / H.R. 3514); Telehealth and digital health; Home health / Hospice; Rural health and Rural Hospital Support Act (S. 335); Graduate medical education; Artificial intelligence; The Affordable Care Act; RESULTS Act (H.R. 5269 / S. 2761); Equitable Community Access to Pharmacist Services (ECAPS) Act (H.R. 3164 / S. 2426); 340B PATIENTS Act (H.R. 4581 / S. 2372); CONNECT for Health Act (H.R. 4206 / S. 1261); H.R. 1708 / S. 1087 Rebuild America's Healthcare Schools Act of 2025; Medicare Physician Reimbursement/MACRA.

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

Issues relating to Medicare reimbursement for rural referral centers (RRCs), sole community hospitals (SCHs) and Medicare dependent hospitals(MDHs), including the Rural Hospital Support Act (S.335) and the Assistance for Rural Community Hospitals Act (H.R.1805).

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

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

S. 2761 / H.R. 5269, the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act , all provisions; H.R. 5142, The Home Health Stabilization Act, all provisions; H.R. 4313 / S. 2237, Hospital Inpatient Services Modernization Act of 2025, all provisions; S. 1261 / H.R. 4206, CONNECT for Health Act of 2025, all provisions; H.R. 1805, Assistance for Rural Community Hospitals (ARCH) Act, all provisions; H.R. 2191, Physician Led and Rural Access to Quality Care Act, all provisions; S. 335, Rural Hospital Support Act, all provisions; S.1816 / H.R.3514 , Improving Seniors Timely Access to Care Act, all provisions; S. 502 / H.R. 6240 , Rural Hospital Closure Relief Act, all provisions; S. 2439 / H.R. 4731, Resident Physician Shortage Reduction Act of 2025, all provisions; H.R. 4002, Patient Access to Higher Quality Health Care Act, all provisions; DRAFT, Blood Pressure MATTERS Act, all provisions; H.R. 5454/S. 2879, the Medicare Advantage Prompt Pay Act, all provisions; DRAFT, Rural Teaching Hospital Relief, all provisions; S. 2793, Ensuring Access to Essential Providers, all provisions; H.R. 10136, Promoting Fairness for Medicare Providers Act, all provisions; H.R. 7409, Defend Rural Health Act, all provisions; H.R. 7830, Women Expansion of Learning and Labor Safety (WELLS) Act, all provisions; Centers for Medicare and Medicaid Services (CMS), Issues pertaining completing the CMS Outpatient Prospective Payment System Drug Acquisition Cost Survey; Centers for Medicare and Medicaid Services (CMS), Issues pertaining to written guidance on acceptable signage and other materials that hospitals can use in their emergency departments to discourage violent behavior; Centers for Medicare and Medicaid Services (CMS), Issue pertaining to the proposed rule on the Increasing Organ Transplant Access Model; Centers for Medicare and Medicaid Services (CMS), Comments pertaining to proposed rule on the Global Benchmark for Efficient Drug Pricing model; The Medicare Payment Advisory Commission (MedPAC), Issues related to proposed payment updates and Medicare Advantage program; Centers for Medicare and Medicaid Services (CMS), Medicare Program Contract Year 2027 Policy and Technical Changes to the Medicare Advantage Program, Issue pertaining to proposed rule for policy and technical changes to the Medicare Advantage and Part D programs in contract year 2027; Centers for Medicare and Medicaid Services (CMS), Issue pertaining to the upcoming rulemaking implementing requirements related to hospital off-campus provider-based departments; Centers for Medicare and Medicaid Services (CMS), Issue pertaining to the Comprehensive Regulations To Uncover Suspicious Healthcare (CRUSH), which includes efforts to combat fraud waste and abuse in federal health care programs; Centers for Medicare and Medicaid Services (CMS), Issue pertaining to the proposed rulemaking on potential options to foster a more resilient supply chain for American-made personal protective equipment and essential medicines; Centers for Medicare and Medicaid Services (CMS), Issue pertaining to expanding the use of Medicare Conditions of Participation (CoP); Centers for Medicare and Medicaid Services (CMS), Issues pertaining to the proposed Notice of Benefit and Payment Parameters for 2027; Centers for Medicare and Medicaid Services (CMS), Issues pertaining to implementation of unique national provider (NPI) for hospital off-campus provider-based departments as outlined in Consolidated Appropriations Act of 2026; Medicaid Program, Issues pertaining to Medicaid program and how states finance programs, reimburse providers, and determine beneficiary eligibility, and implementation of H.R. 1 provisions related to state directed payments and provider taxes; Site Neutral Payments, Issues related to site neutral payment cuts; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, REH's, implementation of Rural Health Transformation Program, rural reclassification policy; Physician Payments, Issues pertaining to alternative payment models, mental health of workforce, physician reimbursement cuts, Medicare Access & CHIP Reauthorization (MACRA) Reforms; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay and cost-based reimbursement for critical access hospitals under Medicare Advantage, Wasteful and Inappropriate Services Reduction (WISeR) model, transparency in plan denial signatures, inappropriate downcoding; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees, DSH cuts, oversight; Expiring Health Care Provisions, Issues pertaining to Telehealth, Hospital at Home, MDH/LVA, Medicaid DSH Program; Post Acute Care, Issues pertaining to expanding and protecting patients access to services provided by long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies; Rural Community Hospital Demonstration Project, Issues related to ending the Rural Community Hospital Demonstration Project.

Urged the Centers for Medicare & Medicaid Services (CMS) to promptly fill the vacant Chief Dental Officer (CDO) position and to ensure that this role remains housed within the Office of the Administrator. Maintaining a senior, agency-wide oral health leader is essential to sustaining CMSs progress with integrating dental care with medical care and supporting innovation that recognizes the connection between oral health and overall health. Urged Congress to address the Medicaid disproportionate share hospital (DSH) program reductions scheduled to begin on Oct. 1, 2025. The Medicaid DSH program supports hospitals that serve disproportionately high numbers of low-income and uninsured patients. These funds help alleviate both Medicaid underpayment and uncompensated care costs, ensuring patients have access to critical services in their community, including trauma care, burn units, maternal care, and high-risk neonatal care. (S.335) - The Rural Hospital Support Act - Expressed support for the Rural Hospital Support Act. This legislation would provide assistance to rural hospitals through the Medicare program, including making the Medicare-dependent Hospital Program permanent.

Client expense: $140,055 · Firm income: Not reported

Q1 Lobbying Report (Jan. 1-March 31) HCR FEMA re: COVID-19 related reimbursement Critical Access Hospital Relief Act (H.R. 538) Rural Hospital Support Act (S. 335) Expanding Medical Education Act (H.R. 2106) Preserving Emergency Access in Key Sites Act (H.R. 3778/S.1860) Improving Seniors Timely Access to Care Act (H.R. 3514/S.1816) Prompt and Fair Pay Act (H.R. 4559) Medicare Advantage Prompt Pay Act (H.R.5454) Apples to Apples Comparison Act of 2025 (H.R. 4093) Protect Our Hospitals Act (H.R. 4807) Resident Physician Shortage Reduction Act of 2025 (H.R. 4731/S.2439) H-1Bs for Physicians and the Healthcare Workforce Act (H.R. 7961) MMM Graduate Medical Education (GME) funding Telehealth flexibilities and payment Californias Medicaid Hospital Quality Assurance Fee Program Medicaid 340B Restoring Rural Health Act (S. 3047) Rural Hospital Fairness Act (H.R. 5821) Defend Rural Health Act of 2026 (H.R.7409) BUD FY 2025 budget FY 2026 appropriations One Big Beautiful Bill Act (H.R. 1)

Client expense: $500,000 · Firm income: Not reported

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

Medicare and Medicaid payment issues and alternative payment models; Health care workforce and H-1B visas; Health care pricing transparency; Site Neutral; 340B Program and Drug Pricing; MA prior authorization; Telehealth and digital health; Home health / Hospice; Rural health and Rural Hospital Support Act (S. 335); Lorna Breen Health Care Worker Safety Reauthorization Act (S. 266 / H.R. 929); Graduate medical education; Artificial intelligence; The Affordable Care Act; RESULTS Act (H.R.5269 / S.2761); Equitable Community Access to Pharmacist Services (ECAPS) Act (H.R. 3164 / S. 2426); 340B PATIENTS Act (H.R.4581 / S.2372); CONNECT for Health Act (H.R.4206 / S.1261)

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

Issues relating to Medicare reimbursement for rural referral centers (RRCs), sole community hospitals (SCHs) and Medicare dependent hospitals(MDHs), including the Rural Hospital Support Act (S.335) and the Assistance for Rural Community Hospitals Act (H.R.1805).

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

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

Q4 Lobbying Report (October 1-December 31) HCR FEMA re: COVID-19 related reimbursement Critical Access Hospital Relief Act (H.R. 538) Rural Hospital Support Act (S. 335) Expanding Medical Education Act (H.R. 2106) Preserving Emergency Access in Key Sites Act (H.R. 3778/S.1860) Improving Seniors Timely Access to Care Act (H.R. 3514/S.1816) Prompt and Fair Pay Act (H.R. 4559) Medicare Advantage Prompt Pay Act (H.R.5454) Apples to Apples Comparison Act of 2025 (H.R. 4093) Protect Our Hospitals Act (H.R. 4807) Resident Physician Shortage Reduction Act of 2025 (H.R. 4731/S.2439) MMM Graduate Medical Education (GME) funding Telehealth flexibilities and payment Californias Medicaid Hospital Quality Assurance Fee Program Medicaid 340B Restoring Rural Health Act (S. 3047) Rural Hospital Fairness Act (H.R. 5821) BUD FY 2025 budget FY 2026 appropriations One Big Beautiful Bill Act (H.R. 1)

Client expense: $520,000 · Firm income: Not reported

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

S. 2761 / H.R. 5269, the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act, all provisions; H.R. 5142, The Home Health Stabilization Act, all provisions; H.R. 4313 / S. 2237, Hospital Inpatient Services Modernization Act of 2025, all provisions; S. 1261 / H.R. 4206, CONNECT for Health Act of 2025, all provisions; H.R. 1805, Assistance for Rural Community Hospitals (ARCH) Act, all provisions; H.R. 2191, Physician Led and Rural Access to Quality Care Act, all provisions; S. 335, Rural Hospital Support Act, all provisions; S.1816 / H.R.3514, Improving Seniors Timely Access to Care Act, all provisions; S. 502, Rural Hospital Closure Relief Act, all provisions; S. 2439 / H.R. 4731, Resident Physician Shortage Reduction Act of 2025, all provisions; H.R. 4002, Patient Access to Higher Quality Health Care Act, all provisions; S.2011/ HR 3884, Telemental Health Care Access Act, all provisions; S. 2279, Protect Medicaid and Rural Hospitals Act, all provisions; H.R. 4619, Medicare Mental Health Inpatient Equity Act, all provisions; H.R. 5454/S. 2879, the Medicare Advantage Prompt Pay Act, all provisions; S. S. 2793, Ensuring Access to Essential Providers, all provisions; H.R. 6240, Rural Hospital Closure Relief Act of 2025, all provisions; DRAFT, Issues related to prior-authorization and employer-sponsored plans; HR 5467, Patient Access to Autoimmune Treatments Act, all provisions; H.R. 6148, Patients Over Paperwork Act, all provisions; Medicare Payment Advisory Commission (MedPAC), Letter to Medicare Payment Advisory Commission, Comments on the Medicare Payment Advisory Commissions (MedPACs) preliminary analysis of the association between Medicare Advantage (MA) enrollment changes and hospital finances; Centers for Medicare and Medicaid Services (CMS), Wasteful and Inappropriate Services Reduction (WISeR) model, Issues pertaining to the Wasteful and Inappropriate Services Reduction (WISeR) model; Centers for Medicare and Medicaid Services (CMS), Medicaid state-directed payments, Comments on implementation of changes to state directed payment provisions; Centers for Medicare and Medicaid Services (CMS), Provider Tax Preliminary Implementation Guidance, Comments pertaining to preliminary guidance on the implementation of sections 71115 and 71117 of H.R. 1 and impact on hospitals and health systems; Medicaid Program, Issues pertaining to Medicaid program and how states finance programs, reimburse providers, and determine beneficiary eligibility, and implementation of H.R. 1 provisions related to state directed payments and provider taxes; Site Neutral Payments, Issues related to site neutral payment cuts; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, REH's, implementation of Rural Health Transformation Program; Physician Payments, Issues pertaining to alternative payment models, mental health of workforce, physician reimbursement cuts for 2025; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay and cost-based reimbursement for critical access hospitals under Medicare Advantage, Wasteful and Inappropriate Services Reduction (WISeR) model; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees, DSH cuts; Expired Health Care Provisions, Issues pertaining to Telehealth, Hospital at Home, MDH/LVA, Medicaid DSH Program; Post Acute Care, Issues pertaining to expanding patients' access to crucial services provided by Long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies; Rural Community Hospital Demonstration Project, Issues related to ending the Rural Community Hospital Demonstration Project.

Urged the Centers for Medicare & Medicaid Services (CMS) to promptly fill the vacant Chief Dental Officer (CDO) position and to ensure that this role remains housed within the Office of the Administrator. Maintaining a senior, agency-wide oral health leader is essential to sustaining CMSs progress with integrating dental care with medical care and supporting innovation that recognizes the connection between oral health and overall health. Urged Congress to address the Medicaid disproportionate share hospital (DSH) program reductions scheduled to begin on Oct. 1, 2025. The Medicaid DSH program supports hospitals that serve disproportionately high numbers of low-income and uninsured patients. These funds help alleviate both Medicaid underpayment and uncompensated care costs, ensuring patients have access to critical services in their community, including trauma care, burn units, maternal care, and high-risk neonatal care. (S.335) - The Rural Hospital Support Act - Expressed support for the Rural Hospital Support Act. This legislation would provide assistance to rural hospitals through the Medicare program, including making the Medicare-dependent Hospital Program permanent.

Client expense: $152,536 · Firm income: Not reported

Medicare and Medicaid payment issues and alternative payment models; Health care workforce and H-1B visas; Health care pricing transparency; Site Neutral; 340B Program and Drug Pricing; MA prior authorization; Telehealth and digital health; Home health / Hospice; Rural health and Rural Hospital Support Act (S. 335); Lorna Breen Health Care Worker Safety Reauthorization Act (S. 266 / H.R. 929); Mobile stroke unit funding and Medicare reimbursement; Graduate medical education; Artificial intelligence; The Affordable Care Act; RESULTS Act (H.R.5269 / S.2761); Equitable Community Access to Pharmacist Services (ECAPS) Act (H.R. 3164 / S. 2426); 340B PATIENTS Act (H.R.4581 / S.2372); CONNECT for Health Act (H.R.4206 / S.1261)

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

Issues relating to Medicare reimbursement for rural referral centers (RRCs), sole community hospitals (SCHs) and Medicare dependent hospitals(MDHs), including the Rural Hospital Support Act (S.335) and the Assistance for Rural Community Hospitals Act (H.R.1805).

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

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

Q3 Lobbying Report (July 1-September 30) HCR FEMA re: COVID-19 related reimbursement Critical Access Hospital Relief Act (H.R. 538) Rural Hospital Support Act (S. 335) Expanding Medical Education Act (H.R. 2106) Preserving Emergency Access in Key Sites Act (H.R. 3778/S.1860) Improving Seniors Timely Access to Care Act (H.R. 3514/S.1816) Prompt and Fair Pay Act (H.R. 4559) Apples to Apples Comparison Act of 2025 (H.R. 4093) Protect Our Hospitals Act (H.R. 4807) Resident Physician Shortage Reduction Act of 2025 (H.R. 4731/S.2439) MMM Graduate Medical Education (GME) funding Telehealth flexibilities and payment Californias Medicaid Hospital Quality Assurance Fee Program Medicaid 340B BUD FY 2025 budget FY 2026 appropriations One Big Beautiful Bill Act (H.R. 1) Submitted Comments (regulatory comment letters) Preserving Medicaid Funding for Vulnerable Populations: Closing a Health Care-Related Tax Loophole Proposed Rule Calendar Year 2026 Home Health Prospective Payment System Rate Update; Requirements for the HH Quality Reporting Program and the HH Value-Based Purchasing Expanded Model; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Updates; DMEPOS Accreditation Requirements; Provider Enrollment; and Other Medicare and Medicaid Policies Proposed Rule 340B Rebate Model Pilot Program Notice CMS Hospital Price Transparency Accuracy and Completeness Request for Information Calendar Year 2026 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program Proposed Rule Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs; Overall Hospital Quality Star Ratings; and Hospital Price Transparency Proposed Rule

H.R. 1, The One Big Beautiful Bill Act (OBBBA)Title VII - Committee on Finance; Subtitle B - Health Care: Issues pertaining to Medicaid, Medicare, Health tax, and Protecting Rural Hospitals and Providers; S. Amdt. 2554 to S. Amdt. 2360 to H.R.1, Scott, Crapo, Johnson, Lee, Lummis Amendment, all provisions; H.R. 4313 / S. 2237, Hospital Inpatient Services Modernization Act of 2025, all provisions; S. 1261 / H.R. 4206, CONNECT for Health Act of 2025, all provisions; H.R. 1805, Assistance for Rural Community Hospitals (ARCH) Act, all provisions; H.R. 2191, Physician Led and Rural Access to Quality Care Act, all provisions; S. 335, Rural Hospital Support Act, all provisions; S.1816 / H.R.3514, Improving Seniors Timely Access to Care Act, all provisions; S. 502, Rural Hospital Closure Relief Act, all provisions; S. 2439 / H.R. 4731, Resident Physician Shortage Reduction Act of 2025, all provisions; H.R. 4002, Patient Access to Higher Quality Health Care Act, all provisions; S.2011/ HR 3884, Telemental Health Care Access Act, all provisions; S. 2279, Protect Medicaid and Rural Hospitals Act, all provisions; H.R. 4619, Medicare Mental Health Inpatient Equity Act, all provisions; H.R. 786/ S. 1460, Preserving Patient Access to Accountable Care Act, all provisions; H.R. 5120, Hospitals As Naloxone Distribution Sites (HANDS) Act, all provisions; H.R. 5454/S. 2879, The Medicare Advantage Prompt Pay Act, all provisions; S. S. 2793, Ensuring Access to Essential Providers, all provisions; H.R. 4470, The Removing Burdens from Organ Donations Act, all provisions; DRAFT, Issues pertaining to compounding of drugs; DRAFT, Legislation to provide relief for Long-Term Care Hospitals (LTCHs); DRAFT, Comments pertaining to legislative relief for independent rural hospitals; H.R.5081, Telehealth Modernization Act, all provisions; Centers for Medicare & Medicaid Services (CMS), RFI: Hospital Price Transparency Accuracy and Completeness Request for Information, Issues pertaining to the accuracy and completeness of hospitals machine-readable files; Centers for Medicare & Medicaid Services (CMS), Rural Health Transformation Fund implementation/revisions, Comments on the Rural Health Transformation Program application and award process; Centers for Medicare & Medicaid Services (CMS), Outpatient Prospective Payment System (OPPS) Proposed rule for Calendar Year (CY2026), Issues pertaining to outpatient and ambulatory surgery center prospective payment system, conditions of participation for maternal health; Centers for Medicare & Medicaid Services (CMS), "Calendar Year (CY) 2026 Home Health Prospective; Payment System (HH PPS) Rate Update", Issues pertaining to the CY26 Home Health Proposed Rule; Centers for Medicare & Medicaid Services (CMS), Physician fee schedule (PFS) proposed rule for calendar year (CY) 2026, Issues pertaining to physician fee schedule; Department of Health & Human Services (HHS) and Centers for Medicare & Medicaid Services, Health Insurer Commitment Prior Auth Process, Issues pertaining to insurer commitment to improved prior authorization processes; Medicaid Program, Issues pertaining to Medicaid program and how states finance programs, reimburse providers, and determine beneficiary eligibility; Site Neutral Payments, Issues related to site neutral payment cuts; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, REH's, implementation of Rural Health Transformation Program; Physician Payments, Issues pertaining to alternative payment models, mental health of workforce, physician reimbursement cuts for 2025; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay and cost-based reimbursement for critical access hospitals under Medicare Advantage; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees, DSH cuts; Expiring Health Care Provisions, Issues pertaining to Telehealth, Hospital at Home, MDH/LVA, Medicaid DSH Program; Rural Health Transformation Fund, Issues pertaining to implementation and impact on rural hospitals.

Urged Congress to address the Medicaid disproportionate share hospital (DSH) program reductions scheduled to begin on Oct. 1, 2025. The Medicaid DSH program supports hospitals that serve disproportionately high numbers of low-income and uninsured patients. These funds help alleviate both Medicaid underpayment and uncompensated care costs, ensuring patients have access to critical services in their community, including trauma care, burn units, maternal care, and high-risk neonatal care. House and Senate Budget Reconciliation (H.R.1) - Urged Congress to protect the Medicaid program and other safety net programs, from devasting cuts and program changes, extent the tax credits under the Affordable Care Act, support technologies and programs assisting rural providers and their communities, revisit the minimum staff requirement for long-term care facilities, and protect the role and tax-exempt status of non-profit health care. (S.335) - The Rural Hospital Support Act - Expressed support for the Rural Hospital Support Act. This legislation would provide assistance to rural hospitals through the Medicare program, including making the Medicare-dependent Hospital Program permanent.

Client expense: $146,466 · Firm income: Not reported

Medicare and Medicaid payment issues; Health care workforce; Health care pricing transparency; Site Neutral; 340B Drug Pricing; MA prior authorization; Telehealth and digital health; Home health / Hospice; Rural health and Rural Hospital Support Act (S. 335); Lorna Breen Health Care Worker Safety Reauthorization Act (S. 266 / H.R. 929); Mobile stroke unit funding and Medicare reimbursement; H.R.1., Budget Reconciliation; Graduate medical education; FEMA hospital funding and workforce; Nonprofit tax policy

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

Issues relating to Medicare reimbursement for rural referral centers (RRCs), sole community hospitals (SCHs) and Medicare dependent hospitals(MDHs), including the Rural Hospital Support Act (S.335) and the Assistance for Rural Community Hospitals Act (H.R.1805).

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

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

S.1834Supporting Healthy Moms and Babies Act , all provisions; S. 1261 / H.R. 4206, CONNECT for Health Act of 2025, all provisions; DRAFT, Hospital Inpatient Services Modernization Act of 2025, all provisions; H.R. 2191, Physician Led and Rural Access to Quality Care Act, all provisions; S. 335, Rural Hospital Support Act, all provisions; H.R. 1683, Protecting America's Seniors Access to Care Act, all provisions; H.R. 1805, Assistance for Rural Community Hospitals (ARCH) Act, all provisions; H.R. 1924, Securing Access to Care for Seniors in Critical Condition Act of 2025, all provisions; S.1816 / H.R.3514, Improving Seniors Timely Access to Care Act, all provisions; S. 502, Rural Hospital Closure Relief Act, all provisions; DRAFT Bill, Resident Physician Shortage Reduction Act, all provisions; Draft Bill, Issues pertaining to proposed changes to the Medicare Graduate Medical Education program and solutions to address workforce shortages in rural areas; H.R. 771, Rural Health Care Access Act of 2025, all provisions; Draft Bill, Clarifying that Rural Emergency Hospitals are eligible for Medicaid hospital reimbursement; S. Amdt. 2554 to S. Amdt. 2360 to H.R.1, Scott, Crapo, Johnson, Lee, Lummis Amendment, all provisions; H.R. 538, Critical Access Hospital Relief Act of 2025, all provisions; H.R.2232, Protecting Access to Ground Ambulance; Medical Services Act of 2025, all provisions; H.R. 2191/ S. 1390, the Physician Led and Rural Access to Quality Care Act, all provisions; H.R. 1, The One Big Beautiful Bill Act (OBBBA), Title VII - Committee on Finance; Subtitle B - Health Care: Issues pertaining to Medicaid, Medicare, Health tax, and Protecting Rural Hospitals and Providers; Medicare Payment Advisory Commission (MedPAC), Comments on physician fee schedule payments; Centers for Medicare & Medicaid Services, Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability, Inappropriate enrollment in the Health Insurance Marketplace and provider impact; Centers for Medicare & Medicaid Services, Request for Information: Deregulation, Comments on how to eliminate burdensome and wasteful administrative requirements for hospitals and health systems; Centers for Medicare & Medicaid Services, Request for Information; Health Technology Ecosystem, Comments on ways to reduce barriers for data interoperability and fostering innovation for better health outcomes; Centers for Medicare & Medicaid Services, LTCH Fy26 Proposed Payment Rule, Issues pertaining to the Long-Term Care Hospitals prospective payment system proposed rule; Centers for Medicare & Medicaid Services, SNF FY26 Proposed Payment Rule, Issues pertaining to the skilled nursing facilities prospective payment system proposed rule; Centers for Medicare & Medicaid Services, IRF FY26 Proposed Payment Rule, Issues pertaining to the inpatient rehabilitation facilities prospective payment system proposed rule; Centers for Medicare & Medicaid Services, IPPS Fy26 Proposed Payment Rule, Issues pertaining to the inpatient prospective payment system proposed rule; Centers for Medicare & Medicaid Services, IPF FY26 Propose Payment Rule, Issues pertaining to the inpatient psychiatric facilities prospective payment system proposed rule; Centers for Medicare & Medicaid Services, TEAM Payment Model in FY26 IPPS rule, Issues pertaining to the TEAM payment model included within the inpatient prospective payment system proposed rule; Medicaid Program, Issues pertaining to Medicaid program and how states finance programs, reimburse providers, and determine beneficiary eligibility; Site Neutral Payments, Issues related to site neutral payment cuts; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, REH's; Physician Payments, Issues pertaining to alternative payment models, mental health of workforce, physician reimbursement cuts for 2025; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay and cost-based reimbursement for critical access hospitals under Medicare Advantage; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees, DSH cuts.

House and Senate Budget Resolution & Reconciliation - Urged Congress to protect the Medicaid program and other safety net programs, from devasting cuts and program changes, extent the tax credits under the Affordable Care Act, support technologies and programs assisting rural providers and their communities, revisit the minimum staff requirement for long-term care facilities, and protect the role and tax-exempt status of non-profit health care. (S.335) - The Rural Hospital Support Act - Expressed support for the Rural Hospital Support Act. This legislation would provide assistance to rural hospitals through the Medicare program, including making the Medicare-dependent Hospital Program permanent.

Client expense: $247,742 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, President of the U.S., SENATE

Medicare and Medicaid payment issues; Health care workforce; Health care pricing transparency; Site Neutral; 340B Drug Pricing; MA prior authorization; Medicare hospital wage index; Telehealth and digital health; Home health / Hospice; Rural health; Lorna Breen Health Care Worker Safety Reauthorization Act (S. 266 / H.R. 929); Mobile stroke unit funding and Medicare reimbursement; Rural Hospital Support Act (S. 335); Medicare physician reimbursement; H.R.1., Budget Reconciliation; Graduate medical education; FEMA hospital funding

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

Q2 Lobbying Report (April 1-June 30) HCR FEMA re: COVID-19 related reimbursement Critical Access Hospital Relief Act (H.R. 538) Rural Hospital Support Act (S. 335) Expanding Medical Education Act (H.R. 2106) Preserving Emergency Access in Key Sites Act (H.R. 3778/S.1860) Improving Seniors Timely Access to Care Act (H.R. 3514/S.1816) MMM Graduate Medical Education (GME) funding Telehealth flexibilities and payment Californias Medicaid Hospital Quality Assurance Fee Program Medicaid 340B BUD FY 2025 budget FY 2026 appropriations One Big Beautiful Bill Act (H.R. 1) Submitted Comments Regulatory Comment Letters Agency Information Collection Activities: Submission for OMB Review; Comment Request; CMS-10905, Service Level Data Collection for Initial Determinations and Appeals, Paperwork Reduction Act (PRA) Listing Request for Information: Unleashing Prosperity Through Deregulation of the Medicare Program (Executive Order 14192) Proposed Rule; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates Proposed Rule; Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability

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

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

Medicare and Medicaid payment issues; Health care workforce; Health care pricing transparency; Site Neutral; 340B Drug Pricing; MA prior authorization; Medicare hospital wage index; Telehealth and digital health; Home health / Hospice; Rural health; Lorna Breen Health Care Worker Safety Reauthorization Act (S. 266 / H.R. 929); Mobile stroke unit funding and Medicare reimbursement; Rural Hospital Support Act (S. 335); Medicare physician reimbursement; H.R.1., Budget Reconciliation; Graduate medical education

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

Issues relating to Medicare reimbursement for rural referral centers (RRCs), sole community hospitals (SCHs) and Medicare dependent hospitals(MDHs), including the Rural Hospital Support Act (S.335) and the Assistance for Rural Community Hospitals Act (H.R.1805).

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

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

S. 1261, CONNECT for Health Act, All provisions; H.R. 2191, To amend title XVII of the Social Security Act to revise certain physician self-referral exemptions relating to physician-owned hospitals, All provisions; DRAFT Bill, Hospital Inpatient Services Modernization Act of 2025, all provisions; S. 335, Rural Hospital Support Act, all provisions; H.R. 1683, Protecting America's Seniors Access to Care Act, All provisions; DRAFT Bill, Clarifying that Rural Emergency Hospitals are eligible for Medicaid hospital reimbursement; Draft Bill, Issues pertaining to proposed changes to the Medicare Graduate Medical Education program and solutions to address workforce shortages in rural areas; DRAFT Bill, Resident Physician Shortage Reduction Act, All provisions; H.R. 1805, Assistance for Rural Community Hospitals (ARCH) Act, All provisions; H.R. 1924, Securing Access to Care for Seniors in Critical Condition Act of 2025, All provisions; H.R. 771, Rural Health Care Access Act of 2025, All provisions; DRAFT Bill, Supporting Healthy Moms and Babies Act, All provisions; S. 502, Rural Hospital Closure Relief Act of 2025, All provisions; Centers for Medicare & Medicaid Services (CMS), 2026 Medicare Advantage and Part D CY 2026 proposed rule, Insights on proposed policies that would increase oversight of Medicare Advantage plans and better align coverage and access under MA with Traditional Medicare; Medicare Payment Advisory Commission (MedPAC) January meeting, Inpatient and outpatient prospective payment systems (PPS), inpatient rehabilitation facilities (IRFs), hospital-based skilled nursing facilities (SNFs), and home health (HH) agencies, and physician reimbursement; Medicare Payment Advisory Commission (MedPAC), Medicare beneficiary cost-sharing in rural facilities; Site Neutral Payments, Issues related to site neutral payment cuts; Provider Reimbursements, Issues related to provider reimbursement, site neutral payment cuts, Medicare/Medicaid program funding, facility fees, DSH cuts; Expiring Health Care Provisions, Issues pertaining to Telehealth, Hospital at Home, MDH/LVA, Medicaid DSH Program; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay and cost-based reimbursement for critical access hospitals under Medicare Advantage; Physician Payments, Issues pertaining to alternative payment models, mental health of workforce, physician reimbursement cuts for 2025; Rural Hospitals, Issues pertaining to the sustainability of MDHS, CAHs, SCHs, REH's; Medicaid Program, Issues pertaining to Medicaid program.

Q1 Lobbying Report (Jan. 1-March 31) HCR FEMA re: COVID-19 related reimbursement Critical Access Hospital Relief Act (H.R. 538) Rural Hospital Support Act (S. 335) Expanding Medical Education Act (H.R. 2106) MMM Graduate Medical Education (GME) funding Telehealth flexibilities and payment Californias Medicaid Hospital Quality Assurance Fee Program Medicaid 340B BUD FY 2025 budget FY 2026 appropriations Submitted Comments Regulatory Comment Letters Proposed Rule; Medicare and Medicaid Programs: Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly Proposed Rule; Health Insurance Portability and Accountability Act Security Rule to Strengthen the Cybersecurity of Electronic Protected Health Information Proposed Rule; Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability

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

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

House and Senate Budget Resolution & Reconciliation" urged Congress to protect the Medicaid program from devasting cuts and program changes and other safety net programs, the extension of the premium tax credits under the Affordable Care Act, support for technologies and programs assisting rural providers and their communities, revisiting the minimum staff requirement for long-term care facilities, and protecting the role and tax-exempt status of non-profit health care. Urged Congress and administration officials to address the ministry's advocacy priorities around protecting safety net programs, ensuring coverage for all, improving the health of communities, and strengthening aging and chronic care services. (S.335) - The Rural Hospital Support Act - Expressed support for the Rural Hospital Support Act. This legislation would provide assistance to rural hospitals through the Medicare program, including making the Medicare-dependent Hospital Program permanent.

Client expense: $176,345 · Firm income: Not reported

Medicare and Medicaid payment issues; Health care workforce; Health care pricing transparency; Site Neutral; 340B Drug Pricing; MA prior authorization; Medicare hospital wage index; Telehealth and digital health; Home health / Hospice; Rural health; Lorna Breen Health Care Worker Safety Reauthorization Act (S. 266 / H.R. 929); Mobile stroke unit funding; Rural Hospital Support Act (S. 335); Medicare physician reimbursement

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

Issues relating to Medicare reimbursement for rural referral centers (RRCs), sole community hospitals (SCHs) and Medicare dependent hospitals(MDHs), including the Rural Hospital Support Act (S.335) and the Assistance for Rural Community Hospitals Act (H.R.1805).

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

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