A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting".

Meetings, Letters, and Briefings in House and Senate on CMS Nursing Home Staffing Rule, and sharing SEIU strong Opposition to HR 5796, H.R. 7513, S. 3410, H.J. Res. 139 and S.J. Res. 91 that would prohibit the rule. Sent letter and held meetings with several House and Senate individual officers and Committee Staff of House Energy and Commerce, House Ways and Means and Senate Finance in Opposition to HR 6860/S.5018, the Restore Protections for Dialysis Patients Act (RPDPA).

Client expense: $220,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

MMM [House, Senate, HHS, CMS, FDA, Administration on Aging, EOP, DOC] Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2023 (H.R. 5138 and S. 4137): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Medicare Drug Prices (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act; to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer; to block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. Medicare Drug Costs. The Pharmaceutical Research Transparency Act of 2023 (S. 1476 and H.R. 3160): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Medicare Drug Savings. The Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 2893): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. (No bills): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and to raise the income threshold for the Low-Income Subsidy program offering assistance in paying for drugs. Medicare Prescription Drugs. The Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2023 (H.R. 3093): Proposals to require companies that receive federal funding for research (or a license of the rights to a patent or regulatory test data) for a biomedical product or service to agree to set reasonable prices for the resulting biomedical product or service and authorize to determine a reasonable price based on a formula that ensures the U.S. price for the product or service is not more than the median price for the product or service in Canada and six other reference countries. Medicare Prescription Drugs. (No bill): A regulatory proposal encouraging the Secretaries of the Departments of Health and Human Services (HHS) and Commerce to exercise march in rights that would aim to better control the pricing of prescription drugs. Medicare Prescription Drugs. (No bill): An HHS regulatory proposal to ensure robust negotiation rules and processes that aim to curtail the cost of certain prescription drugs, as authorized by the Inflation Reduction Act (Public Law No: 117-169). Medicare and Medicaid Prescription Drugs. (No bill): Joined comments with 19 other organizations urging HHS to use its existing authority to license competition in order to lower consumer and taxpayer costs for semaglutide drugs treating diabetes and weight management (e.g., Ozempic and Wegovy). Medicare Prescription Drugs. The PACE Part D Choice Act (H.R. 3549 and S. 1703): Proposal to increase the affordability of the Program of All-Inclusive Care for the Elderly (PACE) for Medicare beneficiaries by lowering the cost of Part D premiums substantially for Medicare-only enrollees, thus opening up the PACE program to this population. Medicare Low-Income Subsidy (LIS) Program. (No bill): Proposal to increase funding for LIS outreach and enrollment, so that low-income beneficiaries can more readily access needed medications at prices they can afford. Medicare Reform. The Assuring Medicares Promise Act (H.R. 34) and The Medicare and Social Security Fair Share Act (S. 1174 and H.R. 4535): Proposals to close the loophole for wealthy individuals who bypass paying net investment income tax (NIIT) and directing the revenue to the Hospital Insurance Trust Fund, which pays for Medicare Part A that covers inpatient care in hospitals, and to the Social Security Trust Funds. Medicare Trustees Report (No bill). Review of the findings on economic, legislative and other developments affecting the actuarial soundness of the Medicare Part A (Hospital Insurance) Trust Fund and the Trust Funds for Parts B and D coverage. Medicare Dental Coverage. The Medicare Dental Benefit Act (S. 2012 and H.R. 4146): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Help Extend Auditory Relief Act of 2024 (H.R. 8064): Proposal to expand Medicare coverage to include hearing examinations and diagnoses, fittings and hearing aids. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with the Department of Health and Humans Services/Center for Medicare and Medicaid Services) HHS/CMS. Public Health Emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage (MA). (No bill): Proposals to create transparency around Medicare Advantage plans using prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Advantage. (No bill): Proposals to apply a higher coding adjustment factor to fully account for intensive upcoding by MA plans and to exclude certain information for MA risk adjustment scores and payments; to use two years of traditional Medicare and MA diagnostic data for calculating MA risk-adjusted payments; and to promulgate more fundamental changes to the Hierarchical Condition Category (HCC) risk adjustment model. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid Home and Community-Based Services. The HCBS Access Act (H.R. 1493 and S. 762): Proposals to make home and community-based services (HCBS) a mandatory benefit within Medicaid, and to ensure eligible older adults and people with disabilities have the option to choose between home care and institutional care. Caregiving. The Alleviating Barriers to Caregiving Act (H.R. 8018 and S. 3109): Proposal to require the Secretaries of HHS and SSA to review and streamline enrollment in coverage and benefits for family caregivers in Medicare, Medicaid, CHIP and Social Security. Medicare and Medicaid Nursing Homes. The Nursing Home Disclosure Act (H.R. 177): Proposal to direct HHS to establish a national registry of medical directors. Medicare, Medicaid Nursing Homes. The Protecting Americas Seniors Access to Care Act (H.R. 7513 and S. 3410): Proposal to prohibit the HHS Secretary from promulgating national staffing standards in nursing homes. Medicare, Medicaid Nursing Homes. (H.J. Res. 139 and S.J. Res. 91): Proposal to use the Congressional Review Act to disapprove the HHS Secretarys final rule promulgating national staffing standards in nursing homes Medicare, Medicaid Nursing Homes. The Building Americas Health Care Workforce Act (H.R. 9067): Proposal to allow time spent working in a nursing home (prior to any formal training, and permitted during the COVID-19 pandemic) to count toward a 75-hour minimum federal training standard that is required for certified nursing assistants. Medicare, Medicaid Nursing Homes. The Ensuring Seniors Access to Quality Care Act (H.R. 3227): Proposal to repeal regulations that prohibit certified nursing assistant training and competency evaluation programs in skilled nursing facilities that have a record of health and safety deficiencies and have incurred penalties (e.g., civil monetary penalties for substandard quality of care). Medicare, Medicaid Nursing Homes, Assisted Living and Other Long Term Care Services and Supports (LTSS) Settings. The Long-Term Care Workforce Support Act (H.R. 7994 and S. 4120): Proposals to increase the number of direct care professionals, including in rural communities; pathways to enter and be supported in the workforce for women, people of color, and people with disabilities; and to improve compensation for direct care professionals to reduce vacancies and turnover. Medicare and Medicaid Nursing Home Ownership. (No bill): A final HHS regulation for comprehensive ownership disclosure in the nursing home sector issued on November 17th, 2023. Rule calls for strengthened cost reporting requirements, together with ongoing national analyses and monitoring of the performance of the nursing home sector that uses ownership, staffing, cost report data and inspection data. Medicare and Medicaid Nursing Home Staffing. (No bill): Final regulations establishing national staffing standards in nursing homes that would safeguard the health and safety of all elderly and disabled residents. Medicaid Long-Term Services and Supports (LTSS). (No bill): Proposals to request that CMS collect standardized LTSS expenditure data annually from every state and across all LTSS programs and for disaggregation of expenditure data by the delivery system and demographic characteristics in order to identify disparities in access and use of LTSS and help states and CMS deploy targeted strategies to meet the needs of older adults and people with disabilities. Oversight of Health Care Industry Owned by Private Equity Firms. (No bill): Joined with other organizations in submitting comments (April 2024) to HHS, the Federal Trade Commission and the Department of Justice urging sustained, stepped up and rigorous oversight be extended to health care industry transactions that are financed by private equity company companies and other types of private investors. Medicaid Eligibility and Beneficiary Assets. Medicaid Estate Recovery Act (H.R. 7573): Proposals to provide financial protection to the families of Medicaid beneficiaries, including ending Medicaid estate claims and Medicaid liens, except in cases when benefits had been incorrectly paid, as determined by a court.

Extension of COVID-19 public health emergency waivers Nurse staffing shortages Removing barriers to care (H.R.2713/S.2418) I CAN Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act (S.3860/H.R.7546) Nurse Overtime and Patient Safety Act (H.R.2530 / S.1113) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Issues surrounding Medicare Part B reform Issues surrounding CMS Long Term Care staffing final rule (H.J. Res. 139) Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S.J. Res. 91) A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S. 2016/H.R. 4189) CONNECT for Health Act (H.R.2583/S.3481) Increasing Access to Quality Cardiac Rehabilitation Care Act H.R.3227 - Ensuring Seniors Access to Quality Care Act H.R.468 - Building Americas Health Care Workforce Act (S.5236) Keeping Obstetrics Local Act S.4338 - Pay PCPs Act of 2024 Issues surrounding Medicare reimbursement Issues surrounding surgical smoke (H.R. 8702/S. 4532) Improving Seniors Timely Access to Care Act of 2024 (H.R.10445) Further Continuing Appropriations and Disaster Relief Supplemental Appropriations Act, 2025 (H.R.10545) American Relief Act, 2025 (H.R.10515) American Relief Act, 2025

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

-HR 5378 - Lower Costs More Transparency Act, Provisions related to pharmacy benefit manager and health plan transparency -HR 7513 - Protecting America's Seniors' Access to Care Act -HR 485 - Protecting Health Care for All Patients Act -HR 468 - Building America's Health Care Workforce Act -HR 3227 - Ensuring Seniors' Access to Quality Care Act -S 4381 - The Right to Contraception Act -HR 4367/S 2625 - FAMILY Act -HJ Res. 139/SJ Res. 91 - Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting" -HR 8114 - o prohibit the Secretary of Health and Human Services from finalizing a rule proposed by the Centers for Medicare & Medicaid Services to place certain limitations on Medicaid payments for home or community-based services -HR 4818 - Treat and Reduce Obesity Act (Provisions related to Medicare coverage of anti-obesity medications and intensive behavioral therapy)

Client expense: $560,000 · Firm income: Not reported

S. 3109/H.R. 8018, the Alleviating Barriers for Caregivers Act. S. 3766/H.R. 7274, the Connecting Caregivers to Medicare Act. No bill number. Discussed funding for SHIP low-income outreach and enrollment programs. No bill number. Discussed Medicare Advantage and health savings accounts. H.R.7623/S.3697, the Telehealth Modernization Act. S. 5070/H.R. 8107, the Ensuring Access to Medicaid Buy-In Programs Act. No bill number. Discussed Medicare Physician Fee Schedule for calendar year 2025. No bill number. Discussed Medicare Hospital Outpatient Prospective Payment System for calendar year 2025. No bill number. Discussed Fiscal Year 2025 Home Health Prospective Payment System Rate Update. No bill number. Discussed Medicare open enrollment. H.R. 8702/S.4532, the Improving Seniors Timely Access to Care Act of 2024. H.R. 8331/S. 4280, the Essential Caregivers Act. H.J.Res.139, Providing for Congressional disapproval of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. S.J.Res.91, A joint resolution providing for Congressional disapproval of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting" H.R. 8244, the Ensuring Seniors Access to Quality Care Act. S.1749/H.R. 3227, the Ensuring Seniors Access to Quality Care Act. S.3410/H.R. 7513, the Protecting Americas Seniors Access to Care Act. H.R. 468, the Building Americas Health Care Workforce Act. H.R. 9067, the Building Americas Health Care Workforce Act. S. 5023, the Stand Strong Falls Prevention Act. S.1190, the Direct Support Worker Training Reimbursement Act of 2023. S.1196, the Mollie Baldwin Upskilling of Personal and Home Care Aides Act of 2023. S.1192, the CADSAW Act of 2023. No bill number. Discussed Medicaid home and community-based services and presumptive eligibility and self-directed services. No bill number. Discussed Caregiver Training Services. No bill number. Discussed GUIDE Model. No bill number. Discussed Medicare, Medicaid, and family caregivers. No bill number. Discussed Medicaid access final rule. H.R. 8108, the Care for Military Kids Act. H. R. 8106, to increase transparency and expand coverage options for home and community-based services under a Medicaid waiver. No bill number. Discussed long-term care. H.R. 9803, the Hospice Care Act.

Extension of COVID-19 public health emergency waivers Nurse staffing shortages Removing barriers to care (H.R.2713/S.2418) I CAN Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act (S.3860/H.R.7546) Nurse Overtime and Patient Safety Act (H.R.2530 / S.1113) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Issues surrounding Medicare Part B reform Issues surrounding CMS Long Term Care staffing final rule (H.J. Res. 139) Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S.J. Res. 91) A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S. 2016/H.R. 4189) CONNECT for Health Act (H.R.2583/S.3481) Increasing Access to Quality Cardiac Rehabilitation Care Act H.R.3227 - Ensuring Seniors Access to Quality Care Act H.R.468 - Building Americas Health Care Workforce Act (S.5236) Keeping Obstetrics Local Act S.4338 - Pay PCPs Act of 2024

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

S 4724, HR 9101- 9/11 Responder and Survivor Health Funding Correction Act of 2024 HR 5378- Lower Costs, More Transparency Act HR 4895- Lowering Drug Costs for American Families HR 5796- Protecting Rural Seniors Access to Care Act HR 7513- Protecting America's Seniors Access to Care Act HR 485- Protecting Health Care for All Patients Act S 3679- Lorna Breen Health Care Provider Protection Reauthorization Act HJ Res 139, SJ Res 91- CRA to rescind nursing home staffing rule HR 468, HR 9067- Building America's Health Care Workforce Act HR 3227- Ensuring Seniors' Access to Quality Care Act HJ Res 181- CRA to rescind the Association Health Plan Rule S 4671- Capping Prescription Costs Act S 4804, HR 9156- Health Over Wealth Act

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2023 (H.R. 5138 and S. 4137): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Medicare Drug Prices (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act; to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer; to block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. Medicare Drug Costs. The Pharmaceutical Research Transparency Act of 2023 (S. 1476 and H.R. 3160): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Medicare Drug Savings. The Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 2893): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. (No bills): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and to raise the income threshold for the Low-Income Subsidy program offering assistance in paying for drugs. Medicare Prescription Drugs. The Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2023 (H.R. 3093): Proposals to require companies that receive federal funding for research (or a license of the rights to a patent or regulatory test data) for a biomedical product or service to agree to set reasonable prices for the resulting biomedical product or service and authorize to determine a reasonable price based on a formula that ensures the U.S. price for the product or service is not more than the median price for the product or service in Canada and six other reference countries. Medicare Prescription Drugs. (No bill): A regulatory proposal encouraging the Secretaries of the Departments of Health and Human Services (HHS) and Commerce to exercise march in rights that would aim to better control the pricing of prescription drugs. Medicare Prescription Drugs. (No bill): An HHS regulatory proposal to ensure robust negotiation rules and processes that aim to curtail the cost of certain prescription drugs, as authorized by the Inflation Reduction Act (Public Law No: 117-169). Medicare and Medicaid Prescription Drugs. (No bill): Joined comments with 19 other organizations urging HHS to use its existing authority to license competition in order to lower consumer and taxpayer costs for semaglutide drugs treating diabetes and weight management (e.g., Ozempic and Wegovy). Medicare Prescription Drugs. The PACE Part D Choice Act (H.R. 3549 and S. 1703): Proposal to increase the affordability of the Program of All-Inclusive Care for the Elderly (PACE) for Medicare beneficiaries by lowering the cost of Part D premiums substantially for Medicare-only enrollees, thus opening up the PACE program to this population. Medicare Low-Income Subsidy (LIS) Program. (No bill): Proposal to increase funding for LIS outreach and enrollment, so that low-income beneficiaries can more readily access needed medications at prices they can afford. Medicare Reform. The Assuring Medicares Promise Act (H.R. 34) and The Medicare and Social Security Fair Share Act (S. 1174 and H.R. 4535): Proposals to close the loophole for wealthy individuals who bypass paying net investment income tax (NIIT) and directing the revenue to the Hospital Insurance Trust Fund, which pays for Medicare Part A that covers inpatient care in hospitals, and to the Social Security Trust Funds. Medicare Trustees Report (No bill). Review of the findings on economic, legislative and other developments affecting the actuarial soundness of the Medicare Part A (Hospital Insurance) Trust Fund and the Trust Funds for Parts B and D coverage. Medicare Dental Coverage. The Medicare Dental Benefit Act (S. 2012 and H.R. 4146): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Help Extend Auditory Relief Act of 2024 (H.R. 8064): Proposal to expand Medicare coverage to include hearing examinations and diagnoses, fittings and hearing aids. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with the Department of Health and Humans Services/Center for Medicare and Medicaid Services) HHS/CMS. Public Health Emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage (MA). (No bill): Proposals to create transparency around Medicare Advantage plans using prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Advantage. (No bill): Proposals to apply a higher coding adjustment factor to fully account for intensive upcoding by MA plans and to exclude certain information for MA risk adjustment scores and payments; to use two years of traditional Medicare and MA diagnostic data for calculating MA risk-adjusted payments; and to promulgate more fundamental changes to the Hierarchical Condition Category (HCC) risk adjustment model. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid Home and Community-Based Services. The HCBS Access Act (H.R. 1493 and S. 762): Proposals to make home and community-based services (HCBS) a mandatory benefit within Medicaid, and to ensure eligible older adults and people with disabilities have the option to choose between home care and institutional care. Caregiving. The Alleviating Barriers to Caregiving Act (H.R. 8018 and S. 3109): Proposal to require the Secretaries of HHS and SSA to review and streamline enrollment in coverage and benefits for family caregivers in Medicare, Medicaid, CHIP and Social Security. Medicare and Medicaid Nursing Homes. The Nursing Home Disclosure Act (H.R. 177): Proposal to direct HHS to establish a national registry of medical directors. Medicare, Medicaid Nursing Homes. The Protecting Americas Seniors Access to Care Act (H.R. 7513 and S. 3410): Proposal to prohibit the HHS Secretary from promulgating national staffing standards in nursing homes. Medicare, Medicaid Nursing Homes. (H.J. Res. 139 and S.J. Res. 91): Proposal to use the Congressional Review Act to disapprove the HHS Secretarys final rule promulgating national staffing standards in nursing homes Medicare, Medicaid Nursing Homes. The Building Americas Health Care Workforce Act (H.R. 9067): Proposal to allow time spent working in a nursing home (prior to any formal training, and permitted during the COVID-19 pandemic) to count toward a 75-hour minimum federal training standard that is required for certified nursing assistants. Medicare, Medicaid Nursing Homes. The Ensuring Seniors Access to Quality Care Act (H.R. 3227): Proposal to repeal regulations that prohibit certified nursing assistant training and competency evaluation programs in skilled nursing facilities that have a record of health and safety deficiencies and have incurred penalties (e.g., civil monetary penalties for substandard quality of care). Medicare, Medicaid Nursing Homes, Assisted Living and Other Long Term Care Services and Supports (LTSS) Settings. The Long-Term Care Workforce Support Act (H.R. 7994 and S. 4120): Proposals to increase the number of direct care professionals, including in rural communities; pathways to enter and be supported in the workforce for women, people of color, and people with disabilities; and to improve compensation for direct care professionals to reduce vacancies and turnover. Medicare and Medicaid Nursing Home Ownership. (No bill): A final HHS regulation for comprehensive ownership disclosure in the nursing home sector issued on November 17th, 2023. Rule calls for strengthened cost reporting requirements, together with ongoing national analyses and monitoring of the performance of the nursing home sector that uses ownership, staffing, cost report data and inspection data. Medicare and Medicaid Nursing Home Staffing. (No bill): Final regulations establishing national staffing standards in nursing homes that would safeguard the health and safety of all elderly and disabled residents. Medicaid Long-Term Services and Supports (LTSS). (No bill): Proposals to request that CMS collect standardized LTSS expenditure data annually from every state and across all LTSS programs and for disaggregation of expenditure data by the delivery system and demographic characteristics in order to identify disparities in access and use of LTSS and help states and CMS deploy targeted strategies to meet the needs of older adults and people with disabilities. Oversight of Health Care Industry Owned by Private Equity Firms. (No bill): Joined with other organizations in submitting comments (April 2024) to HHS, the Federal Trade Commission and the Department of Justice urging sustained, stepped up and rigorous oversight be extended to health care industry transactions that are financed by private equity company companies and other types of private investors.

CMS Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities H.J. RES. 139 and S.J. RES 91 providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to :Medicare and Medicaid Programs; Minimum Staffing 'Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting.

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

Government targets: HOUSE OF REPRESENTATIVES, Occupational Safety & Health Administration (OSHA), SENATE

Meetings, Letters, Press Conference and Briefings in House and Senate on CMS Nursing Home Staffing Rule, and sharing SEIU strong Opposition to HR 5796, H.R. 7513, S. 3410, H.J. Res. 139 and S.J. Res. 91 that would prohibit the rule. Sent letter and held meetings with several House and Senate individual officers and Committee Staff of House Energy and Commerce, House Ways and Means and Senate Finance in Opposition to HR 6860/S.5018, the Restore Protections for Dialysis Patients Act (RPDPA). Meetings with House Offices in Opposition to H.R. 3227, Ensuring Seniors' Access to Quality Care Act.

Client expense: $240,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

Extension of COVID-19 public health emergency waivers Nurse staffing shortages Removing barriers to care (H.R.2713/S.2418) I CAN Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act (S.3860/H.R.7546) Nurse Overtime and Patient Safety Act (H.R.2530 / S.1113) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Issues surrounding Medicare Part B reform Issues surrounding CMS Long Term Care staffing final rule (H.J. Res. 139) Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S.J. Res. 91) A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S. 2016/H.R. 4189) CONNECT for Health Act (H.R.2583/S.3481) Increasing Access to Quality Cardiac Rehabilitation Care Act H.R.3227 - Ensuring Seniors Access to Quality Care Act H.R.468 - Building Americas Health Care Workforce Act (S.5236) Keeping Obstetrics Local Act S.4338 - Pay PCPs Act of 2024

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

Support Workplace Violence Prevention for Health Care & Social Workers Act H.R. 2663/ S. 1176 Support Long-term Care Workforce Support Act H.R. 7994/ S. 4120 Support Nursing Standards for Hospital Patient Safety and Quality Care Act H.R. 2530/ S. 1113 Support Protecting America's Seniors' Access to Care Act H.R. 7986 CRA of Minimum Staffing Standards for Long-Term Care Facilities S.J. Res 91/ H.J. Res 139

Client expense: $650,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

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

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.

Medicare Observation Stays. The Improving Access to Medicare Coverage Act of 2023 (H.R. 5138 and S. 4137): Proposals to count time spent in observation status toward the three-day prior inpatient stay required under Medicare for coverage of a subsequent stay in a skilled nursing facility. Medicare Drug Prices (No bill): Proposal to have the Biden Administration lower the price of the prostate cancer drug Xtandi through executive action by using so-called march-in rights under the Bayh-Dole Act; to amend the Federal Food, Drug, and Cosmetic Act to grant eligible researchers access to drugs or biologic products for research purposes at a price no higher than the cost to the manufacturer; to block so-called Dispense-As-Written campaigns where drug manufacturers incentivize health care providers to specify a brand drug on a prescription to block generic substitution at the pharmacy. Medicare Drug Costs. The Pharmaceutical Research Transparency Act of 2023 (S. 1476 and H.R. 3160): Proposal to amend the Public Health Service Act and the Security Exchange Act to require pharmaceutical manufacturers to report their costs related to clinical trials and research and development. Medicare Drug Savings. The Seniors Securing Access to Vital and Essential Prescription Drugs Act (H.R. 2893): Proposals to discount the treatment of eligible retirement plans in determining the eligibility of individuals for premium and cost sharing subsidies under Part D of the Medicare program. (No bills): Proposals to eliminate the Medicare Part D low-income subsidy programs asset test and raise the income eligibility levels to 200 percent of the federal poverty level. Medicare Prescription Drugs. Drug Costs. Inflation Reduction Act (Public Law No: 117-169): Proposal to allow Medicare to negotiate prices with drug makers, cap prices at inflation in Part B and D, cap beneficiary out-of-pocket costs in Part D, eliminate cost-sharing for vaccines, eliminate cost-sharing in the catastrophic phase of Part D, and to raise the income threshold for the Low-Income Subsidy program offering assistance in paying for drugs. Medicare Prescription Drugs. The Affordable Pricing for Taxpayer-Funded Prescription Drugs Act of 2023 (H.R. 3093): Proposals to require companies that receive federal funding for research (or a license of the rights to a patent or regulatory test data) for a biomedical product or service to agree to set reasonable prices for the resulting biomedical product or service and authorize to determine a reasonable price based on a formula that ensures the U.S. price for the product or service is not more than the median price for the product or service in Canada and six other reference countries. Medicare Prescription Drugs. (No bill): A regulatory proposal encouraging the Secretaries of the Departments of Health and Human Services (HHS) and Commerce to exercise march in rights that would aim to better control the pricing of prescription drugs. Medicare Prescription Drugs. (No bill): An HHS regulatory proposal to ensure robust negotiation rules and processes that aim to curtail the cost of certain prescription drugs, as authorized by the Inflation Reduction Act. Medicare Low-Income Subsidy (LIS) Program. (No bill): Proposal to increase funding for LIS outreach and enrollment, so that low-income beneficiaries can more readily access needed medications at prices they can afford. Medicare Reform. The Assuring Medicares Promise Act (H.R. 34) and The Medicare and Social Security Fair Share Act (S. 1174 and H.R. 4535): Proposals to close the loophole for wealthy individuals who bypass paying net investment income tax (NIIT) and directing the revenue to the Hospital Insurance Trust Fund, which pays for Medicare Part A that covers inpatient care in hospitals, and to the Social Security Trust Funds. Medicare Dental Coverage. The Medicare Dental Benefit Act (S. 2012 and H.R. 4146): Proposal to add a dental benefit to Medicare. Medicare Hearing Coverage. The Medicare Hearing Aid Coverage Act of 2021 (H.R. 244): Proposal to expand Medicare coverage to include hearing aids and services for seniors under Medicare Part B. Medicare call center (No bill): Proposal to address the poor working conditions of the call center workers employed by Maximus, a federal contractor with the Department of Health and Humans Services/Center for Medicare and Medicaid Services) HHS/CMS. Public Health Emergency (No bill): Proposals to ensure the transition out of the public health emergency doesnt create enrollment or coverage gaps for Medicare eligible individuals. Medicare Advantage (MA). (No bill): Proposals to create transparency around Medicare Advantage plans using prior authorization and supplemental benefits that are not offered under traditional Medicare. Medicare Advantage. (No bill): Proposals to apply a higher coding adjustment factor to fully account for intensive upcoding by MA plans and to exclude certain information for MA risk adjustment scores and payments; to use two years of traditional Medicare and MA diagnostic data for calculating MA risk-adjusted payments; and to promulgate more fundamental changes to the Hierarchical Condition Category (HCC) risk adjustment model. Medicare Privatization (No bill): Proposals to create reimbursement policies in traditional Medicare that mimic those used by private health insurance plans. Medicaid Home And Community-Based Services. The HCBS Access Act (H.R. 1493 and S. 762): Proposals to make home and community-based services (HCBS) a mandatory benefit within Medicaid, and to ensure eligible older adults and people with disabilities have the option to choose between home care and institutional care. Caregiving. The Alleviating Barriers to Caregiving Act (H.R. 8018 and S. 3109): Proposal to require the Secretaries of HHS and SSA to review and streamline enrollment in coverage and benefits for family caregivers in Medicare, Medicaid, CHIP and Social Security. Medicare and Medicaid Nursing Homes. The Nursing Home Disclosure Act (H.R. 177): Proposal to direct HHS to establish a national registry of medical directors. Medicare, Medicaid Nursing Homes. The Protecting Americas Seniors Access to Care Act (H.R. 7513 and S. 3410): Proposal to prohibit the HHS Secretary from promulgating national staffing standards in nursing homes. Medicare, Medicaid Nursing Homes. (H.J. Res. 139 and S.J. Res. 91): Proposal to use the Congressional Review Act to disapprove the HHS Secretarys final rule promulgating national staffing standards in nursing homes Medicare, Medicaid Nursing Homes, Assisted Living and Other Long Term Care Services and Supports (LTSS) Settings. The Long-Term Care Workforce Support Act (H.R. 7994 and S. 4120): Proposal to increase the number of direct care professionals, including in rural communities; pathways to enter and be supported in the workforce for women, people of color, and people with disabilities; and to improve compensation for direct care professionals to reduce vacancies and turnover. Medicare and Medicaid Nursing Home Ownership. (No bill): A proposed final HHS regulation for comprehensive ownership disclosure in the nursing home sector issued on November 17th, 2023. Rule calls for strengthened cost reporting requirements, together with ongoing national analyses and monitoring of the performance of the nursing home sector that uses ownership, staffing, cost report data and inspection data. Medicare and Medicaid Nursing Home Staffing. (No bill): Final regulations establishing national staffing standards in nursing homes that would safeguard the health and safety of all elderly and disabled residents. Medicaid Long-Term Services and Supports (LTSS). (No bill): Proposal to request that CMS collect standardized LTSS expenditure data annually from every state and across all LTSS programs and for disaggregation of expenditure data by the delivery system and demographic characteristics in order to identify disparities in access and use of LTSS and help states and CMS deploy targeted strategies to meet the needs of older adults and people with disabilities.

S 4445- The Right to IVF Act HR 6283- Delinking Revenue from Unfair Gouging (DRUG) Act HR 5378- Lower Costs, More Transparency Act HR 4895- Lowering Drug Costs for American Families HR 5796- Protecting Rural Seniors Access to Care Act HR 7513- Protecting America's Seniors Access to Care Act HR 485- Protecting Care for All Patients Care Act S 3679- Lorna Breen Health Care Provider Protection Reauthorization Act HJ Res 139, SJ Res 91- CRA to rescind nursing home staffing rule

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

Government targets: HOUSE OF REPRESENTATIVES, SENATE

-HR 5378 - Lower Costs More Transparency Act, Provisions related to pharmacy benefit manager and health plan transparency -HR 7513 - Protecting America's Seniors' Access to Care Act -HR 485 - Protecting Health Care for All Patients Act -HR 468 - Building America's Health Care Workforce Act -HR 3227 - Ensuring Seniors' Access to Quality Care Act -S 4381 - The Right to Contraception Act -HR 4367/S 2625 - FAMILY Act -HJ Res. 139/SJ Res. 91 - Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting" -HR 8114 - o prohibit the Secretary of Health and Human Services from finalizing a rule proposed by the Centers for Medicare & Medicaid Services to place certain limitations on Medicaid payments for home or community-based services -HR 4818 - Treat and Reduce Obesity Act (Provisions related to Medicare coverage of anti-obesity medications and intensive behavioral therapy)

Client expense: $560,000 · Firm income: Not reported

Extension of COVID-19 public health emergency waiversNurse staffing shortages Removing barriers to care (H.R.2713/S.2418) I CAN Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act (S.3860/H.R.7546) Nurse Overtime and Patient Safety Act (H.R.2530 / S.1113) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Issues surrounding Medicare Part B reform Issues surrounding CMS Long Term Care staffing final rule (H.J. Res. 139) Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S.J. Res. 91) A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S. 2016/H.R. 4189) CONNECT for Health Act (H.R.2583/S.3481) Increasing Access to Quality Cardiac Rehabilitation Care Act H.R.3227 - Ensuring Seniors Access to Quality Care Act H.R.468 - Building Americas Health Care Workforce Act

Client expense: $220,000 · Firm income: Not reported

Meetings, Letters, Press Conference and Briefings in House and Senate on CMS Nursing Home Staffing Rule, and sharing SEIU strong Opposition to HR 5796, H.R. 7513, S. 3410, H.J. Res. 139 and S.J. Res. 91 that would prohibit the rule. Meeting in House in Opposition to HR 6860, the Restore Protections for Dialysis Patients Act (RPDPA) Letter and meetings in Opposition to H.R. 8114, Legislation that would prohibit the Secretary of Health and Human Services from finalizing a rule proposed by the Centers for Medicare & Medicaid Services to place certain limitations on Medicaid payments for home or community-based services. Letter and meetings with House Offices in Opposition to H.R. 3227, Ensuring Seniors Access to Quality Care Act. Letter in Support for H.R. 7573, the Stop Unfair Medicaid Recoveries Act which seeks to halt unfair Medicaid recovery practices, and H.R. 8106 which proposes to remove institutional care criteria for Home and Community-Based Services (HCBS) eligibility, improving access and equity within the long-term care system.

Client expense: $230,000 · Firm income: Not reported

Government targets: Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE

CMS Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities H.J. RES. 139 and S.J. RES 91 providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to :Medicare and Medicaid Programs; Minimum Staffing 'Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting.

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

Government targets: HOUSE OF REPRESENTATIVES, Occupational Safety & Health Administration (OSHA), SENATE

Extension of COVID-19 public health emergency waivers Nurse staffing shortages Removing barriers to care (H.R.2713/S.2418) I CAN Act (S.1586/H.R.3623) Educating Future Nurses Act (S.1869) SITE Act (S.3860/H.R.7546) Nurse Overtime and Patient Safety Act (H.R.2530 / S.1113) Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (H.R. 7513) Protecting Americas Seniors Access to Care Act Issues surrounding Medicare Part B reform Issues surrounding CMS Long Term Care staffing final rule (H.J. Res. 139) Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S.J. Res. 91) A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting". (S. 2016/H.R. 4189) CONNECT for Health Act (H.R.2583/S.3481) Increasing Access to Quality Cardiac Rehabilitation Care Act H.R.3227 - Ensuring Seniors Access to Quality Care Act H.R.468 - Building Americas Health Care Workforce Act

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

No bill number. Discussed medically necessary dental coverage and oral health care in Medicare. No bill number. Discussed Medicare coverage for telehealth services. No bill number. Discussed workforce training, physician reimbursement, and Medicare provider access. No bill number. Discussed Improving Seniors Timely Access to Care Act of 2024. H.R. 2407, the Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act. No bill number. Discussed Medicaid estate recovery. No bill number. Discussed Medicare Advantage data. H.R. 3549/ S. 1703, the PACE Part D Choice Act of 2023. No bill number. Discussed family caregivers and Medicare and Medicaid policy. No bill number. Discussed Medicare FY25 Skilled Nursing Facility Payment Proposed Rule. No bill number. Discussed Medicare FY25 Hospital Inpatient Payment Proposed Rule. No bill number. Discussed hospitals and a buffer of essential medicines. No bill number. Discussed Medicaid unwinding. H.R. 8114, To prohibit the Secretary of Health and Human Services from finalizing a rule proposed by the Centers for Medicare & Medicaid Services to place certain limitations on Medicaid payments for home or community-based services. No bill number. Discussed Care Executive Order. H.R. 8018, the Alleviating Barriers for Caregivers Act. S. 3109, Alleviating Barriers for Caregivers Act. S. 3766/H.R. 7274, Connecting Caregivers to Medicare Act. No bill number. Discussed Acute Hospital Care at Home waiver and family caregivers. No bill number. Discussed family caregivers, direct care workers, care at home, and in other settings. S. 4120/H.R. 7994, the Long-Term Care Workforce Support Act. H.R. 8094, to amend Title XIX of the Social Security Act to modify certain asset recovery rules. H.R. 7573, the Stop Unfair Medicaid Recoveries Act. No bill number. Discussed the Coordinating Care for Veterans and Wounded Warriors Act. No bill number. Discussed nursing home staffing standards. No bill number. Discussed Medicare home health and hospice benefits. No bill number. Discussed health care coverage expansion. H.R. 8331/S. 4280, the Essential Caregivers Act. H.R. 7442, Philippine Medicare Portability Study Act. H.R. 3227, the Ensuring Seniors Access to Quality Care Act. H.R. 8244, Ensuring Seniors Access to Quality Care Act. H.R.468, the Building Americas Health Care Workforce Act. HR 7513/S.3410, the Protecting Americas Seniors Access to Care Act. H.J.Res.139, Providing for Congressional disapproval of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting. S.J.Res.91, A joint resolution providing for congressional disapproval of the rule submitted by the Centers for Medicare & Medicaid Services relating to "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting" S.4137, the Improving Access to Medicare Coverage Act of 2024.