mr DANIEL LANDON

- Distributed to the members of the Missouri congressional delegation a summary of hospital issues that may be discussed during the August recess. - Corresponded with a member of the Missouri congressional delegation regarding a request for MHA review of a draft letter to Dept. of Health and Human Services officials. The draft letter asks for expedited action against certain pharmaceutical manufacturers which were referred to the HHS Office of Inspector General by the Health Resources and Services Administration for alleged violation of federal standards governing the 340B drug discount program. - Corresponded with a member of the Missouri congressional delegation regarding a requested review by the Missouri Hospital Association of proposed legislation concerning Medicare payment and supervision standards for physical therapy assistants. - Corresponded with a member of the Missouri congressional delegation regarding his co-sponsorship of the Senate version of the Provider Relief Fund Deadline Extension Act. - Corresponded with a member of the Missouri congressional delegation to provide requested information regarding Dept. of Health and Human Services spending and reporting deadlines for federal Provider Relief Funds. - Corresponded with a member of the Missouri congressional delegation regarding the availability of hospital beds and ventilator in each county in the of the 8th congressional district. - Corresponded with a member of the Missouri congressional delegation regarding participation in the Missouri Hospital Associations September 22 advocacy briefing in Washington, DC. - Distributed to the Missouri congressional delegation the Missouri Hospital Associations update on the COVID-19 pandemic that was distributed to the Missouri General Assembly for its annual veto session. - Corresponded with a member of the Missouri congressional delegation to respond to a request for sources of funding and other resources to help hospitals respond to the COVID-19 pandemic and association hospital staffing challenges. - Convened a conference call with a new staffer in the office of a member of the Missouri congressional delegation to discuss the Missouri Hospital Association. - Corresponded with a member of the Missouri congressional delegation to respond to a request regarding likely state legislative and gubernatorial actions to implement Medicaid expansion. - Corresponded with members of the Missouri congressional delegation regarding opportunities for them to meet with Missouri hospital executives and others during their September 21-22 trip to Washington, DC. - Corresponded with a member of the Missouri congressional delegation regarding an agencys withdrawal of a proposal to change the population standard used to define a metropolitan area for purposes of various federal programs. - Corresponded with a member of the Missouri congressional delegation regarding a transition of staffing responsibilities within the members office. - Corresponded with members of the Missouri congressional delegation regarding a Human Trafficking Toolkit jointly produced by the Missouri Hospital Association and the Missouri Attorney Generals office. - Convened a virtual briefing session for the Missouri congressional delegation regarding the resurgence of COVID-19 in Missouri. - Corresponded with a member of the Missouri congressional delegation regarding documentation given out as a release by a Missouri hospital that was being used to discourage COVID-19 vaccination. - Interacted with a member of the Missouri congressional delegation to discuss draft legislation on rural hospital infrastructure needs that is being developed by Senator Bennett of Colorado. - Corresponded with members of the Missouri congressional delegation to promote H.R. 3173, H.R. 3203/S. 773. - Corresponded with a member of the Missouri congressional delegation regarding a campaign twitter account tweet asserting federal officials were going door-to-door doing forced vaccinations for COVID-19 and the message being counterproductive to efforts to promote vaccination to offset the Delta variant surge in Missouri.

- Distributed to the Centers for Medicare and Medicaid Services a copy of the talking points from the September 9 virtual meeting regarding Medicare Advantage Sepsis Down coding and Prior Authorization. - Corresponded with a member of the Missouri congressional delegation on questions regarding HHS distribution of CARES Act General Distribution Phase 4 funds. - Corresponded with Senate members of the Missouri congressional delegation regarding the pending House Amendment to S. 610. - Responded to a member of the Missouri congressional delegations questions regarding American Rescue Plan Act rural health funding and Medicare Accelerated and Advance Payments. - Corresponded with a member of the Missouri congressional delegation regarding HHS and HRSAs distribution of American Rescue Plan Act payments to providers and suppliers who serve rural Medicaid, Childrens Health Insurance Program (CHIP) and Medicare beneficiaries. - Corresponded with a member of the Missouri congressional delegation regarding the findings of the CMS survey on regulations mandating COVID-19 vaccination of employees and others in CMS-regulated settings. - Distributed to the House members of the Missouri congressional delegation a memorandum of support for H.R. 5963, the Provider Relief Fund Improvement Act. - Conversation via telephone with a member of Missouri congressional delegation regarding the expected effects of the vaccine mandate. - Distributed to the members of the Missouri congressional delegation a document concerning ARPA pandemic financial relief for hospitals in Missouri. - Distributed to the members of the Missouri congressional delegation a fact sheet prepared by the Missouri Hospital Association outlining the issues being faced by health care providers regarding the disruption caused using temporary staffing agencies and the inability of nursing schools to enroll all interested students. - Corresponded with a member of the Missouri congressional delegation regarding HRSA Resiliency Grants and related testimony from a House Energy and Commerce Committee hearing on health workforce shortages. - Convened a virtual meeting with a member of the Missouri congressional delegation regarding the potential legislation to relieve pandemic stresses on nurses. - Responded to a member of the Missouri congressional delegation regarding Missouri Hospital Associations position on HR 3165, the Nurse Staffing Standards for Hospital Patient Safety & Quality Care Act. - Corresponded with a member of the Missouri congressional delegation regarding an upcoming HRSA deadline to apply for funding from the Provider Relief Fund Phase 4 and ARPA rural distribution. - Corresponded with a member of the Missouri congressional delegation regarding legislative language regarding Medicare reimbursement reductions on services furnished by Physical Therapy Assistants and Occupational Therapy Assistants. - Corresponded with a member of the Missouri congressional delegation regarding issues from hospitals concerning workforce, provider relief funding expenditure deadlines and reporting concerns, 340B concerns and vaccination mandates. Also, discussed the impending Medicare cut from PAYGO and the expiration of the moratorium on the Medicare sequestration and support of H.R. 4735/S.2493. - Corresponded with a member of the Missouri congressional delegation regarding Medicare Sequestration Relief and prevention of the PAYGO cut. - Corresponded with members of the Missouri congressional delegation regarding Missouri Hospital Associations staff transitions at the end of 2021.

- Distributed to the Centers for Medicare and Medicaid Services a copy of the talking points from the September 9 virtual meeting regarding Medicare Advantage Sepsis Down coding and Prior Authorization. - Corresponded with a member of the Missouri congressional delegation on questions regarding HHS distribution of CARES Act General Distribution Phase 4 funds. - Corresponded with Senate members of the Missouri congressional delegation regarding the pending House Amendment to S. 610. - Responded to a member of the Missouri congressional delegations questions regarding American Rescue Plan Act rural health funding and Medicare Accelerated and Advance Payments. - Corresponded with a member of the Missouri congressional delegation regarding HHS and HRSAs distribution of American Rescue Plan Act payments to providers and suppliers who serve rural Medicaid, Childrens Health Insurance Program (CHIP) and Medicare beneficiaries. - Corresponded with a member of the Missouri congressional delegation regarding the findings of the CMS survey on regulations mandating COVID-19 vaccination of employees and others in CMS-regulated settings. - Distributed to the House members of the Missouri congressional delegation a memorandum of support for H.R. 5963, the Provider Relief Fund Improvement Act. - Conversation via telephone with a member of Missouri congressional delegation regarding the expected effects of the vaccine mandate. - Distributed to the members of the Missouri congressional delegation a document concerning ARPA pandemic financial relief for hospitals in Missouri. - Distributed to the members of the Missouri congressional delegation a fact sheet prepared by the Missouri Hospital Association outlining the issues being faced by health care providers regarding the disruption caused using temporary staffing agencies and the inability of nursing schools to enroll all interested students. - Corresponded with a member of the Missouri congressional delegation regarding HRSA Resiliency Grants and related testimony from a House Energy and Commerce Committee hearing on health workforce shortages. - Convened a virtual meeting with a member of the Missouri congressional delegation regarding the potential legislation to relieve pandemic stresses on nurses. - Responded to a member of the Missouri congressional delegation regarding Missouri Hospital Associations position on HR 3165, the Nurse Staffing Standards for Hospital Patient Safety & Quality Care Act. - Corresponded with a member of the Missouri congressional delegation regarding an upcoming HRSA deadline to apply for funding from the Provider Relief Fund Phase 4 and ARPA rural distribution. - Corresponded with a member of the Missouri congressional delegation regarding legislative language regarding Medicare reimbursement reductions on services furnished by Physical Therapy Assistants and Occupational Therapy Assistants. - Corresponded with a member of the Missouri congressional delegation regarding issues from hospitals concerning workforce, provider relief funding expenditure deadlines and reporting concerns, 340B concerns and vaccination mandates. Also, discussed the impending Medicare cut from PAYGO and the expiration of the moratorium on the Medicare sequestration and support of H.R. 4735/S.2493. - Corresponded with a member of the Missouri congressional delegation regarding Medicare Sequestration Relief and prevention of the PAYGO cut. - Corresponded with members of the Missouri congressional delegation regarding Missouri Hospital Associations staff transitions at the end of 2021.

- Distributed to the Centers for Medicare and Medicaid Services a copy of the talking points from the September 9 virtual meeting regarding Medicare Advantage Sepsis Down coding and Prior Authorization. - Corresponded with a member of the Missouri congressional delegation on questions regarding HHS distribution of CARES Act General Distribution Phase 4 funds. - Corresponded with Senate members of the Missouri congressional delegation regarding the pending House Amendment to S. 610. - Responded to a member of the Missouri congressional delegations questions regarding American Rescue Plan Act rural health funding and Medicare Accelerated and Advance Payments. - Corresponded with a member of the Missouri congressional delegation regarding HHS and HRSAs distribution of American Rescue Plan Act payments to providers and suppliers who serve rural Medicaid, Childrens Health Insurance Program (CHIP) and Medicare beneficiaries. - Corresponded with a member of the Missouri congressional delegation regarding the findings of the CMS survey on regulations mandating COVID-19 vaccination of employees and others in CMS-regulated settings. - Distributed to the House members of the Missouri congressional delegation a memorandum of support for H.R. 5963, the Provider Relief Fund Improvement Act. - Conversation via telephone with a member of Missouri congressional delegation regarding the expected effects of the vaccine mandate. - Distributed to the members of the Missouri congressional delegation a document concerning ARPA pandemic financial relief for hospitals in Missouri. - Distributed to the members of the Missouri congressional delegation a fact sheet prepared by the Missouri Hospital Association outlining the issues being faced by health care providers regarding the disruption caused using temporary staffing agencies and the inability of nursing schools to enroll all interested students. - Corresponded with a member of the Missouri congressional delegation regarding HRSA Resiliency Grants and related testimony from a House Energy and Commerce Committee hearing on health workforce shortages. - Convened a virtual meeting with a member of the Missouri congressional delegation regarding the potential legislation to relieve pandemic stresses on nurses. - Responded to a member of the Missouri congressional delegation regarding Missouri Hospital Associations position on HR 3165, the Nurse Staffing Standards for Hospital Patient Safety & Quality Care Act. - Corresponded with a member of the Missouri congressional delegation regarding an upcoming HRSA deadline to apply for funding from the Provider Relief Fund Phase 4 and ARPA rural distribution. - Corresponded with a member of the Missouri congressional delegation regarding legislative language regarding Medicare reimbursement reductions on services furnished by Physical Therapy Assistants and Occupational Therapy Assistants. - Corresponded with a member of the Missouri congressional delegation regarding issues from hospitals concerning workforce, provider relief funding expenditure deadlines and reporting concerns, 340B concerns and vaccination mandates. Also, discussed the impending Medicare cut from PAYGO and the expiration of the moratorium on the Medicare sequestration and support of H.R. 4735/S.2493. - Corresponded with a member of the Missouri congressional delegation regarding Medicare Sequestration Relief and prevention of the PAYGO cut. - Corresponded with members of the Missouri congressional delegation regarding Missouri Hospital Associations staff transitions at the end of 2021.

- Distributed to the Centers for Medicare and Medicaid Services a copy of the talking points from the September 9 virtual meeting regarding Medicare Advantage Sepsis Down coding and Prior Authorization. - Corresponded with a member of the Missouri congressional delegation on questions regarding HHS distribution of CARES Act General Distribution Phase 4 funds. - Corresponded with Senate members of the Missouri congressional delegation regarding the pending House Amendment to S. 610. - Responded to a member of the Missouri congressional delegations questions regarding American Rescue Plan Act rural health funding and Medicare Accelerated and Advance Payments. - Corresponded with a member of the Missouri congressional delegation regarding HHS and HRSAs distribution of American Rescue Plan Act payments to providers and suppliers who serve rural Medicaid, Childrens Health Insurance Program (CHIP) and Medicare beneficiaries. - Corresponded with a member of the Missouri congressional delegation regarding the findings of the CMS survey on regulations mandating COVID-19 vaccination of employees and others in CMS-regulated settings. - Distributed to the House members of the Missouri congressional delegation a memorandum of support for H.R. 5963, the Provider Relief Fund Improvement Act. - Conversation via telephone with a member of Missouri congressional delegation regarding the expected effects of the vaccine mandate. - Distributed to the members of the Missouri congressional delegation a document concerning ARPA pandemic financial relief for hospitals in Missouri. - Distributed to the members of the Missouri congressional delegation a fact sheet prepared by the Missouri Hospital Association outlining the issues being faced by health care providers regarding the disruption caused using temporary staffing agencies and the inability of nursing schools to enroll all interested students. - Corresponded with a member of the Missouri congressional delegation regarding HRSA Resiliency Grants and related testimony from a House Energy and Commerce Committee hearing on health workforce shortages. - Convened a virtual meeting with a member of the Missouri congressional delegation regarding the potential legislation to relieve pandemic stresses on nurses. - Responded to a member of the Missouri congressional delegation regarding Missouri Hospital Associations position on HR 3165, the Nurse Staffing Standards for Hospital Patient Safety & Quality Care Act. - Corresponded with a member of the Missouri congressional delegation regarding an upcoming HRSA deadline to apply for funding from the Provider Relief Fund Phase 4 and ARPA rural distribution. - Corresponded with a member of the Missouri congressional delegation regarding legislative language regarding Medicare reimbursement reductions on services furnished by Physical Therapy Assistants and Occupational Therapy Assistants. - Corresponded with a member of the Missouri congressional delegation regarding issues from hospitals concerning workforce, provider relief funding expenditure deadlines and reporting concerns, 340B concerns and vaccination mandates. Also, discussed the impending Medicare cut from PAYGO and the expiration of the moratorium on the Medicare sequestration and support of H.R. 4735/S.2493. - Corresponded with a member of the Missouri congressional delegation regarding Medicare Sequestration Relief and prevention of the PAYGO cut. - Corresponded with members of the Missouri congressional delegation regarding Missouri Hospital Associations staff transitions at the end of 2021.

- Distributed to the members of the Missouri congressional delegation a summary of hospital issues that may be discussed during the August recess. - Corresponded with a member of the Missouri congressional delegation regarding a request for MHA review of a draft letter to Dept. of Health and Human Services officials. The draft letter asks for expedited action against certain pharmaceutical manufacturers which were referred to the HHS Office of Inspector General by the Health Resources and Services Administration for alleged violation of federal standards governing the 340B drug discount program. - Corresponded with a member of the Missouri congressional delegation regarding a requested review by the Missouri Hospital Association of proposed legislation concerning Medicare payment and supervision standards for physical therapy assistants. - Corresponded with a member of the Missouri congressional delegation regarding his co-sponsorship of the Senate version of the Provider Relief Fund Deadline Extension Act. - Corresponded with a member of the Missouri congressional delegation to provide requested information regarding Dept. of Health and Human Services spending and reporting deadlines for federal Provider Relief Funds. - Corresponded with a member of the Missouri congressional delegation regarding the availability of hospital beds and ventilator in each county in the of the 8th congressional district. - Corresponded with a member of the Missouri congressional delegation regarding participation in the Missouri Hospital Associations September 22 advocacy briefing in Washington, DC. - Distributed to the Missouri congressional delegation the Missouri Hospital Associations update on the COVID-19 pandemic that was distributed to the Missouri General Assembly for its annual veto session. - Corresponded with a member of the Missouri congressional delegation to respond to a request for sources of funding and other resources to help hospitals respond to the COVID-19 pandemic and association hospital staffing challenges. - Convened a conference call with a new staffer in the office of a member of the Missouri congressional delegation to discuss the Missouri Hospital Association. - Corresponded with a member of the Missouri congressional delegation to respond to a request regarding likely state legislative and gubernatorial actions to implement Medicaid expansion. - Corresponded with members of the Missouri congressional delegation regarding opportunities for them to meet with Missouri hospital executives and others during their September 21-22 trip to Washington, DC. - Corresponded with a member of the Missouri congressional delegation regarding an agencys withdrawal of a proposal to change the population standard used to define a metropolitan area for purposes of various federal programs. - Corresponded with a member of the Missouri congressional delegation regarding a transition of staffing responsibilities within the members office. - Corresponded with members of the Missouri congressional delegation regarding a Human Trafficking Toolkit jointly produced by the Missouri Hospital Association and the Missouri Attorney Generals office. - Convened a virtual briefing session for the Missouri congressional delegation regarding the resurgence of COVID-19 in Missouri. - Corresponded with a member of the Missouri congressional delegation regarding documentation given out as a release by a Missouri hospital that was being used to discourage COVID-19 vaccination. - Interacted with a member of the Missouri congressional delegation to discuss draft legislation on rural hospital infrastructure needs that is being developed by Senator Bennett of Colorado. - Corresponded with members of the Missouri congressional delegation to promote H.R. 3173, H.R. 3203/S. 773. - Corresponded with a member of the Missouri congressional delegation regarding a campaign twitter account tweet asserting federal officials were going door-to-door doing forced vaccinations for COVID-19 and the message being counterproductive to efforts to promote vaccination to offset the Delta variant surge in Missouri.

- Corresponded with a member of the Missouri congressional delegation to respond to questions regarding Missouris use of state provider taxes to fund its Medicaid program. - Corresponded with a member of the Missouri congressional delegation regarding updated guidance on the reporting and repayment standards of the Provider Relief Fund. - Corresponded with a member of the Missouri congressional delegation regarding the availability of data on the presence in Missouri of the Delta variant of the COVID-19 virus. - Corresponded with a member of the Missouri congressional delegation regarding advocacy to the Biden Administration regarding regulatory implementation of the No Surprises Act governing billing and payment for out-of-network health care services. - Corresponded with a member of the Missouri congressional delegation regarding an assessment of the legislative prognosis of the Comprehensive Debt Collection Improvement Act component of H.R. 2547 - Corresponded with a member of the Missouri congressional delegation regarding the cessation of MHAs regularly scheduled calls to update the delegation on the COVID-19 pandemic and Missouri hospitals role in responding to it. - Corresponded with a member of the congressional delegation by summarizing a briefing for the delegation regarding the COVID-19 pandemic and provided additional information regarding the State and Local Fiscal Recovery Funds authorized by the American Rescue Plan Act enactment. - Corresponded with the Missouri congressional delegation informing them of National Nurses Week and National Hospital Week and suggesting ways for them to recognize and thank nurses and hospitals. - Distributed to the Missouri congressional delegation several Missouri Hospital Associations COVID-19 snapshot documents providing information on metrics on the virus spread and effects, data on the administration of COVID-19 vaccine and links to recent media articles. - Corresponded with some members of Missouri congressional delegation urging support and sponsorship of S. 773, which revises eligibility criteria for participation in the 340B drug discount program in response to the COVID-19 pandemic. - Distributed to the Missouri congressional delegation Missouri Hospital Associations infographic on COVID-19 and Adolescent Mental Health. - Distributed to the members of the Missouri congressional delegation a Missouri Hospital Association media release regarding the results of a public opinion poll on attitudes regarding COVID-19 vaccination.

-Corresponded with members of the Missouri congressional delegation regarding a new advisory opinion from HHS legal counsel on 340B discounts for contract pharmacies. -Corresponded with a member of the Missouri congressional delegation regarding H.R. 133s extension of state governments deadline to spend their federal Coronavirus Relief Funds. -Responded to a query from a member of the Missouri congressional delegation regarding an MHA-member hospitals concerns with the COVID-19 vaccine distribution process. -Corresponded with members of the Missouri congressional delegation regarding the Centers for Medicare & Medicaid Services Medicare payment rates for administering COVID-19 vaccinations. -Corresponded with members of the Missouri congressional delegation regarding a change in Missouri state governments policy for allocating the Moderna vaccine. -Responded to a request by a member of the Missouri congressional delegation for data on federally designated critical access hospitals in Missouri. -Responded to a member of the Missouri congressional delegation for an assessment of a letter to HHS Secretary Azar regarding repayment and reporting standards for the Provider Relief Fund. -Corresponded with several members of the Missouri congressional delegation regarding the effect of the enhanced Federal Medicaid Assistance Percentage enacted in the Families First Coronavirus Relief Act on Missouri Medicaid Disproportionate Share Hospital payments. -Distributed to the members of the Missouri congressional delegation the Missouri Hospital Associations COVID-19 Snapshot document for Dec. 15, 2020. -Distributed to the members of the Missouri congressional delegation a document listing the Missouri Hospital Associations congressional advocacy requests for December 2020. These focused on potential components of H.R. 133. -Corresponded with a member of the Missouri congressional delegation regarding sponsorship of legislation to extend the deadline for state governments to spend their Coronavirus Relief Funds. -Corresponded with a member of the Missouri congressional delegation regarding a legislative amendment proposed by Kentucky hospitals regarding repayment standards for the Provider Relief Fund. -Responded to a member of the Missouri congressional delegation regarding an updated version of a 2016 MHA document on Critical Access Hospitals. -Responded to a member of the Missouri congressional delegation regarding legislation to extend the deadline for state governments to spend their Coronavirus Relief Funds. -Responded to a member of the Missouri congressional delegation regarding the Missouri Dept. of Health and Senior Services tabletop exercise on distribution of the Pfizer vaccine. -Corresponded with a member of the Missouri congressional delegation regarding legislation to extend the deadline for state governments to spend their Coronavirus Relief Funds. -Forwarded to members of the Missouri congressional delegation information about a state COVID-19 prevention campaign implemented by a coalition of organizations. -Responded to a member of the Missouri congressional delegation regarding a request to join a congressional conference call with constituent hospitals on COVID-19 issues. -Corresponded and conversed with several members of the Missouri congressional delegation regarding legislation to extend the deadline for state governments to spend their Coronavirus Relief Funds. -Responded to a query of a member of the Missouri congressional delegation regarding updated Provider Relief Funds reporting and repayment requirements. -Distributed to the members of the Missouri congressional delegation the Missouri Hospital Associations Covid-19 Snapshot for November 18, 2020. -Corresponded with the members of the Missouri congressional delegation regarding Provider Relief Fund repayment and reporting standards. -Forwarded to the members of the Missouri congressional delegation the Missouri Hospital Associations COVID-19 Data Dashboard, with the addition of data on influenza and related illnesses. -Responded to a query from a member of the Missouri congressional delegation regarding a federal court ruling in Missouri on the regulatory closure of a COVID-19 laboratory serving many long-term care facilities. -Forwarded to the members of the Missouri congressional delegation MHAs letter to HHS Deputy Secretary Eric Hargan on Multiplex COVID-19 testing. -Corresponded with members of the Missouri congressional delegation regarding a joint letter on CARES Act Provider Relief Fund Repayment. -Corresponded with a member of the Missouri congressional delegation regarding a GAO survey on COVID-19 data collection processes and concerns. -Expressed support to members of the Missouri congressional delegation for legislation to extend the waiver of Medicare sequestration for the duration of the federally-declared public health emergency. -Corresponded regarding a letter from a member of the Missouri congressional delegation to HHS Secretary Azar on the distribution of COVID-19 funding to high-impact providers. -Sent an MHA letter to Secretary Azar regarding Provider Relief Fund repayment standards and distributed it to the Missouri congressional delegation. -Corresponded with a member of the Missouri congressional delegation regarding MHAs assessment of price transparency legislation. -Corresponded with a member of the Missouri congressional delegation regarding Sen. Blackburns joint letter to Secretary Azar on CARES Act Provider Relief fund repayment standards.

- Corresponded with members of the Missouri congressional delegation regarding letters to Secretary of Health and Human Services Azar on the topic of Provider Relief Fund repayment standards. - Convened a series of biweekly conference calls to discuss issues related to COVID-19 and Missouri. Health and district staff of the Missouri congressional delegation were invited to participate. - Provided members of the Missouri congressional delegation with a summary of advocacy issues that may be brought up by Missouri hospitals during the October district work period. - Briefed a staffer of a member of the Missouri congressional delegation regarding COVID-19 and Missouri hospitals. - Sent a letter to CMS Administrator Seema Verma regarding COVID-19 data reporting requirements for hospitals as established by a CMS interim final rule. - Corresponded with a member of the Missouri congressional delegation regarding co sponsorship of H.R. 7759. - Arranged for virtual meetings or conference calls between 8 of the 10 members of the Missouri congressional delegation and Missouri hospital executives to discuss advocacy issues, including: the 340B drug discount program, additional COVID-19 (CARES Act) federal financial assistance to health care providers, terms of repayment for Medicare Accelerated Payments provided under the Corona virus, Aid, Relief and Economic Security Act, delay of pending reductions of federal funding allotments for states to support Medicaid Disproportionate Share Hospital payments, continuation of expanded telemedicine use in the Medicare program, and COVID-19 liability protection. - Corresponded with members of the Missouri congressional delegation regarding joint legislative letters to Secretary of Health and Human Services Azar regarding efforts by pharmaceutical manufacturers to unilaterally restrict the scope of the 340B drug discount program. - Forwarded to the Missouri congressional delegation a letter from the Missouri Hospital Association and the Missouri Primary Care Association to Secretary of Health and Human Services Azar regarding efforts by pharmaceutical manufacturers to unilaterally restrict the scope of the 340B drug discount program. - Forwarded to members of the Missouri congressional delegation links to a Missouri Hospital Association interactive data dashboard regarding COVID-19 in Missouri. - Participated in a conference call briefing by the Office of Intergovernmental and External Affairs of the Dept. of Health and Human Services regarding efforts to expand access to affordable health care for all Americans. - Corresponded with a member of the Missouri congressional delegation regarding compliance with COVID-19 data reporting requirements by hospitals in the legislators district. - Sent a letter to the members of the Missouri congressional delegation asking them to contact Secretary of Health and Human Services Azar to delay implementation of an interim final rule establishing and immediately implementing new requirements for reporting COVID-19 data to federal officials. - Corresponded with members of the Missouri congressional delegation regarding noncompliance with new COVID-19 data reporting requirements established by an interim final rule of HHS. - Distributed to the members of the Missouri congressional delegation information regarding a public relations campaign by MHA and education officials and organizations to promote the wearing of masks by school children to reduce the spread of COVID-19. - Responded to a query from the member of the Missouri congressional delegation regarding the number of hospitals that are not critical access hospitals and have more than 10 psychiatric hospital beds. - Responded to a request for information from a member of the Missouri congressional delegation regarding COVID-19 advocacy issues that may be raised in conversations with Missouri hospital executives. - Queried the members of the Missouri congressional delegation regarding their preferences as to technology to use in organizing virtual meetings between legislators/staff and Missouri hospital executives. - Responded to a member of the Missouri congressional delegation regarding legislative district-specific data on the distribution of federal CARES Act funding to Missouri hospitals. - Corresponded with selected members of the Missouri congressional delegation regarding CMS policies on adjusting Medicare cost reports to offset COVID-19 federal financial assistance payments. - Wrote a letter to Secretary of Health and Human Services Azar regarding recommendations for incorporating federal COVID-19 financial assistance in Medicare cost reports. - Invited several members of the Missouri congressional delegation to participate in separate or joint conference calls with Missouri hospital executives to discuss letters from Congress to the Dept. of Health and Human Services regarding the role of federal COVID-19 assistance payment in Medicare cost reports. - Provided a summary of COVID-19 data and activities to the members of the Missouri congressional delegation for use during the August district work period. - Forwarded to the members of the Missouri congressional delegation a letter from three U.S. Senators to CMS Administrator Seema Verma regarding CMS standards for accounting for Paycheck Protection Program funds in Medicare cost reports. - Corresponded with a member of the Missouri congressional delegation regarding H.R. 7759. - Arranged and implemented a conference call in response to a request from a member of the Missouri congressional delegation for a briefing on COVID-19 advocacy issues affecting Missouri hospitals. - Corresponded with the members of the Missouri congressional delegation regarding the Missouri Hospital Associations recommendations regarding COVID-19 funding needs. - Responded to a query by a member of the Missouri congressional delegation for contact information for executives at a Missouri childrens hospital. - Responded to correspondence from a member of the Missouri congressional delegation regarding pending action by the Senate Finance Committee regarding repayment standards for Medicare Accelerated Payments, authority to extend current regulatory waivers and additional COVID-19 federal financial assistance. - Corresponded with a member of the Missouri congressional delegation regarding a potential letter of support for H.R. 7759. - Responded to a query from a member of the Missouri congressional delegation regarding COVID-19 data reporting requirements. - Organized and implemented a conference call with selected members of the Missouri congressional delegation to discuss changes in COVID-19 data reporting requirements. - Provided follow-up written information regarding an abrupt change in COVID-19 data reporting requirements. - Provided information to the members of the Missouri congressional delegation regarding a promotional campaign by the Missouri Hospital Association and other Missouri provider associations to encourage the wearing of masks to curtail the spread of COVID-19. - Organized a virtual conference between representatives of Missouris childrens hospitals and selected members of the Missouri congressional delegation. - Distributed to the members of the Missouri congressional delegation the Missouri Hospital Associations comments regarding CMS proposed regulatory changes to the Medicare Inpatient Prospective Payment System for federal fiscal year 2021. - Responded to a query from a member of the Missouri congressional delegation regarding the status of rapid testing technology in Missouri. - Corresponded with a member of the Missouri congressional delegation regarding potential endorsement of a joint legislative letter to Secretary of Health and Human Services Azar regarding the distribution of COVID-19 federal financial relief to childrens hospitals.

- Corresponded with staff of a member of the Missouri congressional delegation regarding incidents of workplace violence occurring in Missouri hospitals, the Missouri Hospital Associations collection of data on such incidents and a 2019 joint report by CMS and OSHA regarding workplace violence. - Forwarded to a member of the Missouri congressional delegation a publication by the Missouri Hospital Association on this topic. MHA noted that it opposes H.R. 1309 and S. 851, which were summarized in the publication. - Conveyed to several members of the Missouri congressional delegation briefing materials regarding rural hospitals in Missouri. - Provided information to respond to a request from a member of the Missouri congressional delegation regarding drug shortage in rural Missouri hospitals. - Corresponded with a member of the Missouri congressional delegation to arrange for conversations between the Missouri Hospital Association and staff of the Dept. of Health and Human Services regarding workplace violence in Missouri hospitals. - Corresponded with a member of the Missouri congressional delegation regarding further incidents of workplace violence in Missouri hospitals and the reaction of CMS hospital compliance surveyors to those incidents. - Conveyed an infographic on workplace violence in Missouri hospitals to a member of the Missouri congressional delegation. - Corresponded with a member of the Missouri congressional delegation regarding discussions between the Missouri Hospital Association and staff of the Dept. of Health and Human Services. - Responded to a request from a member of the Missouri congressional delegation for comments regarding H.R. 3654. - Corresponded with staff of the Dept. of Health and Human Services to coordinate the logistics of a telephone call regarding workplace violence in Missouri hospitals. - Engaged in a telephone conversation with a staff member of the Dept. of Health and Human Services to discuss workplace violence in Missouri hospitals and regulatory standards for such incidents. - Corresponded with the members of the Missouri congressional delegation to promote legislation to block or delay implementation of a reduction in states allotments of federal funding to support Medicaid Disproportionate Share Hospital payments. - Conveyed to the members of the Missouri congressional delegation a new report by the Missouri Hospital Association on the topic of maternal mortality, as well as policy recommendations made in conjunction with a Missouri state Reimagine Rural Health initiative. - Responded to a request from a member of the Missouri congressional delegation to comment on the Missouri Hospital Associations position on surprise billing legislation developed by U.S. Sen. Lamar Alexander and other members of the Senate Health, Education, Labor and Pensions committee.

- Provided the members of the Missouri congressional delegation with advocacy materials regarding current federal laws reductions in states allotments of federal funding to support Medicaid Disproportionate Share hospital payments, including a reference to H.R. 2328. - Provided the members of the Missouri congressional delegation with advocacy materials regarding potential congressional action on legislation on the topic of surprise billing by physicians or other practitioners who do not participate in a provider network covered by the patients insurer. Supported provisions allowing billing disputes to be resolved by negotiation and/or binding arbitration rather than a governmentally-dictated payment amount. - Expressed support to the members of the Missouri congressional delegation for H.R. 728 and S. 1399, which would reauthorize the Title VIII Nursing Workforce program. - Provided the members of the Missouri congressional delegation with advocacy materials expressing support for reauthorization and expansion of the Medicaid demonstration project to deliver mental health services through Certified Community Behavioral Health Clinics. - Provided the members of the Missouri congressional delegation with advocacy materials regarding obstacles to the use and coverage of services delivered through telemedicine in Missouri. - Provided the members of the Missouri congressional delegation with updates on federal regulatory issues, including the Medicare wage index component of Medicare hospital payment formulas, changes in Medicare Disproportionate Share Hospital payments to Missouri hospitals, and changes affecting a national budget neutrality adjustment concerning a rural floor for hospital payments made by the Medicare program. - Provided the members of the Missouri congressional delegation with advocacy materials related to the Missouri Governors state fiscal year recommendations and final budget authorizations for various proposals related to rural health care delivery and financing. - Provided the members of the Missouri congressional delegation with informational materials regarding the number, type and finances of hospitals that are members of the Missouri Hospital Association. - Provided the members of the Missouri congressional delegation with informational materials regarding 2017 contributions of Missouri hospitals to the economy of Missouri. - Provided the members of the Missouri congressional delegation with information about Missouri hospitals that are owned by local governments and which have property or sales tax levies to support their operations. - Provided a member of the Missouri congressional delegation requested information regarding examples of workplace violence occurring in Missouri hospitals and interactions with regional federal regulators on this topic. - Responded to a request from a member of the Missouri congressional delegation for an assessment of a 2019 version of H.R. 3224 of the 115th Congress (the Critical Access and Rural Equity Act). - Provided a member of the Missouri congressional delegation with a draft letter to federal regulators at CMS and OSHA regarding workplace violence occurring in health care settings. - Corresponded with a member of the Missouri congressional delegation regarding staff changes and contact information within the members office. - Conversed with a staffer of a member of the Missouri congressional delegation regarding a joint report on workplace violence occurring in health care settings that was prepared by the Centers for Medicare & Medicaid Services of the Dept. of Health and Human Services and the Occupational Safety and Health Administration of the Dept. of Labor. - Provided a member of the Missouri congressional delegation with written commentary regarding a joint report on workplace violence occurring in health care settings that was prepared by the Centers for Medicare & Medicaid Services of the Dept. of Health and Human Services and the Occupational Safety and Health Administration of the Dept. of Labor. - Contacted selected members of the Missouri congressional delegation to coordinate logistics of meetings between executives of Missouri hospitals and the legislators and their staffs in Washington, DC. - Provided a member of the Missouri congressional delegation with a requested review of the Protecting People form Surprise Medical Bills Act. - Corresponded with a member of the Missouri congressional delegation regarding the No Surprises Act pending in the House of Representatives Energy and Commerce Committee.

- Responded to a request from the staff of a member of the Missouri congressional delegation to review the proposed Protecting Life and Taxpayers Act of 2019 and the Patient Rights Act. - Sent the members of the Missouri congressional delegation a document describing the Missouri Hospital Associations principles and past actions regarding transparency of hospital price and quality data. - Corresponded with members of the Missouri congressional delegation regarding a Dear Colleague letter to the Centers for Medicare & Medicaid Services regarding proposed regulatory changes affecting the Medicare hospital wage index for federal fiscal year 2020. - Invited selected members of the Missouri congressional delegation to attend a briefing in Washington DC done by a coalition of state and regional hospital associations regarding the Medicare wage index used in calculating Medicare hospital payments. - Responded to a query from the staff of a member of the Missouri congressional delegation regarding the care provided by Missouri hospitals to a relative of the congressional staffer. - Corresponded with a member of the Missouri congressional delegation regarding H.R. 3022, which would repeal the pending reductions in state allotments of federal funding for Medicaid Disproportionate Share Hospital payments. - Responded to a query from a member of the Missouri congressional delegation regarding the legislators potential endorsement of a Missouri hospitals proposal for expedited review of an application for Medicare Sole Community Provider status. - Corresponded with six members of the Missouri congressional delegation to thank them for endorsing a Dear Colleague letter to support a delay in the statutory reduction of state allotments of federal funding for Medicaid Disproportionate Share Hospital payments. - Corresponded with two members of the Missouri congressional delegation regarding the adoption by the Missouri House of Representatives of a resolution supporting those legislators work to oppose regulatory changes in policy governing the allocation of donated livers for transplantation. - Conversed with a staffer of a member of the Missouri congressional delegation regarding the delivery of a joint report by the Departments of Health and Human Services and Labor on the topic of regulatory standards governing workplace violence in health care settings. - Corresponded with a member of the Missouri congressional delegation regarding a joint letter from the Missouri and Kansas state hospital associations regarding comments by the Department of Health and Human Services regarding workplace violence in health care settings. - Provided data and explanation to the staff of a member of the Missouri congressional delegation regarding proposed regulatory changes to the Medicare wage index used to calculate Medicare hospital payments. - Corresponded with a member of the Missouri congressional delegation regarding the legislators work to oppose regulatory changes to policies governing the allocation of donated livers for transplantation. - Corresponded with a member of the Missouri congressional delegation regarding media comments by the Department of Health and Human Services regarding workplace violence in health care settings. - Corresponded with a member of the Missouri congressional delegation regarding proposed questions of Secretary Azar regarding a joint report to congressional committees to be prepared by the Departments of Health and Human Services and Labor regarding regulatory standards governing workplace violence in health care settings. - Corresponded with a member of the Missouri congressional delegation regarding a letter to the editor in the Modern Healthcare publication regarding the legislators work on regulatory standards governing workplace violence in health care settings.

- Corresponded with staff of a member of the Missouri congressional delegation regarding incidents of workplace violence occurring in Missouri hospitals, the Missouri Hospital Associations collection of data on such incidents and a 2019 joint report by CMS and OSHA regarding workplace violence. - Forwarded to a member of the Missouri congressional delegation a publication by the Missouri Hospital Association on this topic. MHA noted that it opposes H.R. 1309 and S. 851, which were summarized in the publication. - Conveyed to several members of the Missouri congressional delegation briefing materials regarding rural hospitals in Missouri. - Provided information to respond to a request from a member of the Missouri congressional delegation regarding drug shortage in rural Missouri hospitals. - Corresponded with a member of the Missouri congressional delegation to arrange for conversations between the Missouri Hospital Association and staff of the Dept. of Health and Human Services regarding workplace violence in Missouri hospitals. - Corresponded with a member of the Missouri congressional delegation regarding further incidents of workplace violence in Missouri hospitals and the reaction of CMS hospital compliance surveyors to those incidents. - Conveyed an infographic on workplace violence in Missouri hospitals to a member of the Missouri congressional delegation. - Corresponded with a member of the Missouri congressional delegation regarding discussions between the Missouri Hospital Association and staff of the Dept. of Health and Human Services. - Responded to a request from a member of the Missouri congressional delegation for comments regarding H.R. 3654. - Corresponded with staff of the Dept. of Health and Human Services to coordinate the logistics of a telephone call regarding workplace violence in Missouri hospitals. - Engaged in a telephone conversation with a staff member of the Dept. of Health and Human Services to discuss workplace violence in Missouri hospitals and regulatory standards for such incidents. - Corresponded with the members of the Missouri congressional delegation to promote legislation to block or delay implementation of a reduction in states allotments of federal funding to support Medicaid Disproportionate Share Hospital payments. - Conveyed to the members of the Missouri congressional delegation a new report by the Missouri Hospital Association on the topic of maternal mortality, as well as policy recommendations made in conjunction with a Missouri state Reimagine Rural Health initiative. - Responded to a request from a member of the Missouri congressional delegation to comment on the Missouri Hospital Associations position on surprise billing legislation developed by U.S. Sen. Lamar Alexander and other members of the Senate Health, Education, Labor and Pensions committee.

- Provided the members of the Missouri congressional delegation with advocacy materials regarding current federal laws reductions in states allotments of federal funding to support Medicaid Disproportionate Share hospital payments, including a reference to H.R. 2328. - Provided the members of the Missouri congressional delegation with advocacy materials regarding potential congressional action on legislation on the topic of surprise billing by physicians or other practitioners who do not participate in a provider network covered by the patients insurer. Supported provisions allowing billing disputes to be resolved by negotiation and/or binding arbitration rather than a governmentally-dictated payment amount. - Expressed support to the members of the Missouri congressional delegation for H.R. 728 and S. 1399, which would reauthorize the Title VIII Nursing Workforce program. - Provided the members of the Missouri congressional delegation with advocacy materials expressing support for reauthorization and expansion of the Medicaid demonstration project to deliver mental health services through Certified Community Behavioral Health Clinics. - Provided the members of the Missouri congressional delegation with advocacy materials regarding obstacles to the use and coverage of services delivered through telemedicine in Missouri. - Provided the members of the Missouri congressional delegation with updates on federal regulatory issues, including the Medicare wage index component of Medicare hospital payment formulas, changes in Medicare Disproportionate Share Hospital payments to Missouri hospitals, and changes affecting a national budget neutrality adjustment concerning a rural floor for hospital payments made by the Medicare program. - Provided the members of the Missouri congressional delegation with advocacy materials related to the Missouri Governors state fiscal year recommendations and final budget authorizations for various proposals related to rural health care delivery and financing. - Provided the members of the Missouri congressional delegation with informational materials regarding the number, type and finances of hospitals that are members of the Missouri Hospital Association. - Provided the members of the Missouri congressional delegation with informational materials regarding 2017 contributions of Missouri hospitals to the economy of Missouri. - Provided the members of the Missouri congressional delegation with information about Missouri hospitals that are owned by local governments and which have property or sales tax levies to support their operations. - Provided a member of the Missouri congressional delegation requested information regarding examples of workplace violence occurring in Missouri hospitals and interactions with regional federal regulators on this topic. - Responded to a request from a member of the Missouri congressional delegation for an assessment of a 2019 version of H.R. 3224 of the 115th Congress (the Critical Access and Rural Equity Act). - Provided a member of the Missouri congressional delegation with a draft letter to federal regulators at CMS and OSHA regarding workplace violence occurring in health care settings. - Corresponded with a member of the Missouri congressional delegation regarding staff changes and contact information within the members office. - Conversed with a staffer of a member of the Missouri congressional delegation regarding a joint report on workplace violence occurring in health care settings that was prepared by the Centers for Medicare & Medicaid Services of the Dept. of Health and Human Services and the Occupational Safety and Health Administration of the Dept. of Labor. - Provided a member of the Missouri congressional delegation with written commentary regarding a joint report on workplace violence occurring in health care settings that was prepared by the Centers for Medicare & Medicaid Services of the Dept. of Health and Human Services and the Occupational Safety and Health Administration of the Dept. of Labor. - Contacted selected members of the Missouri congressional delegation to coordinate logistics of meetings between executives of Missouri hospitals and the legislators and their staffs in Washington, DC. - Provided a member of the Missouri congressional delegation with a requested review of the Protecting People form Surprise Medical Bills Act. - Corresponded with a member of the Missouri congressional delegation regarding the No Surprises Act pending in the House of Representatives Energy and Commerce Committee.

- Provided the members of the Missouri congressional delegation with advocacy materials regarding current federal laws reductions in states allotments of federal funding to support Medicaid Disproportionate Share hospital payments, including a reference to H.R. 2328. - Provided the members of the Missouri congressional delegation with advocacy materials regarding potential congressional action on legislation on the topic of surprise billing by physicians or other practitioners who do not participate in a provider network covered by the patients insurer. Supported provisions allowing billing disputes to be resolved by negotiation and/or binding arbitration rather than a governmentally-dictated payment amount. - Expressed support to the members of the Missouri congressional delegation for H.R. 728 and S. 1399, which would reauthorize the Title VIII Nursing Workforce program. - Provided the members of the Missouri congressional delegation with advocacy materials expressing support for reauthorization and expansion of the Medicaid demonstration project to deliver mental health services through Certified Community Behavioral Health Clinics. - Provided the members of the Missouri congressional delegation with advocacy materials regarding obstacles to the use and coverage of services delivered through telemedicine in Missouri. - Provided the members of the Missouri congressional delegation with updates on federal regulatory issues, including the Medicare wage index component of Medicare hospital payment formulas, changes in Medicare Disproportionate Share Hospital payments to Missouri hospitals, and changes affecting a national budget neutrality adjustment concerning a rural floor for hospital payments made by the Medicare program. - Provided the members of the Missouri congressional delegation with advocacy materials related to the Missouri Governors state fiscal year recommendations and final budget authorizations for various proposals related to rural health care delivery and financing. - Provided the members of the Missouri congressional delegation with informational materials regarding the number, type and finances of hospitals that are members of the Missouri Hospital Association. - Provided the members of the Missouri congressional delegation with informational materials regarding 2017 contributions of Missouri hospitals to the economy of Missouri. - Provided the members of the Missouri congressional delegation with information about Missouri hospitals that are owned by local governments and which have property or sales tax levies to support their operations. - Provided a member of the Missouri congressional delegation requested information regarding examples of workplace violence occurring in Missouri hospitals and interactions with regional federal regulators on this topic. - Responded to a request from a member of the Missouri congressional delegation for an assessment of a 2019 version of H.R. 3224 of the 115th Congress (the Critical Access and Rural Equity Act). - Provided a member of the Missouri congressional delegation with a draft letter to federal regulators at CMS and OSHA regarding workplace violence occurring in health care settings. - Corresponded with a member of the Missouri congressional delegation regarding staff changes and contact information within the members office. - Conversed with a staffer of a member of the Missouri congressional delegation regarding a joint report on workplace violence occurring in health care settings that was prepared by the Centers for Medicare & Medicaid Services of the Dept. of Health and Human Services and the Occupational Safety and Health Administration of the Dept. of Labor. - Provided a member of the Missouri congressional delegation with written commentary regarding a joint report on workplace violence occurring in health care settings that was prepared by the Centers for Medicare & Medicaid Services of the Dept. of Health and Human Services and the Occupational Safety and Health Administration of the Dept. of Labor. - Contacted selected members of the Missouri congressional delegation to coordinate logistics of meetings between executives of Missouri hospitals and the legislators and their staffs in Washington, DC. - Provided a member of the Missouri congressional delegation with a requested review of the Protecting People form Surprise Medical Bills Act. - Corresponded with a member of the Missouri congressional delegation regarding the No Surprises Act pending in the House of Representatives Energy and Commerce Committee.

- Corresponded with staff of a member of the Missouri congressional delegation regarding incidents of workplace violence occurring in Missouri hospitals, the Missouri Hospital Associations collection of data on such incidents and a 2019 joint report by CMS and OSHA regarding workplace violence. - Forwarded to a member of the Missouri congressional delegation a publication by the Missouri Hospital Association on this topic. MHA noted that it opposes H.R. 1309 and S. 851, which were summarized in the publication. - Conveyed to several members of the Missouri congressional delegation briefing materials regarding rural hospitals in Missouri. - Provided information to respond to a request from a member of the Missouri congressional delegation regarding drug shortage in rural Missouri hospitals. - Corresponded with a member of the Missouri congressional delegation to arrange for conversations between the Missouri Hospital Association and staff of the Dept. of Health and Human Services regarding workplace violence in Missouri hospitals. - Corresponded with a member of the Missouri congressional delegation regarding further incidents of workplace violence in Missouri hospitals and the reaction of CMS hospital compliance surveyors to those incidents. - Conveyed an infographic on workplace violence in Missouri hospitals to a member of the Missouri congressional delegation. - Corresponded with a member of the Missouri congressional delegation regarding discussions between the Missouri Hospital Association and staff of the Dept. of Health and Human Services. - Responded to a request from a member of the Missouri congressional delegation for comments regarding H.R. 3654. - Corresponded with staff of the Dept. of Health and Human Services to coordinate the logistics of a telephone call regarding workplace violence in Missouri hospitals. - Engaged in a telephone conversation with a staff member of the Dept. of Health and Human Services to discuss workplace violence in Missouri hospitals and regulatory standards for such incidents. - Corresponded with the members of the Missouri congressional delegation to promote legislation to block or delay implementation of a reduction in states allotments of federal funding to support Medicaid Disproportionate Share Hospital payments. - Conveyed to the members of the Missouri congressional delegation a new report by the Missouri Hospital Association on the topic of maternal mortality, as well as policy recommendations made in conjunction with a Missouri state Reimagine Rural Health initiative. - Responded to a request from a member of the Missouri congressional delegation to comment on the Missouri Hospital Associations position on surprise billing legislation developed by U.S. Sen. Lamar Alexander and other members of the Senate Health, Education, Labor and Pensions committee.

- Provided the members of the Missouri congressional delegation with advocacy materials regarding current federal laws reductions in states allotments of federal funding to support Medicaid Disproportionate Share hospital payments, including a reference to H.R. 2328. - Provided the members of the Missouri congressional delegation with advocacy materials regarding potential congressional action on legislation on the topic of surprise billing by physicians or other practitioners who do not participate in a provider network covered by the patients insurer. Supported provisions allowing billing disputes to be resolved by negotiation and/or binding arbitration rather than a governmentally-dictated payment amount. - Expressed support to the members of the Missouri congressional delegation for H.R. 728 and S. 1399, which would reauthorize the Title VIII Nursing Workforce program. - Provided the members of the Missouri congressional delegation with advocacy materials expressing support for reauthorization and expansion of the Medicaid demonstration project to deliver mental health services through Certified Community Behavioral Health Clinics. - Provided the members of the Missouri congressional delegation with advocacy materials regarding obstacles to the use and coverage of services delivered through telemedicine in Missouri. - Provided the members of the Missouri congressional delegation with updates on federal regulatory issues, including the Medicare wage index component of Medicare hospital payment formulas, changes in Medicare Disproportionate Share Hospital payments to Missouri hospitals, and changes affecting a national budget neutrality adjustment concerning a rural floor for hospital payments made by the Medicare program. - Provided the members of the Missouri congressional delegation with advocacy materials related to the Missouri Governors state fiscal year recommendations and final budget authorizations for various proposals related to rural health care delivery and financing. - Provided the members of the Missouri congressional delegation with informational materials regarding the number, type and finances of hospitals that are members of the Missouri Hospital Association. - Provided the members of the Missouri congressional delegation with informational materials regarding 2017 contributions of Missouri hospitals to the economy of Missouri. - Provided the members of the Missouri congressional delegation with information about Missouri hospitals that are owned by local governments and which have property or sales tax levies to support their operations. - Provided a member of the Missouri congressional delegation requested information regarding examples of workplace violence occurring in Missouri hospitals and interactions with regional federal regulators on this topic. - Responded to a request from a member of the Missouri congressional delegation for an assessment of a 2019 version of H.R. 3224 of the 115th Congress (the Critical Access and Rural Equity Act). - Provided a member of the Missouri congressional delegation with a draft letter to federal regulators at CMS and OSHA regarding workplace violence occurring in health care settings. - Corresponded with a member of the Missouri congressional delegation regarding staff changes and contact information within the members office. - Conversed with a staffer of a member of the Missouri congressional delegation regarding a joint report on workplace violence occurring in health care settings that was prepared by the Centers for Medicare & Medicaid Services of the Dept. of Health and Human Services and the Occupational Safety and Health Administration of the Dept. of Labor. - Provided a member of the Missouri congressional delegation with written commentary regarding a joint report on workplace violence occurring in health care settings that was prepared by the Centers for Medicare & Medicaid Services of the Dept. of Health and Human Services and the Occupational Safety and Health Administration of the Dept. of Labor. - Contacted selected members of the Missouri congressional delegation to coordinate logistics of meetings between executives of Missouri hospitals and the legislators and their staffs in Washington, DC. - Provided a member of the Missouri congressional delegation with a requested review of the Protecting People form Surprise Medical Bills Act. - Corresponded with a member of the Missouri congressional delegation regarding the No Surprises Act pending in the House of Representatives Energy and Commerce Committee.

- Forwarded to a member of the Missouri congressional delegation responses to a series of questions posted about transparency of price and quality data in health care - Invited the members of the Missouri congressional delegation to submit commentaries on health policy topics of their choice, to be published in the Missouri Hospital Associations electronic newsletter - Relayed comments to a member of the Missouri congressional delegation about audience reaction to his remarks at a Missouri event sponsored by the Missouri Hospital Association - Responded to a query from a member of the Missouri congressional delegation regarding accreditation changes imposed by the Higher Learning Commission for hospital-based nursing programs and their effect on Medicare pass-through payments for nursing education - Provided comments to a member of the Missouri congressional delegation regarding seven bills regarding opioid policy that were being reviewed by a House committee. They included H.R. 2851, H.R. 5041, H.R. 4275, and four draft proposals. - Forwarded to the members of the Missouri congressional delegation a copy of a memorandum to the Missouri General Assembly regarding policies of the health insurer Anthem to limit coverage of hospital emergency department services. Signatories to the memorandum were the Missouri Hospital Association, the Missouri State Medical Association, the Missouri Association of Osteopathic Physicians and Surgeons, the Missouri College of Emergency Physicians and the American Heart Association/American Stroke Association - Responded to a query for lists of hospitals in Missouri that are critical access hospitals, Medicare Dependent hospitals, Low-Volume hospitals, or receive Medicaid DSH or Medicare DSH payments, as well as a list of federally qualified health centers and their satellite clinics in Missouri. - Conversed with staff of a member of the Missouri congressional delegation regarding policies of the health insurer Anthem to restrict coverage of hospital emergency department services - Forwarded to a member of the Missouri congressional delegation a copy of an op-ed on the opioid crisis that was authored by the President/CEO of the Missouri Hospital Association and published in The Hill. - Forwarded to the members of the Missouri congressional delegation an infographic published by the Missouri Hospital Association regarding payments cuts for drugs acquired by hospitals under the federal 340B drug discount program - Responded to a query from a member of the Missouri congressional delegation regarding the members hospital-specific reductions in Medicaid DSH payments that took effect on October 1, 2017 - Forwarded to a member of the Missouri congressional delegation a Modern Healthcare article in which the member was quoted regarding opioid policy - Responded to a query from a member of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding payments to hospitals in the members district based on Low-Volume and Medicare Dependent status. - Conversed with a staffer of a member of the Missouri congressional delegation regarding H.R. 365, concerning payments to hospitals - Responded to two separate queries from members of the Missouri congressional delegation regarding federal and state legislation and law regarding direct primary care arrangements and H.R. 365 - Responded to a query from a member of the Missouri congressional delegation regarding the methodology of Medicare payments designated to low-volume hospitals - Forwarded to the members of the Missouri congressional delegation a copy of a statement from the Missouri Hospital Association regarding opioid abuse treatment and prevention initiatives expected to be mentioned in the State of the Union address - Corresponded with the office of a member of the Missouri congressional delegation regarding staffing changes in the office - Corresponded with a member of the Missouri congressional delegation regarding the release of information solicited by the member regarding restrictions on coverage of hospital emergency department services by the health insurer Anthem - Corresponded with two members of the Missouri congressional delegation regarding restrictions on coverage of hospital emergency department services by the health insurer Anthem - Forwarded to the members of the Missouri congressional delegation a letter from national physician specialty organizations regarding restrictions on coverage of hospital emergency department services by the health insurer Anthem - Forwarded to the members of the Missouri congressional delegation a report and news release by the Missouri Hospital Association regarding the economic cost of opioid abuse in Missouri. - Sent a letter to a member of the Missouri congressional delegation regarding the appointment of Alex Azar to be the Secretary of Health and Human Services - Forwarded to the members of the Missouri congressional delegation a Missouri Hospital Association report comparing deaths from opioid abuse and motor vehicle accidents, both in Missouri and nationally. - Corresponded with a member of the Missouri congressional delegation regarding the ongoing effect of section 31411 of the Patient Protection and Affordable Care Act of 2010 on Medicare payments to hospitals across the nation. - Corresponded with members of the Missouri congressional delegation regarding pending legislative issues affecting Missouri hospitals, including reauthorization of the Childrens Health Insurance Program and various Medicare extender payments to hospitals, addressing the 340B drug discount program, and delaying reductions to states Medicaid DSH allotments. - Corresponded with a member of the Missouri congressional delegation regarding the members letter of inquiry to the health insurer Anthem regarding its policies to restrict coverage of hospital emergency department services

- Forwarded to a member of the Missouri congressional delegation responses to a series of questions posted about transparency of price and quality data in health care - Invited the members of the Missouri congressional delegation to submit commentaries on health policy topics of their choice, to be published in the Missouri Hospital Associations electronic newsletter - Relayed comments to a member of the Missouri congressional delegation about audience reaction to his remarks at a Missouri event sponsored by the Missouri Hospital Association - Responded to a query from a member of the Missouri congressional delegation regarding accreditation changes imposed by the Higher Learning Commission for hospital-based nursing programs and their effect on Medicare pass-through payments for nursing education - Provided comments to a member of the Missouri congressional delegation regarding seven bills regarding opioid policy that were being reviewed by a House committee. They included H.R. 2851, H.R. 5041, H.R. 4275, and four draft proposals. - Forwarded to the members of the Missouri congressional delegation a copy of a memorandum to the Missouri General Assembly regarding policies of the health insurer Anthem to limit coverage of hospital emergency department services. Signatories to the memorandum were the Missouri Hospital Association, the Missouri State Medical Association, the Missouri Association of Osteopathic Physicians and Surgeons, the Missouri College of Emergency Physicians and the American Heart Association/American Stroke Association - Responded to a query for lists of hospitals in Missouri that are critical access hospitals, Medicare Dependent hospitals, Low-Volume hospitals, or receive Medicaid DSH or Medicare DSH payments, as well as a list of federally qualified health centers and their satellite clinics in Missouri. - Conversed with staff of a member of the Missouri congressional delegation regarding policies of the health insurer Anthem to restrict coverage of hospital emergency department services - Forwarded to a member of the Missouri congressional delegation a copy of an op-ed on the opioid crisis that was authored by the President/CEO of the Missouri Hospital Association and published in The Hill. - Forwarded to the members of the Missouri congressional delegation an infographic published by the Missouri Hospital Association regarding payments cuts for drugs acquired by hospitals under the federal 340B drug discount program - Responded to a query from a member of the Missouri congressional delegation regarding the members hospital-specific reductions in Medicaid DSH payments that took effect on October 1, 2017 - Forwarded to a member of the Missouri congressional delegation a Modern Healthcare article in which the member was quoted regarding opioid policy - Responded to a query from a member of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding payments to hospitals in the members district based on Low-Volume and Medicare Dependent status. - Conversed with a staffer of a member of the Missouri congressional delegation regarding H.R. 365, concerning payments to hospitals - Responded to two separate queries from members of the Missouri congressional delegation regarding federal and state legislation and law regarding direct primary care arrangements and H.R. 365 - Responded to a query from a member of the Missouri congressional delegation regarding the methodology of Medicare payments designated to low-volume hospitals - Forwarded to the members of the Missouri congressional delegation a copy of a statement from the Missouri Hospital Association regarding opioid abuse treatment and prevention initiatives expected to be mentioned in the State of the Union address - Corresponded with the office of a member of the Missouri congressional delegation regarding staffing changes in the office - Corresponded with a member of the Missouri congressional delegation regarding the release of information solicited by the member regarding restrictions on coverage of hospital emergency department services by the health insurer Anthem - Corresponded with two members of the Missouri congressional delegation regarding restrictions on coverage of hospital emergency department services by the health insurer Anthem - Forwarded to the members of the Missouri congressional delegation a letter from national physician specialty organizations regarding restrictions on coverage of hospital emergency department services by the health insurer Anthem - Forwarded to the members of the Missouri congressional delegation a report and news release by the Missouri Hospital Association regarding the economic cost of opioid abuse in Missouri. - Sent a letter to a member of the Missouri congressional delegation regarding the appointment of Alex Azar to be the Secretary of Health and Human Services - Forwarded to the members of the Missouri congressional delegation a Missouri Hospital Association report comparing deaths from opioid abuse and motor vehicle accidents, both in Missouri and nationally. - Corresponded with a member of the Missouri congressional delegation regarding the ongoing effect of section 31411 of the Patient Protection and Affordable Care Act of 2010 on Medicare payments to hospitals across the nation. - Corresponded with members of the Missouri congressional delegation regarding pending legislative issues affecting Missouri hospitals, including reauthorization of the Childrens Health Insurance Program and various Medicare extender payments to hospitals, addressing the 340B drug discount program, and delaying reductions to states Medicaid DSH allotments. - Corresponded with a member of the Missouri congressional delegation regarding the members letter of inquiry to the health insurer Anthem regarding its policies to restrict coverage of hospital emergency department services

- Forwarded to a member of the Missouri congressional delegation responses to a series of questions posted about transparency of price and quality data in health care - Invited the members of the Missouri congressional delegation to submit commentaries on health policy topics of their choice, to be published in the Missouri Hospital Associations electronic newsletter - Relayed comments to a member of the Missouri congressional delegation about audience reaction to his remarks at a Missouri event sponsored by the Missouri Hospital Association - Responded to a query from a member of the Missouri congressional delegation regarding accreditation changes imposed by the Higher Learning Commission for hospital-based nursing programs and their effect on Medicare pass-through payments for nursing education - Provided comments to a member of the Missouri congressional delegation regarding seven bills regarding opioid policy that were being reviewed by a House committee. They included H.R. 2851, H.R. 5041, H.R. 4275, and four draft proposals. - Forwarded to the members of the Missouri congressional delegation a copy of a memorandum to the Missouri General Assembly regarding policies of the health insurer Anthem to limit coverage of hospital emergency department services. Signatories to the memorandum were the Missouri Hospital Association, the Missouri State Medical Association, the Missouri Association of Osteopathic Physicians and Surgeons, the Missouri College of Emergency Physicians and the American Heart Association/American Stroke Association - Responded to a query for lists of hospitals in Missouri that are critical access hospitals, Medicare Dependent hospitals, Low-Volume hospitals, or receive Medicaid DSH or Medicare DSH payments, as well as a list of federally qualified health centers and their satellite clinics in Missouri. - Conversed with staff of a member of the Missouri congressional delegation regarding policies of the health insurer Anthem to restrict coverage of hospital emergency department services - Forwarded to a member of the Missouri congressional delegation a copy of an op-ed on the opioid crisis that was authored by the President/CEO of the Missouri Hospital Association and published in The Hill. - Forwarded to the members of the Missouri congressional delegation an infographic published by the Missouri Hospital Association regarding payments cuts for drugs acquired by hospitals under the federal 340B drug discount program - Responded to a query from a member of the Missouri congressional delegation regarding the members hospital-specific reductions in Medicaid DSH payments that took effect on October 1, 2017 - Forwarded to a member of the Missouri congressional delegation a Modern Healthcare article in which the member was quoted regarding opioid policy - Responded to a query from a member of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding payments to hospitals in the members district based on Low-Volume and Medicare Dependent status. - Conversed with a staffer of a member of the Missouri congressional delegation regarding H.R. 365, concerning payments to hospitals - Responded to two separate queries from members of the Missouri congressional delegation regarding federal and state legislation and law regarding direct primary care arrangements and H.R. 365 - Responded to a query from a member of the Missouri congressional delegation regarding the methodology of Medicare payments designated to low-volume hospitals - Forwarded to the members of the Missouri congressional delegation a copy of a statement from the Missouri Hospital Association regarding opioid abuse treatment and prevention initiatives expected to be mentioned in the State of the Union address - Corresponded with the office of a member of the Missouri congressional delegation regarding staffing changes in the office - Corresponded with a member of the Missouri congressional delegation regarding the release of information solicited by the member regarding restrictions on coverage of hospital emergency department services by the health insurer Anthem - Corresponded with two members of the Missouri congressional delegation regarding restrictions on coverage of hospital emergency department services by the health insurer Anthem - Forwarded to the members of the Missouri congressional delegation a letter from national physician specialty organizations regarding restrictions on coverage of hospital emergency department services by the health insurer Anthem - Forwarded to the members of the Missouri congressional delegation a report and news release by the Missouri Hospital Association regarding the economic cost of opioid abuse in Missouri. - Sent a letter to a member of the Missouri congressional delegation regarding the appointment of Alex Azar to be the Secretary of Health and Human Services - Forwarded to the members of the Missouri congressional delegation a Missouri Hospital Association report comparing deaths from opioid abuse and motor vehicle accidents, both in Missouri and nationally. - Corresponded with a member of the Missouri congressional delegation regarding the ongoing effect of section 31411 of the Patient Protection and Affordable Care Act of 2010 on Medicare payments to hospitals across the nation. - Corresponded with members of the Missouri congressional delegation regarding pending legislative issues affecting Missouri hospitals, including reauthorization of the Childrens Health Insurance Program and various Medicare extender payments to hospitals, addressing the 340B drug discount program, and delaying reductions to states Medicaid DSH allotments. - Corresponded with a member of the Missouri congressional delegation regarding the members letter of inquiry to the health insurer Anthem regarding its policies to restrict coverage of hospital emergency department services

- Corresponded with a member of the Missouri congressional delegation to promote the inclusion of language in the Senate Appropriations legislation for the Departments of Labor and the Health and Human Services regarding an interagency initiative on workplace violence in hospitals. - Responded to an inquiry from a member of the Missouri congressional delegation regarding a Dear Colleague letter to the Secretary of Health and Human Services and the CMS Administrator regarding changes to the wage index component of the Medicare hospital payment system. - Asked the members of the Missouri congressional delegation in the House of Representatives to consider endorsing a Dear Colleague letter to the Secretary of Health and Human Services and the CMS Administrator regarding changes to the wage index component of the Medicare hospital payment system. - Engaged with the staff of a member of the Missouri congressional delegation to discuss problems experienced by Missouri hospitals with the Centers for Medicare & Medicaid Services system of establishing and enforcing hospital regulatory standards. - Asked the members of the Missouri congressional delegation in the House of Representatives to support H.R. 6082 and H.R. 5797, relating to the prevention and treatment of opioid abuse. - Forwarded a Missouri Hospital Association report on neonatal abstinence syndrome to the offices of two U.S. Senators and two members of the House of Representatives who were the sponsors of legislation to reauthorize and revise the PREEMIE Act. - Corresponded with a member of the Missouri congressional delegation regarding medical treatment for opioid dependence and federally-funded opioid initiatives being implemented in Missouri. - Responded to an inquiry from a member of the Missouri congressional delegation regarding problems experienced by Missouri hospitals in the congressional district caused by the billing and claims payment system of the U.S. Veterans Administration. - Corresponded with a member of the Missouri congressional delegation regarding cosponsorship of H.R. 4392. - Corresponded with a member of the Missouri congressional delegation regarding the Missouri Hospital Associations stance on H.R. 5223. - Corresponded with a member of the Missouri congressional delegation regarding price transparency and profitability among Missouri hospitals. - Corresponded with a member of the Missouri congressional delegation regarding publication of a statement of the legislators health policy priorities. - Corresponded with a member of the Missouri congressional delegation regarding a letter to Secretary of Health and Human Services Azar and Secretary of Labor Acosta on the topic of coverage of hospital emergency department services by the health insurer Anthem.

- Forwarded to a member of the Missouri congressional delegation responses to a series of questions posted about transparency of price and quality data in health care - Invited the members of the Missouri congressional delegation to submit commentaries on health policy topics of their choice, to be published in the Missouri Hospital Associations electronic newsletter - Relayed comments to a member of the Missouri congressional delegation about audience reaction to his remarks at a Missouri event sponsored by the Missouri Hospital Association - Responded to a query from a member of the Missouri congressional delegation regarding accreditation changes imposed by the Higher Learning Commission for hospital-based nursing programs and their effect on Medicare pass-through payments for nursing education - Provided comments to a member of the Missouri congressional delegation regarding seven bills regarding opioid policy that were being reviewed by a House committee. They included H.R. 2851, H.R. 5041, H.R. 4275, and four draft proposals. - Forwarded to the members of the Missouri congressional delegation a copy of a memorandum to the Missouri General Assembly regarding policies of the health insurer Anthem to limit coverage of hospital emergency department services. Signatories to the memorandum were the Missouri Hospital Association, the Missouri State Medical Association, the Missouri Association of Osteopathic Physicians and Surgeons, the Missouri College of Emergency Physicians and the American Heart Association/American Stroke Association - Responded to a query for lists of hospitals in Missouri that are critical access hospitals, Medicare Dependent hospitals, Low-Volume hospitals, or receive Medicaid DSH or Medicare DSH payments, as well as a list of federally qualified health centers and their satellite clinics in Missouri. - Conversed with staff of a member of the Missouri congressional delegation regarding policies of the health insurer Anthem to restrict coverage of hospital emergency department services - Forwarded to a member of the Missouri congressional delegation a copy of an op-ed on the opioid crisis that was authored by the President/CEO of the Missouri Hospital Association and published in The Hill. - Forwarded to the members of the Missouri congressional delegation an infographic published by the Missouri Hospital Association regarding payments cuts for drugs acquired by hospitals under the federal 340B drug discount program - Responded to a query from a member of the Missouri congressional delegation regarding the members hospital-specific reductions in Medicaid DSH payments that took effect on October 1, 2017 - Forwarded to a member of the Missouri congressional delegation a Modern Healthcare article in which the member was quoted regarding opioid policy - Responded to a query from a member of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding payments to hospitals in the members district based on Low-Volume and Medicare Dependent status. - Conversed with a staffer of a member of the Missouri congressional delegation regarding H.R. 365, concerning payments to hospitals - Responded to two separate queries from members of the Missouri congressional delegation regarding federal and state legislation and law regarding direct primary care arrangements and H.R. 365 - Responded to a query from a member of the Missouri congressional delegation regarding the methodology of Medicare payments designated to low-volume hospitals - Forwarded to the members of the Missouri congressional delegation a copy of a statement from the Missouri Hospital Association regarding opioid abuse treatment and prevention initiatives expected to be mentioned in the State of the Union address - Corresponded with the office of a member of the Missouri congressional delegation regarding staffing changes in the office - Corresponded with a member of the Missouri congressional delegation regarding the release of information solicited by the member regarding restrictions on coverage of hospital emergency department services by the health insurer Anthem - Corresponded with two members of the Missouri congressional delegation regarding restrictions on coverage of hospital emergency department services by the health insurer Anthem - Forwarded to the members of the Missouri congressional delegation a letter from national physician specialty organizations regarding restrictions on coverage of hospital emergency department services by the health insurer Anthem - Forwarded to the members of the Missouri congressional delegation a report and news release by the Missouri Hospital Association regarding the economic cost of opioid abuse in Missouri. - Sent a letter to a member of the Missouri congressional delegation regarding the appointment of Alex Azar to be the Secretary of Health and Human Services - Forwarded to the members of the Missouri congressional delegation a Missouri Hospital Association report comparing deaths from opioid abuse and motor vehicle accidents, both in Missouri and nationally. - Corresponded with a member of the Missouri congressional delegation regarding the ongoing effect of section 31411 of the Patient Protection and Affordable Care Act of 2010 on Medicare payments to hospitals across the nation. - Corresponded with members of the Missouri congressional delegation regarding pending legislative issues affecting Missouri hospitals, including reauthorization of the Childrens Health Insurance Program and various Medicare extender payments to hospitals, addressing the 340B drug discount program, and delaying reductions to states Medicaid DSH allotments. - Corresponded with a member of the Missouri congressional delegation regarding the members letter of inquiry to the health insurer Anthem regarding its policies to restrict coverage of hospital emergency department services

- Corresponded with a member of the Missouri congressional delegation to promote the inclusion of language in the Senate Appropriations legislation for the Departments of Labor and the Health and Human Services regarding an interagency initiative on workplace violence in hospitals. - Responded to an inquiry from a member of the Missouri congressional delegation regarding a Dear Colleague letter to the Secretary of Health and Human Services and the CMS Administrator regarding changes to the wage index component of the Medicare hospital payment system. - Asked the members of the Missouri congressional delegation in the House of Representatives to consider endorsing a Dear Colleague letter to the Secretary of Health and Human Services and the CMS Administrator regarding changes to the wage index component of the Medicare hospital payment system. - Engaged with the staff of a member of the Missouri congressional delegation to discuss problems experienced by Missouri hospitals with the Centers for Medicare & Medicaid Services system of establishing and enforcing hospital regulatory standards. - Asked the members of the Missouri congressional delegation in the House of Representatives to support H.R. 6082 and H.R. 5797, relating to the prevention and treatment of opioid abuse. - Forwarded a Missouri Hospital Association report on neonatal abstinence syndrome to the offices of two U.S. Senators and two members of the House of Representatives who were the sponsors of legislation to reauthorize and revise the PREEMIE Act. - Corresponded with a member of the Missouri congressional delegation regarding medical treatment for opioid dependence and federally-funded opioid initiatives being implemented in Missouri. - Responded to an inquiry from a member of the Missouri congressional delegation regarding problems experienced by Missouri hospitals in the congressional district caused by the billing and claims payment system of the U.S. Veterans Administration. - Corresponded with a member of the Missouri congressional delegation regarding cosponsorship of H.R. 4392. - Corresponded with a member of the Missouri congressional delegation regarding the Missouri Hospital Associations stance on H.R. 5223. - Corresponded with a member of the Missouri congressional delegation regarding price transparency and profitability among Missouri hospitals. - Corresponded with a member of the Missouri congressional delegation regarding publication of a statement of the legislators health policy priorities. - Corresponded with a member of the Missouri congressional delegation regarding a letter to Secretary of Health and Human Services Azar and Secretary of Labor Acosta on the topic of coverage of hospital emergency department services by the health insurer Anthem.

- Corresponded with a member of the Missouri congressional delegation to promote the inclusion of language in the Senate Appropriations legislation for the Departments of Labor and the Health and Human Services regarding an interagency initiative on workplace violence in hospitals. - Responded to an inquiry from a member of the Missouri congressional delegation regarding a Dear Colleague letter to the Secretary of Health and Human Services and the CMS Administrator regarding changes to the wage index component of the Medicare hospital payment system. - Asked the members of the Missouri congressional delegation in the House of Representatives to consider endorsing a Dear Colleague letter to the Secretary of Health and Human Services and the CMS Administrator regarding changes to the wage index component of the Medicare hospital payment system. - Engaged with the staff of a member of the Missouri congressional delegation to discuss problems experienced by Missouri hospitals with the Centers for Medicare & Medicaid Services system of establishing and enforcing hospital regulatory standards. - Asked the members of the Missouri congressional delegation in the House of Representatives to support H.R. 6082 and H.R. 5797, relating to the prevention and treatment of opioid abuse. - Forwarded a Missouri Hospital Association report on neonatal abstinence syndrome to the offices of two U.S. Senators and two members of the House of Representatives who were the sponsors of legislation to reauthorize and revise the PREEMIE Act. - Corresponded with a member of the Missouri congressional delegation regarding medical treatment for opioid dependence and federally-funded opioid initiatives being implemented in Missouri. - Responded to an inquiry from a member of the Missouri congressional delegation regarding problems experienced by Missouri hospitals in the congressional district caused by the billing and claims payment system of the U.S. Veterans Administration. - Corresponded with a member of the Missouri congressional delegation regarding cosponsorship of H.R. 4392. - Corresponded with a member of the Missouri congressional delegation regarding the Missouri Hospital Associations stance on H.R. 5223. - Corresponded with a member of the Missouri congressional delegation regarding price transparency and profitability among Missouri hospitals. - Corresponded with a member of the Missouri congressional delegation regarding publication of a statement of the legislators health policy priorities. - Corresponded with a member of the Missouri congressional delegation regarding a letter to Secretary of Health and Human Services Azar and Secretary of Labor Acosta on the topic of coverage of hospital emergency department services by the health insurer Anthem.

- Corresponded with a member of the Missouri congressional delegation to promote the inclusion of language in the Senate Appropriations legislation for the Departments of Labor and the Health and Human Services regarding an interagency initiative on workplace violence in hospitals. - Responded to an inquiry from a member of the Missouri congressional delegation regarding a Dear Colleague letter to the Secretary of Health and Human Services and the CMS Administrator regarding changes to the wage index component of the Medicare hospital payment system. - Asked the members of the Missouri congressional delegation in the House of Representatives to consider endorsing a Dear Colleague letter to the Secretary of Health and Human Services and the CMS Administrator regarding changes to the wage index component of the Medicare hospital payment system. - Engaged with the staff of a member of the Missouri congressional delegation to discuss problems experienced by Missouri hospitals with the Centers for Medicare & Medicaid Services system of establishing and enforcing hospital regulatory standards. - Asked the members of the Missouri congressional delegation in the House of Representatives to support H.R. 6082 and H.R. 5797, relating to the prevention and treatment of opioid abuse. - Forwarded a Missouri Hospital Association report on neonatal abstinence syndrome to the offices of two U.S. Senators and two members of the House of Representatives who were the sponsors of legislation to reauthorize and revise the PREEMIE Act. - Corresponded with a member of the Missouri congressional delegation regarding medical treatment for opioid dependence and federally-funded opioid initiatives being implemented in Missouri. - Responded to an inquiry from a member of the Missouri congressional delegation regarding problems experienced by Missouri hospitals in the congressional district caused by the billing and claims payment system of the U.S. Veterans Administration. - Corresponded with a member of the Missouri congressional delegation regarding cosponsorship of H.R. 4392. - Corresponded with a member of the Missouri congressional delegation regarding the Missouri Hospital Associations stance on H.R. 5223. - Corresponded with a member of the Missouri congressional delegation regarding price transparency and profitability among Missouri hospitals. - Corresponded with a member of the Missouri congressional delegation regarding publication of a statement of the legislators health policy priorities. - Corresponded with a member of the Missouri congressional delegation regarding a letter to Secretary of Health and Human Services Azar and Secretary of Labor Acosta on the topic of coverage of hospital emergency department services by the health insurer Anthem.

- Corresponded with selected members of the Missouri congressional delegation regarding the health insurer Anthems discontinuation of participation in the sale of policies of individual health insurance coverage in the federally-subsidized exchange/Marketplace program in 2019 in 14 Missouri counties. - Corresponded with selected members of the Missouri congressional delegation regarding endorsement of a Dear Colleague letter regarding site-neutral payments for Medicare services delivered in certain outpatient hospital settings. - Corresponded with members of the Missouri congressional delegation regarding participation by health staffers in a joint discussion/briefing session on health policy issues with members of the Missouri Hospital Association. - Corresponded with members of the Missouri congressional delegation to invite them to attend a dinner with representatives of members of the Missouri Hospital Association - Received a draft of federal legislation from a member of the Missouri congressional delegation regarding regulation of surprise billing. - Corresponded with a member of the Missouri congressional delegation regarding the status of language in the Conference Report 115-952 for the minibus H.R. 6157 regarding regulatory standards for workplace safety in hospitals. - Corresponded with a member of the Missouri congressional delegation regarding the possibility of scheduling a meeting of the legislator and several members of the Missouri Hospital Association to discuss CMS regulatory standards and processes for hospitals. - Corresponded with the members of the Missouri congressional delegation to transmit a Missouri Hospital Association Trajectories publication regarding opioid use disorder and the use of a medication first treatment model. - Corresponded with the members of the Missouri congressional delegation to transmit a Missouri Hospital Association assessment of the shortage of primary care providers in Missouri. - Responded to a query from staff of a Senate committee regarding trends in the use of emergency departments in Missouri hospitals. - Respond to a query from a member of the Missouri congressional delegation regarding data on insurer participation and enrollment in health insurance plans offered through the federally-subsidized marketplace in 2018. - Corresponded with a new health staffer in the office of a member of the Missouri congressional delegation regarding the Missouri Hospital Association. - Corresponded with a member of the Missouri congressional staff to respond to a request regarding S. 2690 and the calculation of Medicare Disproportionate Share Hospital payments. - Corresponded with a member of the Missouri congressional delegation regarding participation in an event and press conference regarding the prevention and treatment of opioid abuse. - Corresponded with the members of the Missouri congressional delegation to express opposition to legislative efforts to limit the scope of the 340B drug discount program. - Corresponded with a member of the Missouri congressional delegation to convey the Missouri Hospital Associations appreciation for work done to include legislative language on workplace safety standards in hospitals in a version of the Labor/HHS appropriations bill. - Participated in a public event involving a member of the Missouri congressional delegation at a clinic owned by a Missouri hospital. - Communicated with staff of the Centers for Medicare & Medicaid Services and the Department of Labor regarding hospital regulatory standards and practices. - Communicated with staff in the Dept. of Health and Human Services regarding implementation of emergency preparedness and response programs.

- Corresponded with selected members of the Missouri congressional delegation regarding the health insurer Anthems discontinuation of participation in the sale of policies of individual health insurance coverage in the federally-subsidized exchange/Marketplace program in 2019 in 14 Missouri counties. - Corresponded with selected members of the Missouri congressional delegation regarding endorsement of a Dear Colleague letter regarding site-neutral payments for Medicare services delivered in certain outpatient hospital settings. - Corresponded with members of the Missouri congressional delegation regarding participation by health staffers in a joint discussion/briefing session on health policy issues with members of the Missouri Hospital Association. - Corresponded with members of the Missouri congressional delegation to invite them to attend a dinner with representatives of members of the Missouri Hospital Association - Received a draft of federal legislation from a member of the Missouri congressional delegation regarding regulation of surprise billing. - Corresponded with a member of the Missouri congressional delegation regarding the status of language in the Conference Report 115-952 for the minibus H.R. 6157 regarding regulatory standards for workplace safety in hospitals. - Corresponded with a member of the Missouri congressional delegation regarding the possibility of scheduling a meeting of the legislator and several members of the Missouri Hospital Association to discuss CMS regulatory standards and processes for hospitals. - Corresponded with the members of the Missouri congressional delegation to transmit a Missouri Hospital Association Trajectories publication regarding opioid use disorder and the use of a medication first treatment model. - Corresponded with the members of the Missouri congressional delegation to transmit a Missouri Hospital Association assessment of the shortage of primary care providers in Missouri. - Responded to a query from staff of a Senate committee regarding trends in the use of emergency departments in Missouri hospitals. - Respond to a query from a member of the Missouri congressional delegation regarding data on insurer participation and enrollment in health insurance plans offered through the federally-subsidized marketplace in 2018. - Corresponded with a new health staffer in the office of a member of the Missouri congressional delegation regarding the Missouri Hospital Association. - Corresponded with a member of the Missouri congressional staff to respond to a request regarding S. 2690 and the calculation of Medicare Disproportionate Share Hospital payments. - Corresponded with a member of the Missouri congressional delegation regarding participation in an event and press conference regarding the prevention and treatment of opioid abuse. - Corresponded with the members of the Missouri congressional delegation to express opposition to legislative efforts to limit the scope of the 340B drug discount program. - Corresponded with a member of the Missouri congressional delegation to convey the Missouri Hospital Associations appreciation for work done to include legislative language on workplace safety standards in hospitals in a version of the Labor/HHS appropriations bill. - Participated in a public event involving a member of the Missouri congressional delegation at a clinic owned by a Missouri hospital. - Communicated with staff of the Centers for Medicare & Medicaid Services and the Department of Labor regarding hospital regulatory standards and practices. - Communicated with staff in the Dept. of Health and Human Services regarding implementation of emergency preparedness and response programs.

- Discussed S. 2156 with a member of the Missouri congressional delegation. - Corresponded with the members of the Missouri congressional delegation regarding components of H.R. 1 regarding the ability of hospitals to use private activity bonds and advance refunding bonds, the deductibility of medical expenses, an excise tax on compensation of employees of 501(c)(3) tax-exempt organizations, and repeal of the individual mandate for those above certain income thresholds to have health insurance coverage. - Corresponded with the members of the Missouri congressional delegation regarding the health insurer Anthems implementation of coverage restrictions for hospital emergency and imaging services. - Corresponded with several members of the Missouri congressional delegation regarding proposed questions to ask Alex Azar in considering his nomination to be Secretary of Health and Human Services. - Responded to queries from a member of the Missouri congressional delegation regarding proposed revisions to S. 2156. - Corresponded with the members of the Missouri congressional delegation regarding the potential for legislation to reverse a final regulation of the Center for Medicare & Medicaid Services implementing a three-year transition to the use of Worksheet S-10 for distributing Medicare Disproportionate Share Hospital payments. - Responded to a query from a member of the Missouri congressional delegation regarding a constituent query regarding mental health and housing for veterans. - Responded to a query from a member of the Missouri congressional delegation regarding the implications of the lapsing of Medicare Low-Volume Hospital payments as of October 1, 2017. - Responded to a query from a member of the Missouri congressional delegation to discuss the cost implications to Missouri hospitals of section 3141 of the Patient Protection and Affordable Care Act of 2010. - Responded to a query from a member of the Missouri congressional delegation regarding a list of Missouri hospitals designated as rural referral centers. - Prepared materials for use by those who are not federal lobbyists in discussing issues regarding hospital survey and certification regulatory activities of the Centers for Medicare & Medicaid Services. - Corresponded with the chairman of the U.S. House of Representatives Energy and Commerce Committee to express support for H.R. 3922. - Responded to a query from a member of the Missouri congressional delegation regarding coverage restrictions on hospital emergency and imaging services by the health insurer Anthem. - Corresponded with and discussed with a member of the Missouri congressional delegation a draft of legislation by the Senate Finance Committee regarding Medicare Low-Volume Hospital payments to hospitals.

- Discussed S. 2156 with a member of the Missouri congressional delegation. - Corresponded with the members of the Missouri congressional delegation regarding components of H.R. 1 regarding the ability of hospitals to use private activity bonds and advance refunding bonds, the deductibility of medical expenses, an excise tax on compensation of employees of 501(c)(3) tax-exempt organizations, and repeal of the individual mandate for those above certain income thresholds to have health insurance coverage. - Corresponded with the members of the Missouri congressional delegation regarding the health insurer Anthems implementation of coverage restrictions for hospital emergency and imaging services. - Corresponded with several members of the Missouri congressional delegation regarding proposed questions to ask Alex Azar in considering his nomination to be Secretary of Health and Human Services. - Responded to queries from a member of the Missouri congressional delegation regarding proposed revisions to S. 2156. - Corresponded with the members of the Missouri congressional delegation regarding the potential for legislation to reverse a final regulation of the Center for Medicare & Medicaid Services implementing a three-year transition to the use of Worksheet S-10 for distributing Medicare Disproportionate Share Hospital payments. - Responded to a query from a member of the Missouri congressional delegation regarding a constituent query regarding mental health and housing for veterans. - Responded to a query from a member of the Missouri congressional delegation regarding the implications of the lapsing of Medicare Low-Volume Hospital payments as of October 1, 2017. - Responded to a query from a member of the Missouri congressional delegation to discuss the cost implications to Missouri hospitals of section 3141 of the Patient Protection and Affordable Care Act of 2010. - Responded to a query from a member of the Missouri congressional delegation regarding a list of Missouri hospitals designated as rural referral centers. - Prepared materials for use by those who are not federal lobbyists in discussing issues regarding hospital survey and certification regulatory activities of the Centers for Medicare & Medicaid Services. - Corresponded with the chairman of the U.S. House of Representatives Energy and Commerce Committee to express support for H.R. 3922. - Responded to a query from a member of the Missouri congressional delegation regarding coverage restrictions on hospital emergency and imaging services by the health insurer Anthem. - Corresponded with and discussed with a member of the Missouri congressional delegation a draft of legislation by the Senate Finance Committee regarding Medicare Low-Volume Hospital payments to hospitals.

- Discussed S. 2156 with a member of the Missouri congressional delegation. - Corresponded with the members of the Missouri congressional delegation regarding components of H.R. 1 regarding the ability of hospitals to use private activity bonds and advance refunding bonds, the deductibility of medical expenses, an excise tax on compensation of employees of 501(c)(3) tax-exempt organizations, and repeal of the individual mandate for those above certain income thresholds to have health insurance coverage. - Corresponded with the members of the Missouri congressional delegation regarding the health insurer Anthems implementation of coverage restrictions for hospital emergency and imaging services. - Corresponded with several members of the Missouri congressional delegation regarding proposed questions to ask Alex Azar in considering his nomination to be Secretary of Health and Human Services. - Responded to queries from a member of the Missouri congressional delegation regarding proposed revisions to S. 2156. - Corresponded with the members of the Missouri congressional delegation regarding the potential for legislation to reverse a final regulation of the Center for Medicare & Medicaid Services implementing a three-year transition to the use of Worksheet S-10 for distributing Medicare Disproportionate Share Hospital payments. - Responded to a query from a member of the Missouri congressional delegation regarding a constituent query regarding mental health and housing for veterans. - Responded to a query from a member of the Missouri congressional delegation regarding the implications of the lapsing of Medicare Low-Volume Hospital payments as of October 1, 2017. - Responded to a query from a member of the Missouri congressional delegation to discuss the cost implications to Missouri hospitals of section 3141 of the Patient Protection and Affordable Care Act of 2010. - Responded to a query from a member of the Missouri congressional delegation regarding a list of Missouri hospitals designated as rural referral centers. - Prepared materials for use by those who are not federal lobbyists in discussing issues regarding hospital survey and certification regulatory activities of the Centers for Medicare & Medicaid Services. - Corresponded with the chairman of the U.S. House of Representatives Energy and Commerce Committee to express support for H.R. 3922. - Responded to a query from a member of the Missouri congressional delegation regarding coverage restrictions on hospital emergency and imaging services by the health insurer Anthem. - Corresponded with and discussed with a member of the Missouri congressional delegation a draft of legislation by the Senate Finance Committee regarding Medicare Low-Volume Hospital payments to hospitals.

- Discussed S. 2156 with a member of the Missouri congressional delegation. - Corresponded with the members of the Missouri congressional delegation regarding components of H.R. 1 regarding the ability of hospitals to use private activity bonds and advance refunding bonds, the deductibility of medical expenses, an excise tax on compensation of employees of 501(c)(3) tax-exempt organizations, and repeal of the individual mandate for those above certain income thresholds to have health insurance coverage. - Corresponded with the members of the Missouri congressional delegation regarding the health insurer Anthems implementation of coverage restrictions for hospital emergency and imaging services. - Corresponded with several members of the Missouri congressional delegation regarding proposed questions to ask Alex Azar in considering his nomination to be Secretary of Health and Human Services. - Responded to queries from a member of the Missouri congressional delegation regarding proposed revisions to S. 2156. - Corresponded with the members of the Missouri congressional delegation regarding the potential for legislation to reverse a final regulation of the Center for Medicare & Medicaid Services implementing a three-year transition to the use of Worksheet S-10 for distributing Medicare Disproportionate Share Hospital payments. - Responded to a query from a member of the Missouri congressional delegation regarding a constituent query regarding mental health and housing for veterans. - Responded to a query from a member of the Missouri congressional delegation regarding the implications of the lapsing of Medicare Low-Volume Hospital payments as of October 1, 2017. - Responded to a query from a member of the Missouri congressional delegation to discuss the cost implications to Missouri hospitals of section 3141 of the Patient Protection and Affordable Care Act of 2010. - Responded to a query from a member of the Missouri congressional delegation regarding a list of Missouri hospitals designated as rural referral centers. - Prepared materials for use by those who are not federal lobbyists in discussing issues regarding hospital survey and certification regulatory activities of the Centers for Medicare & Medicaid Services. - Corresponded with the chairman of the U.S. House of Representatives Energy and Commerce Committee to express support for H.R. 3922. - Responded to a query from a member of the Missouri congressional delegation regarding coverage restrictions on hospital emergency and imaging services by the health insurer Anthem. - Corresponded with and discussed with a member of the Missouri congressional delegation a draft of legislation by the Senate Finance Committee regarding Medicare Low-Volume Hospital payments to hospitals.

- Discussed S. 2156 with a member of the Missouri congressional delegation. - Corresponded with the members of the Missouri congressional delegation regarding components of H.R. 1 regarding the ability of hospitals to use private activity bonds and advance refunding bonds, the deductibility of medical expenses, an excise tax on compensation of employees of 501(c)(3) tax-exempt organizations, and repeal of the individual mandate for those above certain income thresholds to have health insurance coverage. - Corresponded with the members of the Missouri congressional delegation regarding the health insurer Anthems implementation of coverage restrictions for hospital emergency and imaging services. - Corresponded with several members of the Missouri congressional delegation regarding proposed questions to ask Alex Azar in considering his nomination to be Secretary of Health and Human Services. - Responded to queries from a member of the Missouri congressional delegation regarding proposed revisions to S. 2156. - Corresponded with the members of the Missouri congressional delegation regarding the potential for legislation to reverse a final regulation of the Center for Medicare & Medicaid Services implementing a three-year transition to the use of Worksheet S-10 for distributing Medicare Disproportionate Share Hospital payments. - Responded to a query from a member of the Missouri congressional delegation regarding a constituent query regarding mental health and housing for veterans. - Responded to a query from a member of the Missouri congressional delegation regarding the implications of the lapsing of Medicare Low-Volume Hospital payments as of October 1, 2017. - Responded to a query from a member of the Missouri congressional delegation to discuss the cost implications to Missouri hospitals of section 3141 of the Patient Protection and Affordable Care Act of 2010. - Responded to a query from a member of the Missouri congressional delegation regarding a list of Missouri hospitals designated as rural referral centers. - Prepared materials for use by those who are not federal lobbyists in discussing issues regarding hospital survey and certification regulatory activities of the Centers for Medicare & Medicaid Services. - Corresponded with the chairman of the U.S. House of Representatives Energy and Commerce Committee to express support for H.R. 3922. - Responded to a query from a member of the Missouri congressional delegation regarding coverage restrictions on hospital emergency and imaging services by the health insurer Anthem. - Corresponded with and discussed with a member of the Missouri congressional delegation a draft of legislation by the Senate Finance Committee regarding Medicare Low-Volume Hospital payments to hospitals.

- Discussed S. 2156 with a member of the Missouri congressional delegation. - Corresponded with the members of the Missouri congressional delegation regarding components of H.R. 1 regarding the ability of hospitals to use private activity bonds and advance refunding bonds, the deductibility of medical expenses, an excise tax on compensation of employees of 501(c)(3) tax-exempt organizations, and repeal of the individual mandate for those above certain income thresholds to have health insurance coverage. - Corresponded with the members of the Missouri congressional delegation regarding the health insurer Anthems implementation of coverage restrictions for hospital emergency and imaging services. - Corresponded with several members of the Missouri congressional delegation regarding proposed questions to ask Alex Azar in considering his nomination to be Secretary of Health and Human Services. - Responded to queries from a member of the Missouri congressional delegation regarding proposed revisions to S. 2156. - Corresponded with the members of the Missouri congressional delegation regarding the potential for legislation to reverse a final regulation of the Center for Medicare & Medicaid Services implementing a three-year transition to the use of Worksheet S-10 for distributing Medicare Disproportionate Share Hospital payments. - Responded to a query from a member of the Missouri congressional delegation regarding a constituent query regarding mental health and housing for veterans. - Responded to a query from a member of the Missouri congressional delegation regarding the implications of the lapsing of Medicare Low-Volume Hospital payments as of October 1, 2017. - Responded to a query from a member of the Missouri congressional delegation to discuss the cost implications to Missouri hospitals of section 3141 of the Patient Protection and Affordable Care Act of 2010. - Responded to a query from a member of the Missouri congressional delegation regarding a list of Missouri hospitals designated as rural referral centers. - Prepared materials for use by those who are not federal lobbyists in discussing issues regarding hospital survey and certification regulatory activities of the Centers for Medicare & Medicaid Services. - Corresponded with the chairman of the U.S. House of Representatives Energy and Commerce Committee to express support for H.R. 3922. - Responded to a query from a member of the Missouri congressional delegation regarding coverage restrictions on hospital emergency and imaging services by the health insurer Anthem. - Corresponded with and discussed with a member of the Missouri congressional delegation a draft of legislation by the Senate Finance Committee regarding Medicare Low-Volume Hospital payments to hospitals.

- Corresponded with members of the Missouri congressional delegation regarding a Missouri Hospital Association initiative to promote regulatory reform. Topics included the formula used to calculate Medicare DSH payments, accreditation of sleep laboratories under the Medicare program, Medicaid DSH audit litigation, and changes to the Medicare wage index formula. - Corresponded with members of the Missouri congressional delegation regarding the American Health Care Act, with focus on components of the legislation that provide direct benefits to states that expanded Medicaid eligibility under the Affordable Care Act in comparison to direct benefits to states that did not expand Medicaid eligibility. - Corresponded with members of the Missouri congressional delegation regarding the American Health Care Act, with focus on the state and district-specific effects on coverage of repealing the health care "marketplace" authorized by the Affordable Care Act. - Conversed with an intern in the office of a member of the Missouri congressional delegation regarding health policy. - Corresponded with the Missouri congressional delegation regarding the state and district-specific implications of repealing the payment components of Title III of the Affordable Care Act. - Conversed with staff of selected members of the Missouri congressional delegation regarding a regulatory reform initiative of the Missouri Hospital Association. - Corresponded with members of the Missouri congressional delegation regarding a joint letter with the Missouri Chamber of Commerce and Industry regarding legislation to repeal/replace components of the Affordable Care Act. - Corresponded with members of the Missouri congressional delegation regarding research done by an MHA subsidiary regarding the effects of opioid addiction. - Responded to a request for comment from a member of the Missouri congressional delegation regarding the Save Rural Hospitals Act (H.R. 3225). - Corresponded with a member of the Missouri congressional delegation regarding logistics of visits with representatives of Missouri hospitals. - Corresponded with a staffer for a Missouri congressman who is leaving federal employment. - Corresponded with a member of the Missouri congressional delegation regarding repeal and replacement of the Affordable Care Act and its implications for hospitals. - Responded to a request from a congressional office to send a list of rural hospitals.

- provided information regarding the geographic distribution of behavioral healthcare providers in Missouri - discussed performance improvement initiatives of Missouris small rural hospitals - promoted legislation to curb unnecessary data reporting to the CMS Hospital Compare website - promoted the passage of legislation concerning behavioral healthcare (H. R. 2646, S. 1945) - promoted Missouris participation in phase 2 of the Excellence In Mental Health Act - discussed the implications of fewer marketplace insurers serving the Missouri market in 2017 - promoted changes to the Medicare area wage index formula provided by S. 1135 and H. R. 1479 - expressed concerns regarding the role of CMS controlling the health care market through mandated participation in delivery model reform initiatives - expressed support for protecting the 340B drug discount program - promoted accountability for health information technology vendors as provided by sections of S. 2511 - provided information regarding Missouri hospital utilization and finances, in aggregate and by congressional district - provided information to a member of the Missouri congressional delegation regarding Medicare coverage of telemedicine services - at the request of a member of the Missouri congressional delegation , provided information regarding contact information for selected Missouri chief executive officers` - provided information to members of the Missouri delegation regarding CMS denial of an extension of the institutions for mental disease demonstration project - provided information to members of the congressional delegation regarding the need to adjust data used in CMSs star rating system to account for differences in patients sociodemographic status - provided information to a member of the Missouri congressional delegation regarding critical access hospitals in Missouri - provided information to members of the Missouri congressional delegation regarding CMSs basis for its recent actions to terminate a Missouri hospital from the Medicare program for failing to be primarily engaged in providing inpatient services - contacted a member the Missouri congressional delegation regarding a letter to CMS expressing concern about the Medicare wage index data submission appeal of Nantucket Cottage Hospital of Nantucket, Massachusetts - provided information to a member of the Missouri congressional delegation regarding advocacy on social media on the topic of abuse of opioids - contacted selected members of the Missouri delegation asking them to make contacts with legislative leaders and selected committee leaders regarding the Medicare wage index data submission appeal of Nantucket Cottage Hospital of Nantucket, Massachusetts

- Contacted the members of the Missouri congressional delegation to express opposition to a section of the Common Sense Savings Act of 2016 (H.R. 4725) that would reduce the federal cap on states; use of provider taxes to fund their Medicaid programs. - Encouraged selected Missouri hospitals to contact their congressman to express opposition to Section 4 of H.R. 4725 as considered by the House Energy and Commerce Committee. - Corresponded with the staff of a member of the Missouri congressional delegation regarding advocacy contacts from Missouri hospitals regarding H.R. 4725. - Responded to a query from a member of the Missouri congressional delegation regarding a potential nominee for appointment to the Medicare Payment Advisory Committee. - Responded to a query from a member of the Missouri congressional delegation regarding the number of Missouri hospitals participating in the Federal Housing Administrations mortgage insurance program for hospitals. - Responded to a query from a member hospital for advocacy documents used in briefing members of Missouris congressional delegation in October 2015. The documents were for potential use in the hospitals discussions with its congressional representative. - Provided the members of the Missouri congressional delegation with a copy of the Missouri Hospital Associations comments regarding site-neutral Medicare payments to off-campus hospital outpatient departments. Such comments were solicited by the chairs of the House of Representatives Ways & Means Committee and its Subcommittee on Health. - Furnished the members of the Missouri congressional delegation with the Missouri Hospital Associations 2016 annual report of community benefit activities by Missouri hospitals. - Discussed legislation with a member of the Missouri congressional delegation to promote changes in federal statutes regarding eligibility of federally-designated Medicare sole community hospitals to receive payments for services delivered through telemedicine. The discussion referenced H.R. 2066, the Telehealth Enhancement Act of 2015. - Correspondence regarding a staffing change in the office of a member of the Missouri congressional delegation. - Corresponded with members of the Missouri congressional delegation regarding logistics for an advocacy briefing session in May 2016. - Invited staff of the Missouri congressional delegation to participate in a Missouri Hospital Association telephone conference regarding an MHA hospital price and quality transparency initiative and its use of socio-demographic adjustments to the quality data. - Met with selected members of the Missouri congressional delegation to discuss advocacy topics, including: general prospects for legislative action on health care topics in 2016, recommendations for MHA engagement in advocacy briefing sessions, and H.R. 3288 regarding the use of worksheet S-10 in calculating Medicare Disproportionate Share Hospital payments. - Worked with committee staff and the staff of a member of the Missouri congressional delegation to coordinate logistics and witnesses for a field hearing of the U.S. Senate Special Committee on Aging on the topic of opioid use and abuse by the elderly. - Met with Region 7 and WPS to discuss the problems recent rural health clinic billing will bring to clinics.

-Forwarded to the members of the Missouri congressional delegation a letter from the Alliance for Americas Hospitals, to which the Missouri Hospital Association was a signatory, urging repeal of section 3141 of the Patient Protection and Affordable Care Act of 2010. -Responded to a request from a member of the Missouri congressional delegation regarding the performance of Missouris critical access hospitals if they were included in the Medicare value-based purchasing initiative applicable to Medicare inpatient prospective payment system hospitals. -Responded to a request from a member of the Missouri congressional delegation as to how many Missouri counties have only one insurer offering coverage through the CMS health care marketplace. -Responded to a request from a member of the Missouri congressional delegation to provide comments regarding potential nominees for appointment to leadership positions in the Department of Health and Senior Services or the Centers for Medicare & Medicaid. -Expressed support for enactment of H.R. 34, the 21st Century Cures Act. -In response to a query from a member of the Missouri congressional delegation, expressed opposition to H.R. 2513. -Corresponded with a member of the Missouri congressional delegation regarding potential legislation to repeal section 3141 of the Patient Protection and Affordable Care Act of 2010. -Corresponded with a member of the Missouri congressional delegation regarding his receipt of the Missouri Hospital Associations 2016 Health Policy Leadership award and the logistics of the award presentation to the 2016 Annual Convention and Trade Show of the Missouri Hospital Association. -Responded to a query from a member of the Missouri congressional delegation regarding data from the Centers for Disease Control regarding the incidence of neonatal abstinence syndrome in Missouri -Upon the request of a member of the Missouri congressional delegation, provided an analysis of premiums and tax credits in the CMS health care marketplace in Missouri in 2017. -Sent the members of the Missouri congressional delegation a MHA Issue Brief on CMS final rules to implement the Medicare physician payment system created by the federal MACRA law. -Sent the members of the Missouri congressional delegation a HIDI HealthStats document regarding the incidence of adverse childhood experiences in Missouri and Kansas. HIDI is the Hospital Industry Data Institute, a subsidiary of the Missouri Hospital Association. -Responded to a query from a member of the Missouri congressional delegation regarding an Open Door Forum of the Centers for Medicare & Medicaid Services regarding a proposal in President Obamas FY 2017 Proposed Budget to reduce Medicare reimbursement to federally-designated critical access hospitals by 1%. -Responded to a query from a member of the Missouri congressional delegation regarding the names and/or number of insurers that will be designated to serve Missouri in CMSs health care marketplace in 2017 and their distribution by county.

- provided information regarding the geographic distribution of behavioral healthcare providers in Missouri - discussed performance improvement initiatives of Missouris small rural hospitals - promoted legislation to curb unnecessary data reporting to the CMS Hospital Compare website - promoted the passage of legislation concerning behavioral healthcare (H. R. 2646, S. 1945) - promoted Missouris participation in phase 2 of the Excellence In Mental Health Act - discussed the implications of fewer marketplace insurers serving the Missouri market in 2017 - promoted changes to the Medicare area wage index formula provided by S. 1135 and H. R. 1479 - expressed concerns regarding the role of CMS controlling the health care market through mandated participation in delivery model reform initiatives - expressed support for protecting the 340B drug discount program - promoted accountability for health information technology vendors as provided by sections of S. 2511 - provided information regarding Missouri hospital utilization and finances, in aggregate and by congressional district - provided information to a member of the Missouri congressional delegation regarding Medicare coverage of telemedicine services - at the request of a member of the Missouri congressional delegation , provided information regarding contact information for selected Missouri chief executive officers` - provided information to members of the Missouri delegation regarding CMS denial of an extension of the institutions for mental disease demonstration project - provided information to members of the congressional delegation regarding the need to adjust data used in CMSs star rating system to account for differences in patients sociodemographic status - provided information to a member of the Missouri congressional delegation regarding critical access hospitals in Missouri - provided information to members of the Missouri congressional delegation regarding CMSs basis for its recent actions to terminate a Missouri hospital from the Medicare program for failing to be primarily engaged in providing inpatient services - contacted a member the Missouri congressional delegation regarding a letter to CMS expressing concern about the Medicare wage index data submission appeal of Nantucket Cottage Hospital of Nantucket, Massachusetts - provided information to a member of the Missouri congressional delegation regarding advocacy on social media on the topic of abuse of opioids - contacted selected members of the Missouri delegation asking them to make contacts with legislative leaders and selected committee leaders regarding the Medicare wage index data submission appeal of Nantucket Cottage Hospital of Nantucket, Massachusetts

- Corresponded with members of the Missouri congressional delegation about a pending appeal to the Centers for Medicare & Medicaid Services by Nantucket Cottage Hospital of Nantucket, Massachusetts regarding the submission of Medicare wage index data - Corresponded with regional CMS officials regarding a regulatory change (CR #9658) regarding billing of nontherapy hospital outpatient procedures that are adjunct to Medicare outpatient services - Contacted members of the Missouri congressional delegation to express support for and request cosponsorship of H.R. 3199/S. 2748, the Palliative Care and Hospice Education and Training Act - Responded to Missouri congressional office requests for contact information with Missouri-based hospital organizations - Responded to a Missouri congressional office request for the Missouri Hospital Associations review and comment regarding a draft of the Helping Hospitals Improve Patient Care Act of 2016 - Corresponded with members of the Missouri congressional delegation regarding a potential Dear Colleague letter regarding a proposed demonstration project of the Centers for Medicare & Medicaid Services to require prior authorization of home health services in the Medicare program - Corresponded with members of the Missouri congressional delegation regarding the Centers for Medicare & Medicaid Services Star Rating system for assessing and publicizing the quality of care in hospitals - Corresponded with a member of the Missouri congressional delegation regarding the potential for legislative activity to repeal current restrictions on physician self-referral to hospitals in which the physicians have an ownership or other financial interest - Responded to a request from a member of the Missouri congressional delegation for assistance in compiling information about innovative cancer treatment and/or research in Missouri hospitals - Corresponded with members of the Missouri congressional delegation regarding a proposal by the Centers for Medicare & Medicaid Services to create a demonstration project to revise how Medicare will pay hospitals, physicians and others for drugs paid through the Medicare Part B program. - Corresponded with members of the Missouri congressional delegation regarding a Missouri Hospital Association advocacy briefing session for staff of the Missouri congressional delegation. The briefing session included a review of the Missouri congressional delegations engagement in hospital advocacy issues, emerging trends in health care delivery and financing, data regarding insurance coverage and hospital financial indicators in Missouri, ongoing advocacy concerns regarding Medicare wage index policy, equity in the distribution of reductions in Medicare Disproportionate Share Hospital payments, congressional changes in states use of provider taxes to finance their Medicaid programs, and the use of subregulatory guidance by the Centers for Medicare & Medicaid Services, - Corresponded with the Missouri congressional delegation regarding a letter from congressional signatories to the Centers for Medicare & Medicaid Services to delay the April 21 release of a Medicare Star Rating system regarding quality of care in hospitals - Corresponded with members of the Missouri congressional delegation regarding changes in the Centers for Medicare & Medicaid Services procedures for providers to bill Medicare for services delivered in federally-designated rural health clinics - Participated on a telephone conference with officials of the Centers for Medicare & Medicaid Services regarding changes in the Centers for Medicare & Medicaid Services procedures for providers to bill Medicare for services delivered in federally-designated rural health clinics - Corresponded with members of the Missouri congressional delegation regarding the Missouri Hospital Associations engagement with a collaborative effort to improve the detection and treatment of diabetes

- Corresponded with members of the Missouri congressional delegation about a pending appeal to the Centers for Medicare & Medicaid Services by Nantucket Cottage Hospital of Nantucket, Massachusetts regarding the submission of Medicare wage index data - Corresponded with regional CMS officials regarding a regulatory change (CR #9658) regarding billing of nontherapy hospital outpatient procedures that are adjunct to Medicare outpatient services - Contacted members of the Missouri congressional delegation to express support for and request cosponsorship of H.R. 3199/S. 2748, the Palliative Care and Hospice Education and Training Act - Responded to Missouri congressional office requests for contact information with Missouri-based hospital organizations - Responded to a Missouri congressional office request for the Missouri Hospital Associations review and comment regarding a draft of the Helping Hospitals Improve Patient Care Act of 2016 - Corresponded with members of the Missouri congressional delegation regarding a potential Dear Colleague letter regarding a proposed demonstration project of the Centers for Medicare & Medicaid Services to require prior authorization of home health services in the Medicare program - Corresponded with members of the Missouri congressional delegation regarding the Centers for Medicare & Medicaid Services Star Rating system for assessing and publicizing the quality of care in hospitals - Corresponded with a member of the Missouri congressional delegation regarding the potential for legislative activity to repeal current restrictions on physician self-referral to hospitals in which the physicians have an ownership or other financial interest - Responded to a request from a member of the Missouri congressional delegation for assistance in compiling information about innovative cancer treatment and/or research in Missouri hospitals - Corresponded with members of the Missouri congressional delegation regarding a proposal by the Centers for Medicare & Medicaid Services to create a demonstration project to revise how Medicare will pay hospitals, physicians and others for drugs paid through the Medicare Part B program. - Corresponded with members of the Missouri congressional delegation regarding a Missouri Hospital Association advocacy briefing session for staff of the Missouri congressional delegation. The briefing session included a review of the Missouri congressional delegations engagement in hospital advocacy issues, emerging trends in health care delivery and financing, data regarding insurance coverage and hospital financial indicators in Missouri, ongoing advocacy concerns regarding Medicare wage index policy, equity in the distribution of reductions in Medicare Disproportionate Share Hospital payments, congressional changes in states use of provider taxes to finance their Medicaid programs, and the use of subregulatory guidance by the Centers for Medicare & Medicaid Services, - Corresponded with the Missouri congressional delegation regarding a letter from congressional signatories to the Centers for Medicare & Medicaid Services to delay the April 21 release of a Medicare Star Rating system regarding quality of care in hospitals - Corresponded with members of the Missouri congressional delegation regarding changes in the Centers for Medicare & Medicaid Services procedures for providers to bill Medicare for services delivered in federally-designated rural health clinics - Participated on a telephone conference with officials of the Centers for Medicare & Medicaid Services regarding changes in the Centers for Medicare & Medicaid Services procedures for providers to bill Medicare for services delivered in federally-designated rural health clinics - Corresponded with members of the Missouri congressional delegation regarding the Missouri Hospital Associations engagement with a collaborative effort to improve the detection and treatment of diabetes

- Contacted the members of the Missouri congressional delegation to express opposition to a section of the Common Sense Savings Act of 2016 (H.R. 4725) that would reduce the federal cap on states; use of provider taxes to fund their Medicaid programs. - Encouraged selected Missouri hospitals to contact their congressman to express opposition to Section 4 of H.R. 4725 as considered by the House Energy and Commerce Committee. - Corresponded with the staff of a member of the Missouri congressional delegation regarding advocacy contacts from Missouri hospitals regarding H.R. 4725. - Responded to a query from a member of the Missouri congressional delegation regarding a potential nominee for appointment to the Medicare Payment Advisory Committee. - Responded to a query from a member of the Missouri congressional delegation regarding the number of Missouri hospitals participating in the Federal Housing Administrations mortgage insurance program for hospitals. - Responded to a query from a member hospital for advocacy documents used in briefing members of Missouris congressional delegation in October 2015. The documents were for potential use in the hospitals discussions with its congressional representative. - Provided the members of the Missouri congressional delegation with a copy of the Missouri Hospital Associations comments regarding site-neutral Medicare payments to off-campus hospital outpatient departments. Such comments were solicited by the chairs of the House of Representatives Ways & Means Committee and its Subcommittee on Health. - Furnished the members of the Missouri congressional delegation with the Missouri Hospital Associations 2016 annual report of community benefit activities by Missouri hospitals. - Discussed legislation with a member of the Missouri congressional delegation to promote changes in federal statutes regarding eligibility of federally-designated Medicare sole community hospitals to receive payments for services delivered through telemedicine. The discussion referenced H.R. 2066, the Telehealth Enhancement Act of 2015. - Correspondence regarding a staffing change in the office of a member of the Missouri congressional delegation. - Corresponded with members of the Missouri congressional delegation regarding logistics for an advocacy briefing session in May 2016. - Invited staff of the Missouri congressional delegation to participate in a Missouri Hospital Association telephone conference regarding an MHA hospital price and quality transparency initiative and its use of socio-demographic adjustments to the quality data. - Met with selected members of the Missouri congressional delegation to discuss advocacy topics, including: general prospects for legislative action on health care topics in 2016, recommendations for MHA engagement in advocacy briefing sessions, and H.R. 3288 regarding the use of worksheet S-10 in calculating Medicare Disproportionate Share Hospital payments. - Worked with committee staff and the staff of a member of the Missouri congressional delegation to coordinate logistics and witnesses for a field hearing of the U.S. Senate Special Committee on Aging on the topic of opioid use and abuse by the elderly. - Met with Region 7 and WPS to discuss the problems recent rural health clinic billing will bring to clinics.

-Forwarded to the members of the Missouri congressional delegation a letter from the Alliance for Americas Hospitals, to which the Missouri Hospital Association was a signatory, urging repeal of section 3141 of the Patient Protection and Affordable Care Act of 2010. -Responded to a request from a member of the Missouri congressional delegation regarding the performance of Missouris critical access hospitals if they were included in the Medicare value-based purchasing initiative applicable to Medicare inpatient prospective payment system hospitals. -Responded to a request from a member of the Missouri congressional delegation as to how many Missouri counties have only one insurer offering coverage through the CMS health care marketplace. -Responded to a request from a member of the Missouri congressional delegation to provide comments regarding potential nominees for appointment to leadership positions in the Department of Health and Senior Services or the Centers for Medicare & Medicaid. -Expressed support for enactment of H.R. 34, the 21st Century Cures Act. -In response to a query from a member of the Missouri congressional delegation, expressed opposition to H.R. 2513. -Corresponded with a member of the Missouri congressional delegation regarding potential legislation to repeal section 3141 of the Patient Protection and Affordable Care Act of 2010. -Corresponded with a member of the Missouri congressional delegation regarding his receipt of the Missouri Hospital Associations 2016 Health Policy Leadership award and the logistics of the award presentation to the 2016 Annual Convention and Trade Show of the Missouri Hospital Association. -Responded to a query from a member of the Missouri congressional delegation regarding data from the Centers for Disease Control regarding the incidence of neonatal abstinence syndrome in Missouri -Upon the request of a member of the Missouri congressional delegation, provided an analysis of premiums and tax credits in the CMS health care marketplace in Missouri in 2017. -Sent the members of the Missouri congressional delegation a MHA Issue Brief on CMS final rules to implement the Medicare physician payment system created by the federal MACRA law. -Sent the members of the Missouri congressional delegation a HIDI HealthStats document regarding the incidence of adverse childhood experiences in Missouri and Kansas. HIDI is the Hospital Industry Data Institute, a subsidiary of the Missouri Hospital Association. -Responded to a query from a member of the Missouri congressional delegation regarding an Open Door Forum of the Centers for Medicare & Medicaid Services regarding a proposal in President Obamas FY 2017 Proposed Budget to reduce Medicare reimbursement to federally-designated critical access hospitals by 1%. -Responded to a query from a member of the Missouri congressional delegation regarding the names and/or number of insurers that will be designated to serve Missouri in CMSs health care marketplace in 2017 and their distribution by county.

- Contacted the members of the Missouri congressional delegation to express opposition to a section of the Common Sense Savings Act of 2016 (H.R. 4725) that would reduce the federal cap on states; use of provider taxes to fund their Medicaid programs. - Encouraged selected Missouri hospitals to contact their congressman to express opposition to Section 4 of H.R. 4725 as considered by the House Energy and Commerce Committee. - Corresponded with the staff of a member of the Missouri congressional delegation regarding advocacy contacts from Missouri hospitals regarding H.R. 4725. - Responded to a query from a member of the Missouri congressional delegation regarding a potential nominee for appointment to the Medicare Payment Advisory Committee. - Responded to a query from a member of the Missouri congressional delegation regarding the number of Missouri hospitals participating in the Federal Housing Administrations mortgage insurance program for hospitals. - Responded to a query from a member hospital for advocacy documents used in briefing members of Missouris congressional delegation in October 2015. The documents were for potential use in the hospitals discussions with its congressional representative. - Provided the members of the Missouri congressional delegation with a copy of the Missouri Hospital Associations comments regarding site-neutral Medicare payments to off-campus hospital outpatient departments. Such comments were solicited by the chairs of the House of Representatives Ways & Means Committee and its Subcommittee on Health. - Furnished the members of the Missouri congressional delegation with the Missouri Hospital Associations 2016 annual report of community benefit activities by Missouri hospitals. - Discussed legislation with a member of the Missouri congressional delegation to promote changes in federal statutes regarding eligibility of federally-designated Medicare sole community hospitals to receive payments for services delivered through telemedicine. The discussion referenced H.R. 2066, the Telehealth Enhancement Act of 2015. - Correspondence regarding a staffing change in the office of a member of the Missouri congressional delegation. - Corresponded with members of the Missouri congressional delegation regarding logistics for an advocacy briefing session in May 2016. - Invited staff of the Missouri congressional delegation to participate in a Missouri Hospital Association telephone conference regarding an MHA hospital price and quality transparency initiative and its use of socio-demographic adjustments to the quality data. - Met with selected members of the Missouri congressional delegation to discuss advocacy topics, including: general prospects for legislative action on health care topics in 2016, recommendations for MHA engagement in advocacy briefing sessions, and H.R. 3288 regarding the use of worksheet S-10 in calculating Medicare Disproportionate Share Hospital payments. - Worked with committee staff and the staff of a member of the Missouri congressional delegation to coordinate logistics and witnesses for a field hearing of the U.S. Senate Special Committee on Aging on the topic of opioid use and abuse by the elderly. - Met with Region 7 and WPS to discuss the problems recent rural health clinic billing will bring to clinics.

- provided information regarding the geographic distribution of behavioral healthcare providers in Missouri - discussed performance improvement initiatives of Missouris small rural hospitals - promoted legislation to curb unnecessary data reporting to the CMS Hospital Compare website - promoted the passage of legislation concerning behavioral healthcare (H. R. 2646, S. 1945) - promoted Missouris participation in phase 2 of the Excellence In Mental Health Act - discussed the implications of fewer marketplace insurers serving the Missouri market in 2017 - promoted changes to the Medicare area wage index formula provided by S. 1135 and H. R. 1479 - expressed concerns regarding the role of CMS controlling the health care market through mandated participation in delivery model reform initiatives - expressed support for protecting the 340B drug discount program - promoted accountability for health information technology vendors as provided by sections of S. 2511 - provided information regarding Missouri hospital utilization and finances, in aggregate and by congressional district - provided information to a member of the Missouri congressional delegation regarding Medicare coverage of telemedicine services - at the request of a member of the Missouri congressional delegation , provided information regarding contact information for selected Missouri chief executive officers` - provided information to members of the Missouri delegation regarding CMS denial of an extension of the institutions for mental disease demonstration project - provided information to members of the congressional delegation regarding the need to adjust data used in CMSs star rating system to account for differences in patients sociodemographic status - provided information to a member of the Missouri congressional delegation regarding critical access hospitals in Missouri - provided information to members of the Missouri congressional delegation regarding CMSs basis for its recent actions to terminate a Missouri hospital from the Medicare program for failing to be primarily engaged in providing inpatient services - contacted a member the Missouri congressional delegation regarding a letter to CMS expressing concern about the Medicare wage index data submission appeal of Nantucket Cottage Hospital of Nantucket, Massachusetts - provided information to a member of the Missouri congressional delegation regarding advocacy on social media on the topic of abuse of opioids - contacted selected members of the Missouri delegation asking them to make contacts with legislative leaders and selected committee leaders regarding the Medicare wage index data submission appeal of Nantucket Cottage Hospital of Nantucket, Massachusetts

- provided information regarding the geographic distribution of behavioral healthcare providers in Missouri - discussed performance improvement initiatives of Missouris small rural hospitals - promoted legislation to curb unnecessary data reporting to the CMS Hospital Compare website - promoted the passage of legislation concerning behavioral healthcare (H. R. 2646, S. 1945) - promoted Missouris participation in phase 2 of the Excellence In Mental Health Act - discussed the implications of fewer marketplace insurers serving the Missouri market in 2017 - promoted changes to the Medicare area wage index formula provided by S. 1135 and H. R. 1479 - expressed concerns regarding the role of CMS controlling the health care market through mandated participation in delivery model reform initiatives - expressed support for protecting the 340B drug discount program - promoted accountability for health information technology vendors as provided by sections of S. 2511 - provided information regarding Missouri hospital utilization and finances, in aggregate and by congressional district - provided information to a member of the Missouri congressional delegation regarding Medicare coverage of telemedicine services - at the request of a member of the Missouri congressional delegation , provided information regarding contact information for selected Missouri chief executive officers` - provided information to members of the Missouri delegation regarding CMS denial of an extension of the institutions for mental disease demonstration project - provided information to members of the congressional delegation regarding the need to adjust data used in CMSs star rating system to account for differences in patients sociodemographic status - provided information to a member of the Missouri congressional delegation regarding critical access hospitals in Missouri - provided information to members of the Missouri congressional delegation regarding CMSs basis for its recent actions to terminate a Missouri hospital from the Medicare program for failing to be primarily engaged in providing inpatient services - contacted a member the Missouri congressional delegation regarding a letter to CMS expressing concern about the Medicare wage index data submission appeal of Nantucket Cottage Hospital of Nantucket, Massachusetts - provided information to a member of the Missouri congressional delegation regarding advocacy on social media on the topic of abuse of opioids - contacted selected members of the Missouri delegation asking them to make contacts with legislative leaders and selected committee leaders regarding the Medicare wage index data submission appeal of Nantucket Cottage Hospital of Nantucket, Massachusetts

- provided information regarding the geographic distribution of behavioral healthcare providers in Missouri - discussed performance improvement initiatives of Missouris small rural hospitals - promoted legislation to curb unnecessary data reporting to the CMS Hospital Compare website - promoted the passage of legislation concerning behavioral healthcare (H. R. 2646, S. 1945) - promoted Missouris participation in phase 2 of the Excellence In Mental Health Act - discussed the implications of fewer marketplace insurers serving the Missouri market in 2017 - promoted changes to the Medicare area wage index formula provided by S. 1135 and H. R. 1479 - expressed concerns regarding the role of CMS controlling the health care market through mandated participation in delivery model reform initiatives - expressed support for protecting the 340B drug discount program - promoted accountability for health information technology vendors as provided by sections of S. 2511 - provided information regarding Missouri hospital utilization and finances, in aggregate and by congressional district - provided information to a member of the Missouri congressional delegation regarding Medicare coverage of telemedicine services - at the request of a member of the Missouri congressional delegation , provided information regarding contact information for selected Missouri chief executive officers` - provided information to members of the Missouri delegation regarding CMS denial of an extension of the institutions for mental disease demonstration project - provided information to members of the congressional delegation regarding the need to adjust data used in CMSs star rating system to account for differences in patients sociodemographic status - provided information to a member of the Missouri congressional delegation regarding critical access hospitals in Missouri - provided information to members of the Missouri congressional delegation regarding CMSs basis for its recent actions to terminate a Missouri hospital from the Medicare program for failing to be primarily engaged in providing inpatient services - contacted a member the Missouri congressional delegation regarding a letter to CMS expressing concern about the Medicare wage index data submission appeal of Nantucket Cottage Hospital of Nantucket, Massachusetts - provided information to a member of the Missouri congressional delegation regarding advocacy on social media on the topic of abuse of opioids - contacted selected members of the Missouri delegation asking them to make contacts with legislative leaders and selected committee leaders regarding the Medicare wage index data submission appeal of Nantucket Cottage Hospital of Nantucket, Massachusetts

- Corresponded with members of the Missouri congressional delegation about a pending appeal to the Centers for Medicare & Medicaid Services by Nantucket Cottage Hospital of Nantucket, Massachusetts regarding the submission of Medicare wage index data - Corresponded with regional CMS officials regarding a regulatory change (CR #9658) regarding billing of nontherapy hospital outpatient procedures that are adjunct to Medicare outpatient services - Contacted members of the Missouri congressional delegation to express support for and request cosponsorship of H.R. 3199/S. 2748, the Palliative Care and Hospice Education and Training Act - Responded to Missouri congressional office requests for contact information with Missouri-based hospital organizations - Responded to a Missouri congressional office request for the Missouri Hospital Associations review and comment regarding a draft of the Helping Hospitals Improve Patient Care Act of 2016 - Corresponded with members of the Missouri congressional delegation regarding a potential Dear Colleague letter regarding a proposed demonstration project of the Centers for Medicare & Medicaid Services to require prior authorization of home health services in the Medicare program - Corresponded with members of the Missouri congressional delegation regarding the Centers for Medicare & Medicaid Services Star Rating system for assessing and publicizing the quality of care in hospitals - Corresponded with a member of the Missouri congressional delegation regarding the potential for legislative activity to repeal current restrictions on physician self-referral to hospitals in which the physicians have an ownership or other financial interest - Responded to a request from a member of the Missouri congressional delegation for assistance in compiling information about innovative cancer treatment and/or research in Missouri hospitals - Corresponded with members of the Missouri congressional delegation regarding a proposal by the Centers for Medicare & Medicaid Services to create a demonstration project to revise how Medicare will pay hospitals, physicians and others for drugs paid through the Medicare Part B program. - Corresponded with members of the Missouri congressional delegation regarding a Missouri Hospital Association advocacy briefing session for staff of the Missouri congressional delegation. The briefing session included a review of the Missouri congressional delegations engagement in hospital advocacy issues, emerging trends in health care delivery and financing, data regarding insurance coverage and hospital financial indicators in Missouri, ongoing advocacy concerns regarding Medicare wage index policy, equity in the distribution of reductions in Medicare Disproportionate Share Hospital payments, congressional changes in states use of provider taxes to finance their Medicaid programs, and the use of subregulatory guidance by the Centers for Medicare & Medicaid Services, - Corresponded with the Missouri congressional delegation regarding a letter from congressional signatories to the Centers for Medicare & Medicaid Services to delay the April 21 release of a Medicare Star Rating system regarding quality of care in hospitals - Corresponded with members of the Missouri congressional delegation regarding changes in the Centers for Medicare & Medicaid Services procedures for providers to bill Medicare for services delivered in federally-designated rural health clinics - Participated on a telephone conference with officials of the Centers for Medicare & Medicaid Services regarding changes in the Centers for Medicare & Medicaid Services procedures for providers to bill Medicare for services delivered in federally-designated rural health clinics - Corresponded with members of the Missouri congressional delegation regarding the Missouri Hospital Associations engagement with a collaborative effort to improve the detection and treatment of diabetes

- Corresponded with members of the Missouri congressional delegation about a pending appeal to the Centers for Medicare & Medicaid Services by Nantucket Cottage Hospital of Nantucket, Massachusetts regarding the submission of Medicare wage index data - Corresponded with regional CMS officials regarding a regulatory change (CR #9658) regarding billing of nontherapy hospital outpatient procedures that are adjunct to Medicare outpatient services - Contacted members of the Missouri congressional delegation to express support for and request cosponsorship of H.R. 3199/S. 2748, the Palliative Care and Hospice Education and Training Act - Responded to Missouri congressional office requests for contact information with Missouri-based hospital organizations - Responded to a Missouri congressional office request for the Missouri Hospital Associations review and comment regarding a draft of the Helping Hospitals Improve Patient Care Act of 2016 - Corresponded with members of the Missouri congressional delegation regarding a potential Dear Colleague letter regarding a proposed demonstration project of the Centers for Medicare & Medicaid Services to require prior authorization of home health services in the Medicare program - Corresponded with members of the Missouri congressional delegation regarding the Centers for Medicare & Medicaid Services Star Rating system for assessing and publicizing the quality of care in hospitals - Corresponded with a member of the Missouri congressional delegation regarding the potential for legislative activity to repeal current restrictions on physician self-referral to hospitals in which the physicians have an ownership or other financial interest - Responded to a request from a member of the Missouri congressional delegation for assistance in compiling information about innovative cancer treatment and/or research in Missouri hospitals - Corresponded with members of the Missouri congressional delegation regarding a proposal by the Centers for Medicare & Medicaid Services to create a demonstration project to revise how Medicare will pay hospitals, physicians and others for drugs paid through the Medicare Part B program. - Corresponded with members of the Missouri congressional delegation regarding a Missouri Hospital Association advocacy briefing session for staff of the Missouri congressional delegation. The briefing session included a review of the Missouri congressional delegations engagement in hospital advocacy issues, emerging trends in health care delivery and financing, data regarding insurance coverage and hospital financial indicators in Missouri, ongoing advocacy concerns regarding Medicare wage index policy, equity in the distribution of reductions in Medicare Disproportionate Share Hospital payments, congressional changes in states use of provider taxes to finance their Medicaid programs, and the use of subregulatory guidance by the Centers for Medicare & Medicaid Services, - Corresponded with the Missouri congressional delegation regarding a letter from congressional signatories to the Centers for Medicare & Medicaid Services to delay the April 21 release of a Medicare Star Rating system regarding quality of care in hospitals - Corresponded with members of the Missouri congressional delegation regarding changes in the Centers for Medicare & Medicaid Services procedures for providers to bill Medicare for services delivered in federally-designated rural health clinics - Participated on a telephone conference with officials of the Centers for Medicare & Medicaid Services regarding changes in the Centers for Medicare & Medicaid Services procedures for providers to bill Medicare for services delivered in federally-designated rural health clinics - Corresponded with members of the Missouri congressional delegation regarding the Missouri Hospital Associations engagement with a collaborative effort to improve the detection and treatment of diabetes

- Contacted members of the Missouri congressional delegation asking them to consider endorsing a letter to CMS regarding deadlines for state Medicaid programs to make upper payment limit payments to eligible hospitals - Contacted a member of the Missouri congressional delegation regarding the use and implications of hospital outpatient services on Medicare beneficiaries and hospitals - Responded to a request from a member of the Missouri congressional delegation to review and comment on a draft of legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Contacted members of the Missouri congressional delegation to coordinate logistics for visits to congressional offices to discuss federal policy issues affecting hospitals - Responded to a request from a member of the Missouri congressional delegation for information about a DHHS Office of Inspector General audit of the Missouri Medicaid program regarding collection of National Drug Code data - Provided a letter of endorsement to a member of the Missouri congressional delegation regarding the version of the Hospital Payment Fairness Act to be introduced in the 114th Congress. Verified MHAs willingness to be quoted in a press release from the members office. - Responded to a request from a member of the Missouri congressional delegation regarding Missouri Hospital Association support for proposed legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Provided and discussed advocacy materials on the following topics: (1) replacement of the sustainable growth rate formula used in calculating Medicare payments to physicians; (2) support for H.R. 1479 regarding the Medicare average wage index component of Medicare hospital payments; (3) support for legislation to promote and advance comprehensive reform of the Medicare Recovery Audit Contractor program (4) description of the potential effect of the U.S. Supreme Courts decision in King v. Burwell on health insurance coverage of Missourians (5) H.R. 876, relating to notification requirements for hospitals regarding outpatient observation services delivered to Medicare patients (6) oppose legislative efforts to curtail the scope of the Medicaid 340B prescription drug discount initiative (7) support for H.R. 1343 and S. 688, concerning adjustment of readmissions penalties to reflect the socio-economic status of Medicare patients (8) Support for H.R. 169/S. 258 and H.R. 1611 and S. 257, relating to critical access hospitals (9) a profile of the characteristics of Missouri hospitals - Discussed with several members of the Missouri congressional delegation the wording and implications of H.R. 876 for Missouri hospitals - Provided information to a member of the Missouri congressional delegation regarding Medicare payments to hospitals in the members congressional district - Provided information regarding H.R. 2156 in response to a request from a member of the Missouri congressional delegation - Provided information to a member of the Missouri congressional delegation regarding H.R. 1343 - Contacted the Centers for Medicare & Medicaid Services regarding the potential for extending the duration of the Medicaid Emergency Psychiatric Demonstration - Contacted selected members of the Missouri congressional delegation to express opposition to a proposed amendment to the 21st Century Cures Act regarding the 340B drug discount program - Provided the members of the Missouri congressional delegation a summary of state legislative action in the 2015 session of the Missouri General Assembly regarding health care and hospital-related issues - Responded to requests for information regarding the deadline for Missouris Medicaid program to make Upper Payment Limit payments to Missouri hospitals - Responded to a request from a member of the Missouri congressional delegation regarding a possible suspension of the Medicare Recovery Audit Contractor program pending the awarding of new contracts to vendors to administer the program - Expressed opposition to a member of the Missouri congressional delegation regarding pending legislative amendments that would loosen federal statutory restrictions on physician self-referral to hospitals involving Medicare and Medicaid patients - Contacted a member of the Missouri congressional delegation to express thanks for the members responsiveness to the Missouri Hospital Associations concerns about pending legislative proposals to loosen restrictions on physician self-referral to hospitals - Contacted a member of the Missouri congressional delegation about the possibility of pressing for a CMS response to a written query regarding the deadline for state Medicaid programs to make Upper Payment Limit payments to eligible hospitals - Invited members of the Missouri congressional delegation to join a telephone conference to monitor a Missouri summit on the potential effects of the U.S. Supreme Courts decision in King v. Burwell - Responded to a query from a member of the Missouri congressional delegation regarding enrollment in Missouris federally-subsidized health insurance exchange - Asked a member of the Missouri congressional delegation to co-sponsor S. 1135 - Provided information to a member of the Missouri congressional delegation regarding the performance of the Medicare Recovery Audit Contractor program - Provided and discussed documents with staff of a Senate committee regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services - Provided comments to a member of the Missouri congressional delegation regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Responded to a request from U.S. Senate committee staff for the Missouri Hospital Associations assessment of a proposed CMS regulation - Responded to a request from U.S House of Representatives staff for the Missouri Hospital Associations analysis of H.R. 1201 of the 113th Congress and its implications for Missouri hospitals - Sent information to a staff of the U.S. House of Representatives regarding projections of the future supply of and demand for physicians - Sent a letter of endorsement of H.R 1784, the Making Education for Nurses Dependable for Schools Act, to the bills sponsor and the members of the Missouri congressional delegation - Responded to a request from U.S. House of Representatives staff for an analysis of H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 - Provided information to member hospitals for use in congressional advocacy on medical education projections, H.R. 876 of the 114th Congress, H.R. 1479 of the 114th Congress, H.R. 169/S.258 of the 114th Congress, H.R. 1611/S. 257 of the 114th Congress, H.R. 688/H.R. 1343 of the 114th Congress - Responded to a request from U.S. Senate staff for data and analysis regarding the implications for Missouri hospitals of increases in the price of specific drugs used in medical treatment procedures.

- Contacted members of the Missouri congressional delegation asking them to consider endorsing a letter to CMS regarding deadlines for state Medicaid programs to make upper payment limit payments to eligible hospitals - Contacted a member of the Missouri congressional delegation regarding the use and implications of hospital outpatient services on Medicare beneficiaries and hospitals - Responded to a request from a member of the Missouri congressional delegation to review and comment on a draft of legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Contacted members of the Missouri congressional delegation to coordinate logistics for visits to congressional offices to discuss federal policy issues affecting hospitals - Responded to a request from a member of the Missouri congressional delegation for information about a DHHS Office of Inspector General audit of the Missouri Medicaid program regarding collection of National Drug Code data - Provided a letter of endorsement to a member of the Missouri congressional delegation regarding the version of the Hospital Payment Fairness Act to be introduced in the 114th Congress. Verified MHAs willingness to be quoted in a press release from the members office. - Responded to a request from a member of the Missouri congressional delegation regarding Missouri Hospital Association support for proposed legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Provided and discussed advocacy materials on the following topics: (1) replacement of the sustainable growth rate formula used in calculating Medicare payments to physicians; (2) support for H.R. 1479 regarding the Medicare average wage index component of Medicare hospital payments; (3) support for legislation to promote and advance comprehensive reform of the Medicare Recovery Audit Contractor program (4) description of the potential effect of the U.S. Supreme Courts decision in King v. Burwell on health insurance coverage of Missourians (5) H.R. 876, relating to notification requirements for hospitals regarding outpatient observation services delivered to Medicare patients (6) oppose legislative efforts to curtail the scope of the Medicaid 340B prescription drug discount initiative (7) support for H.R. 1343 and S. 688, concerning adjustment of readmissions penalties to reflect the socio-economic status of Medicare patients (8) Support for H.R. 169/S. 258 and H.R. 1611 and S. 257, relating to critical access hospitals (9) a profile of the characteristics of Missouri hospitals - Discussed with several members of the Missouri congressional delegation the wording and implications of H.R. 876 for Missouri hospitals - Provided information to a member of the Missouri congressional delegation regarding Medicare payments to hospitals in the members congressional district - Provided information regarding H.R. 2156 in response to a request from a member of the Missouri congressional delegation - Provided information to a member of the Missouri congressional delegation regarding H.R. 1343 - Contacted the Centers for Medicare & Medicaid Services regarding the potential for extending the duration of the Medicaid Emergency Psychiatric Demonstration - Contacted selected members of the Missouri congressional delegation to express opposition to a proposed amendment to the 21st Century Cures Act regarding the 340B drug discount program - Provided the members of the Missouri congressional delegation a summary of state legislative action in the 2015 session of the Missouri General Assembly regarding health care and hospital-related issues - Responded to requests for information regarding the deadline for Missouris Medicaid program to make Upper Payment Limit payments to Missouri hospitals - Responded to a request from a member of the Missouri congressional delegation regarding a possible suspension of the Medicare Recovery Audit Contractor program pending the awarding of new contracts to vendors to administer the program - Expressed opposition to a member of the Missouri congressional delegation regarding pending legislative amendments that would loosen federal statutory restrictions on physician self-referral to hospitals involving Medicare and Medicaid patients - Contacted a member of the Missouri congressional delegation to express thanks for the members responsiveness to the Missouri Hospital Associations concerns about pending legislative proposals to loosen restrictions on physician self-referral to hospitals - Contacted a member of the Missouri congressional delegation about the possibility of pressing for a CMS response to a written query regarding the deadline for state Medicaid programs to make Upper Payment Limit payments to eligible hospitals - Invited members of the Missouri congressional delegation to join a telephone conference to monitor a Missouri summit on the potential effects of the U.S. Supreme Courts decision in King v. Burwell - Responded to a query from a member of the Missouri congressional delegation regarding enrollment in Missouris federally-subsidized health insurance exchange - Asked a member of the Missouri congressional delegation to co-sponsor S. 1135 - Provided information to a member of the Missouri congressional delegation regarding the performance of the Medicare Recovery Audit Contractor program - Provided and discussed documents with staff of a Senate committee regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services - Provided comments to a member of the Missouri congressional delegation regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services

- Responded to a request from U.S. Senate committee staff for the Missouri Hospital Associations assessment of a proposed CMS regulation - Responded to a request from U.S House of Representatives staff for the Missouri Hospital Associations analysis of H.R. 1201 of the 113th Congress and its implications for Missouri hospitals - Sent information to a staff of the U.S. House of Representatives regarding projections of the future supply of and demand for physicians - Sent a letter of endorsement of H.R 1784, the Making Education for Nurses Dependable for Schools Act, to the bills sponsor and the members of the Missouri congressional delegation - Responded to a request from U.S. House of Representatives staff for an analysis of H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 - Provided information to member hospitals for use in congressional advocacy on medical education projections, H.R. 876 of the 114th Congress, H.R. 1479 of the 114th Congress, H.R. 169/S.258 of the 114th Congress, H.R. 1611/S. 257 of the 114th Congress, H.R. 688/H.R. 1343 of the 114th Congress - Responded to a request from U.S. Senate staff for data and analysis regarding the implications for Missouri hospitals of increases in the price of specific drugs used in medical treatment procedures.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Responded to a request from U.S. Senate committee staff for the Missouri Hospital Associations assessment of a proposed CMS regulation - Responded to a request from U.S House of Representatives staff for the Missouri Hospital Associations analysis of H.R. 1201 of the 113th Congress and its implications for Missouri hospitals - Sent information to a staff of the U.S. House of Representatives regarding projections of the future supply of and demand for physicians - Sent a letter of endorsement of H.R 1784, the Making Education for Nurses Dependable for Schools Act, to the bills sponsor and the members of the Missouri congressional delegation - Responded to a request from U.S. House of Representatives staff for an analysis of H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 - Provided information to member hospitals for use in congressional advocacy on medical education projections, H.R. 876 of the 114th Congress, H.R. 1479 of the 114th Congress, H.R. 169/S.258 of the 114th Congress, H.R. 1611/S. 257 of the 114th Congress, H.R. 688/H.R. 1343 of the 114th Congress - Responded to a request from U.S. Senate staff for data and analysis regarding the implications for Missouri hospitals of increases in the price of specific drugs used in medical treatment procedures.

- Contacted members of the Missouri congressional delegation asking them to consider endorsing a letter to CMS regarding deadlines for state Medicaid programs to make upper payment limit payments to eligible hospitals - Contacted a member of the Missouri congressional delegation regarding the use and implications of hospital outpatient services on Medicare beneficiaries and hospitals - Responded to a request from a member of the Missouri congressional delegation to review and comment on a draft of legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Contacted members of the Missouri congressional delegation to coordinate logistics for visits to congressional offices to discuss federal policy issues affecting hospitals - Responded to a request from a member of the Missouri congressional delegation for information about a DHHS Office of Inspector General audit of the Missouri Medicaid program regarding collection of National Drug Code data - Provided a letter of endorsement to a member of the Missouri congressional delegation regarding the version of the Hospital Payment Fairness Act to be introduced in the 114th Congress. Verified MHAs willingness to be quoted in a press release from the members office. - Responded to a request from a member of the Missouri congressional delegation regarding Missouri Hospital Association support for proposed legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Provided and discussed advocacy materials on the following topics: (1) replacement of the sustainable growth rate formula used in calculating Medicare payments to physicians; (2) support for H.R. 1479 regarding the Medicare average wage index component of Medicare hospital payments; (3) support for legislation to promote and advance comprehensive reform of the Medicare Recovery Audit Contractor program (4) description of the potential effect of the U.S. Supreme Courts decision in King v. Burwell on health insurance coverage of Missourians (5) H.R. 876, relating to notification requirements for hospitals regarding outpatient observation services delivered to Medicare patients (6) oppose legislative efforts to curtail the scope of the Medicaid 340B prescription drug discount initiative (7) support for H.R. 1343 and S. 688, concerning adjustment of readmissions penalties to reflect the socio-economic status of Medicare patients (8) Support for H.R. 169/S. 258 and H.R. 1611 and S. 257, relating to critical access hospitals (9) a profile of the characteristics of Missouri hospitals - Discussed with several members of the Missouri congressional delegation the wording and implications of H.R. 876 for Missouri hospitals - Provided information to a member of the Missouri congressional delegation regarding Medicare payments to hospitals in the members congressional district - Provided information regarding H.R. 2156 in response to a request from a member of the Missouri congressional delegation - Provided information to a member of the Missouri congressional delegation regarding H.R. 1343 - Contacted the Centers for Medicare & Medicaid Services regarding the potential for extending the duration of the Medicaid Emergency Psychiatric Demonstration - Contacted selected members of the Missouri congressional delegation to express opposition to a proposed amendment to the 21st Century Cures Act regarding the 340B drug discount program - Provided the members of the Missouri congressional delegation a summary of state legislative action in the 2015 session of the Missouri General Assembly regarding health care and hospital-related issues - Responded to requests for information regarding the deadline for Missouris Medicaid program to make Upper Payment Limit payments to Missouri hospitals - Responded to a request from a member of the Missouri congressional delegation regarding a possible suspension of the Medicare Recovery Audit Contractor program pending the awarding of new contracts to vendors to administer the program - Expressed opposition to a member of the Missouri congressional delegation regarding pending legislative amendments that would loosen federal statutory restrictions on physician self-referral to hospitals involving Medicare and Medicaid patients - Contacted a member of the Missouri congressional delegation to express thanks for the members responsiveness to the Missouri Hospital Associations concerns about pending legislative proposals to loosen restrictions on physician self-referral to hospitals - Contacted a member of the Missouri congressional delegation about the possibility of pressing for a CMS response to a written query regarding the deadline for state Medicaid programs to make Upper Payment Limit payments to eligible hospitals - Invited members of the Missouri congressional delegation to join a telephone conference to monitor a Missouri summit on the potential effects of the U.S. Supreme Courts decision in King v. Burwell - Responded to a query from a member of the Missouri congressional delegation regarding enrollment in Missouris federally-subsidized health insurance exchange - Asked a member of the Missouri congressional delegation to co-sponsor S. 1135 - Provided information to a member of the Missouri congressional delegation regarding the performance of the Medicare Recovery Audit Contractor program - Provided and discussed documents with staff of a Senate committee regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services - Provided comments to a member of the Missouri congressional delegation regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Contacted members of the Missouri congressional delegation asking them to consider endorsing a letter to CMS regarding deadlines for state Medicaid programs to make upper payment limit payments to eligible hospitals - Contacted a member of the Missouri congressional delegation regarding the use and implications of hospital outpatient services on Medicare beneficiaries and hospitals - Responded to a request from a member of the Missouri congressional delegation to review and comment on a draft of legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Contacted members of the Missouri congressional delegation to coordinate logistics for visits to congressional offices to discuss federal policy issues affecting hospitals - Responded to a request from a member of the Missouri congressional delegation for information about a DHHS Office of Inspector General audit of the Missouri Medicaid program regarding collection of National Drug Code data - Provided a letter of endorsement to a member of the Missouri congressional delegation regarding the version of the Hospital Payment Fairness Act to be introduced in the 114th Congress. Verified MHAs willingness to be quoted in a press release from the members office. - Responded to a request from a member of the Missouri congressional delegation regarding Missouri Hospital Association support for proposed legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Provided and discussed advocacy materials on the following topics: (1) replacement of the sustainable growth rate formula used in calculating Medicare payments to physicians; (2) support for H.R. 1479 regarding the Medicare average wage index component of Medicare hospital payments; (3) support for legislation to promote and advance comprehensive reform of the Medicare Recovery Audit Contractor program (4) description of the potential effect of the U.S. Supreme Courts decision in King v. Burwell on health insurance coverage of Missourians (5) H.R. 876, relating to notification requirements for hospitals regarding outpatient observation services delivered to Medicare patients (6) oppose legislative efforts to curtail the scope of the Medicaid 340B prescription drug discount initiative (7) support for H.R. 1343 and S. 688, concerning adjustment of readmissions penalties to reflect the socio-economic status of Medicare patients (8) Support for H.R. 169/S. 258 and H.R. 1611 and S. 257, relating to critical access hospitals (9) a profile of the characteristics of Missouri hospitals - Discussed with several members of the Missouri congressional delegation the wording and implications of H.R. 876 for Missouri hospitals - Provided information to a member of the Missouri congressional delegation regarding Medicare payments to hospitals in the members congressional district - Provided information regarding H.R. 2156 in response to a request from a member of the Missouri congressional delegation - Provided information to a member of the Missouri congressional delegation regarding H.R. 1343 - Contacted the Centers for Medicare & Medicaid Services regarding the potential for extending the duration of the Medicaid Emergency Psychiatric Demonstration - Contacted selected members of the Missouri congressional delegation to express opposition to a proposed amendment to the 21st Century Cures Act regarding the 340B drug discount program - Provided the members of the Missouri congressional delegation a summary of state legislative action in the 2015 session of the Missouri General Assembly regarding health care and hospital-related issues - Responded to requests for information regarding the deadline for Missouris Medicaid program to make Upper Payment Limit payments to Missouri hospitals - Responded to a request from a member of the Missouri congressional delegation regarding a possible suspension of the Medicare Recovery Audit Contractor program pending the awarding of new contracts to vendors to administer the program - Expressed opposition to a member of the Missouri congressional delegation regarding pending legislative amendments that would loosen federal statutory restrictions on physician self-referral to hospitals involving Medicare and Medicaid patients - Contacted a member of the Missouri congressional delegation to express thanks for the members responsiveness to the Missouri Hospital Associations concerns about pending legislative proposals to loosen restrictions on physician self-referral to hospitals - Contacted a member of the Missouri congressional delegation about the possibility of pressing for a CMS response to a written query regarding the deadline for state Medicaid programs to make Upper Payment Limit payments to eligible hospitals - Invited members of the Missouri congressional delegation to join a telephone conference to monitor a Missouri summit on the potential effects of the U.S. Supreme Courts decision in King v. Burwell - Responded to a query from a member of the Missouri congressional delegation regarding enrollment in Missouris federally-subsidized health insurance exchange - Asked a member of the Missouri congressional delegation to co-sponsor S. 1135 - Provided information to a member of the Missouri congressional delegation regarding the performance of the Medicare Recovery Audit Contractor program - Provided and discussed documents with staff of a Senate committee regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services - Provided comments to a member of the Missouri congressional delegation regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services

- Responded to a request from U.S. Senate committee staff for the Missouri Hospital Associations assessment of a proposed CMS regulation - Responded to a request from U.S House of Representatives staff for the Missouri Hospital Associations analysis of H.R. 1201 of the 113th Congress and its implications for Missouri hospitals - Sent information to a staff of the U.S. House of Representatives regarding projections of the future supply of and demand for physicians - Sent a letter of endorsement of H.R 1784, the Making Education for Nurses Dependable for Schools Act, to the bills sponsor and the members of the Missouri congressional delegation - Responded to a request from U.S. House of Representatives staff for an analysis of H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 - Provided information to member hospitals for use in congressional advocacy on medical education projections, H.R. 876 of the 114th Congress, H.R. 1479 of the 114th Congress, H.R. 169/S.258 of the 114th Congress, H.R. 1611/S. 257 of the 114th Congress, H.R. 688/H.R. 1343 of the 114th Congress - Responded to a request from U.S. Senate staff for data and analysis regarding the implications for Missouri hospitals of increases in the price of specific drugs used in medical treatment procedures.

- Responded to a request from U.S. Senate committee staff for the Missouri Hospital Associations assessment of a proposed CMS regulation - Responded to a request from U.S House of Representatives staff for the Missouri Hospital Associations analysis of H.R. 1201 of the 113th Congress and its implications for Missouri hospitals - Sent information to a staff of the U.S. House of Representatives regarding projections of the future supply of and demand for physicians - Sent a letter of endorsement of H.R 1784, the Making Education for Nurses Dependable for Schools Act, to the bills sponsor and the members of the Missouri congressional delegation - Responded to a request from U.S. House of Representatives staff for an analysis of H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 - Provided information to member hospitals for use in congressional advocacy on medical education projections, H.R. 876 of the 114th Congress, H.R. 1479 of the 114th Congress, H.R. 169/S.258 of the 114th Congress, H.R. 1611/S. 257 of the 114th Congress, H.R. 688/H.R. 1343 of the 114th Congress - Responded to a request from U.S. Senate staff for data and analysis regarding the implications for Missouri hospitals of increases in the price of specific drugs used in medical treatment procedures.

- Upon request of a member of the Missouri congressional delegation, discussed the implications of potential legislative proposal to reduce the federal cap on state provider taxes used to fund the Medicaid program. - Worked with the Missouri congressional delegation to produce and promote a letter from the delegation regarding proposed payment reductions for critical access hospitals. - Contacted selected members of the Missouri congressional delegation regarding the reauthorization or extension and expansion of the Medicaid Emergency Demonstration project initially authorized by section 2707 of the Patient Protection and Affordable Care Act of 2010. - Asked members of the Missouri congressional delegation to endorse a Dear Colleague letter regarding the implementation of the Improving Medicare Post-Acute Care Transformation Act of 2014 and potential legislative changes to the data collection requirements under that law. - Contacted selected members of the Missouri congressional delegation to promote repeal of the section 3141 of the Patient Protection and Affordable Care Act of 2010. - Provided information upon request regarding the number of Missouri hospitals receiving Medicare Dependent Hospital payments and that amount of those payments, in regards to legislation (H.R. 2) to provide statutory reauthorization for those payments. - Advocated regarding Medicare and Medicaid aspects of H.R. 2. - Promoted the inclusion of H.R. 1479 of the current Congress and S. 183 of the previous Congress in H.R. 2. - Provided information upon request to selected members of the Missouri congressional delegation regarding payment modifications to hospitals in other states under section 3141 of the Patient Protection and Affordable Care Act of 2010.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Contacted members of the Missouri congressional delegation asking them to consider endorsing a letter to CMS regarding deadlines for state Medicaid programs to make upper payment limit payments to eligible hospitals - Contacted a member of the Missouri congressional delegation regarding the use and implications of hospital outpatient services on Medicare beneficiaries and hospitals - Responded to a request from a member of the Missouri congressional delegation to review and comment on a draft of legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Contacted members of the Missouri congressional delegation to coordinate logistics for visits to congressional offices to discuss federal policy issues affecting hospitals - Responded to a request from a member of the Missouri congressional delegation for information about a DHHS Office of Inspector General audit of the Missouri Medicaid program regarding collection of National Drug Code data - Provided a letter of endorsement to a member of the Missouri congressional delegation regarding the version of the Hospital Payment Fairness Act to be introduced in the 114th Congress. Verified MHAs willingness to be quoted in a press release from the members office. - Responded to a request from a member of the Missouri congressional delegation regarding Missouri Hospital Association support for proposed legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Provided and discussed advocacy materials on the following topics: (1) replacement of the sustainable growth rate formula used in calculating Medicare payments to physicians; (2) support for H.R. 1479 regarding the Medicare average wage index component of Medicare hospital payments; (3) support for legislation to promote and advance comprehensive reform of the Medicare Recovery Audit Contractor program (4) description of the potential effect of the U.S. Supreme Courts decision in King v. Burwell on health insurance coverage of Missourians (5) H.R. 876, relating to notification requirements for hospitals regarding outpatient observation services delivered to Medicare patients (6) oppose legislative efforts to curtail the scope of the Medicaid 340B prescription drug discount initiative (7) support for H.R. 1343 and S. 688, concerning adjustment of readmissions penalties to reflect the socio-economic status of Medicare patients (8) Support for H.R. 169/S. 258 and H.R. 1611 and S. 257, relating to critical access hospitals (9) a profile of the characteristics of Missouri hospitals - Discussed with several members of the Missouri congressional delegation the wording and implications of H.R. 876 for Missouri hospitals - Provided information to a member of the Missouri congressional delegation regarding Medicare payments to hospitals in the members congressional district - Provided information regarding H.R. 2156 in response to a request from a member of the Missouri congressional delegation - Provided information to a member of the Missouri congressional delegation regarding H.R. 1343 - Contacted the Centers for Medicare & Medicaid Services regarding the potential for extending the duration of the Medicaid Emergency Psychiatric Demonstration - Contacted selected members of the Missouri congressional delegation to express opposition to a proposed amendment to the 21st Century Cures Act regarding the 340B drug discount program - Provided the members of the Missouri congressional delegation a summary of state legislative action in the 2015 session of the Missouri General Assembly regarding health care and hospital-related issues - Responded to requests for information regarding the deadline for Missouris Medicaid program to make Upper Payment Limit payments to Missouri hospitals - Responded to a request from a member of the Missouri congressional delegation regarding a possible suspension of the Medicare Recovery Audit Contractor program pending the awarding of new contracts to vendors to administer the program - Expressed opposition to a member of the Missouri congressional delegation regarding pending legislative amendments that would loosen federal statutory restrictions on physician self-referral to hospitals involving Medicare and Medicaid patients - Contacted a member of the Missouri congressional delegation to express thanks for the members responsiveness to the Missouri Hospital Associations concerns about pending legislative proposals to loosen restrictions on physician self-referral to hospitals - Contacted a member of the Missouri congressional delegation about the possibility of pressing for a CMS response to a written query regarding the deadline for state Medicaid programs to make Upper Payment Limit payments to eligible hospitals - Invited members of the Missouri congressional delegation to join a telephone conference to monitor a Missouri summit on the potential effects of the U.S. Supreme Courts decision in King v. Burwell - Responded to a query from a member of the Missouri congressional delegation regarding enrollment in Missouris federally-subsidized health insurance exchange - Asked a member of the Missouri congressional delegation to co-sponsor S. 1135 - Provided information to a member of the Missouri congressional delegation regarding the performance of the Medicare Recovery Audit Contractor program - Provided and discussed documents with staff of a Senate committee regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services - Provided comments to a member of the Missouri congressional delegation regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Responded to a request from U.S. Senate committee staff for the Missouri Hospital Associations assessment of a proposed CMS regulation - Responded to a request from U.S House of Representatives staff for the Missouri Hospital Associations analysis of H.R. 1201 of the 113th Congress and its implications for Missouri hospitals - Sent information to a staff of the U.S. House of Representatives regarding projections of the future supply of and demand for physicians - Sent a letter of endorsement of H.R 1784, the Making Education for Nurses Dependable for Schools Act, to the bills sponsor and the members of the Missouri congressional delegation - Responded to a request from U.S. House of Representatives staff for an analysis of H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 - Provided information to member hospitals for use in congressional advocacy on medical education projections, H.R. 876 of the 114th Congress, H.R. 1479 of the 114th Congress, H.R. 169/S.258 of the 114th Congress, H.R. 1611/S. 257 of the 114th Congress, H.R. 688/H.R. 1343 of the 114th Congress - Responded to a request from U.S. Senate staff for data and analysis regarding the implications for Missouri hospitals of increases in the price of specific drugs used in medical treatment procedures.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Responded to a request from U.S. Senate committee staff for the Missouri Hospital Associations assessment of a proposed CMS regulation - Responded to a request from U.S House of Representatives staff for the Missouri Hospital Associations analysis of H.R. 1201 of the 113th Congress and its implications for Missouri hospitals - Sent information to a staff of the U.S. House of Representatives regarding projections of the future supply of and demand for physicians - Sent a letter of endorsement of H.R 1784, the Making Education for Nurses Dependable for Schools Act, to the bills sponsor and the members of the Missouri congressional delegation - Responded to a request from U.S. House of Representatives staff for an analysis of H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 - Provided information to member hospitals for use in congressional advocacy on medical education projections, H.R. 876 of the 114th Congress, H.R. 1479 of the 114th Congress, H.R. 169/S.258 of the 114th Congress, H.R. 1611/S. 257 of the 114th Congress, H.R. 688/H.R. 1343 of the 114th Congress - Responded to a request from U.S. Senate staff for data and analysis regarding the implications for Missouri hospitals of increases in the price of specific drugs used in medical treatment procedures.

- Contacted members of the Missouri congressional delegation asking them to consider endorsing a letter to CMS regarding deadlines for state Medicaid programs to make upper payment limit payments to eligible hospitals - Contacted a member of the Missouri congressional delegation regarding the use and implications of hospital outpatient services on Medicare beneficiaries and hospitals - Responded to a request from a member of the Missouri congressional delegation to review and comment on a draft of legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Contacted members of the Missouri congressional delegation to coordinate logistics for visits to congressional offices to discuss federal policy issues affecting hospitals - Responded to a request from a member of the Missouri congressional delegation for information about a DHHS Office of Inspector General audit of the Missouri Medicaid program regarding collection of National Drug Code data - Provided a letter of endorsement to a member of the Missouri congressional delegation regarding the version of the Hospital Payment Fairness Act to be introduced in the 114th Congress. Verified MHAs willingness to be quoted in a press release from the members office. - Responded to a request from a member of the Missouri congressional delegation regarding Missouri Hospital Association support for proposed legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Provided and discussed advocacy materials on the following topics: (1) replacement of the sustainable growth rate formula used in calculating Medicare payments to physicians; (2) support for H.R. 1479 regarding the Medicare average wage index component of Medicare hospital payments; (3) support for legislation to promote and advance comprehensive reform of the Medicare Recovery Audit Contractor program (4) description of the potential effect of the U.S. Supreme Courts decision in King v. Burwell on health insurance coverage of Missourians (5) H.R. 876, relating to notification requirements for hospitals regarding outpatient observation services delivered to Medicare patients (6) oppose legislative efforts to curtail the scope of the Medicaid 340B prescription drug discount initiative (7) support for H.R. 1343 and S. 688, concerning adjustment of readmissions penalties to reflect the socio-economic status of Medicare patients (8) Support for H.R. 169/S. 258 and H.R. 1611 and S. 257, relating to critical access hospitals (9) a profile of the characteristics of Missouri hospitals - Discussed with several members of the Missouri congressional delegation the wording and implications of H.R. 876 for Missouri hospitals - Provided information to a member of the Missouri congressional delegation regarding Medicare payments to hospitals in the members congressional district - Provided information regarding H.R. 2156 in response to a request from a member of the Missouri congressional delegation - Provided information to a member of the Missouri congressional delegation regarding H.R. 1343 - Contacted the Centers for Medicare & Medicaid Services regarding the potential for extending the duration of the Medicaid Emergency Psychiatric Demonstration - Contacted selected members of the Missouri congressional delegation to express opposition to a proposed amendment to the 21st Century Cures Act regarding the 340B drug discount program - Provided the members of the Missouri congressional delegation a summary of state legislative action in the 2015 session of the Missouri General Assembly regarding health care and hospital-related issues - Responded to requests for information regarding the deadline for Missouris Medicaid program to make Upper Payment Limit payments to Missouri hospitals - Responded to a request from a member of the Missouri congressional delegation regarding a possible suspension of the Medicare Recovery Audit Contractor program pending the awarding of new contracts to vendors to administer the program - Expressed opposition to a member of the Missouri congressional delegation regarding pending legislative amendments that would loosen federal statutory restrictions on physician self-referral to hospitals involving Medicare and Medicaid patients - Contacted a member of the Missouri congressional delegation to express thanks for the members responsiveness to the Missouri Hospital Associations concerns about pending legislative proposals to loosen restrictions on physician self-referral to hospitals - Contacted a member of the Missouri congressional delegation about the possibility of pressing for a CMS response to a written query regarding the deadline for state Medicaid programs to make Upper Payment Limit payments to eligible hospitals - Invited members of the Missouri congressional delegation to join a telephone conference to monitor a Missouri summit on the potential effects of the U.S. Supreme Courts decision in King v. Burwell - Responded to a query from a member of the Missouri congressional delegation regarding enrollment in Missouris federally-subsidized health insurance exchange - Asked a member of the Missouri congressional delegation to co-sponsor S. 1135 - Provided information to a member of the Missouri congressional delegation regarding the performance of the Medicare Recovery Audit Contractor program - Provided and discussed documents with staff of a Senate committee regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services - Provided comments to a member of the Missouri congressional delegation regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services

- Responded to a request from U.S. Senate committee staff for the Missouri Hospital Associations assessment of a proposed CMS regulation - Responded to a request from U.S House of Representatives staff for the Missouri Hospital Associations analysis of H.R. 1201 of the 113th Congress and its implications for Missouri hospitals - Sent information to a staff of the U.S. House of Representatives regarding projections of the future supply of and demand for physicians - Sent a letter of endorsement of H.R 1784, the Making Education for Nurses Dependable for Schools Act, to the bills sponsor and the members of the Missouri congressional delegation - Responded to a request from U.S. House of Representatives staff for an analysis of H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 - Provided information to member hospitals for use in congressional advocacy on medical education projections, H.R. 876 of the 114th Congress, H.R. 1479 of the 114th Congress, H.R. 169/S.258 of the 114th Congress, H.R. 1611/S. 257 of the 114th Congress, H.R. 688/H.R. 1343 of the 114th Congress - Responded to a request from U.S. Senate staff for data and analysis regarding the implications for Missouri hospitals of increases in the price of specific drugs used in medical treatment procedures.

- Contacted members of the Missouri congressional delegation asking them to consider endorsing a letter to CMS regarding deadlines for state Medicaid programs to make upper payment limit payments to eligible hospitals - Contacted a member of the Missouri congressional delegation regarding the use and implications of hospital outpatient services on Medicare beneficiaries and hospitals - Responded to a request from a member of the Missouri congressional delegation to review and comment on a draft of legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Contacted members of the Missouri congressional delegation to coordinate logistics for visits to congressional offices to discuss federal policy issues affecting hospitals - Responded to a request from a member of the Missouri congressional delegation for information about a DHHS Office of Inspector General audit of the Missouri Medicaid program regarding collection of National Drug Code data - Provided a letter of endorsement to a member of the Missouri congressional delegation regarding the version of the Hospital Payment Fairness Act to be introduced in the 114th Congress. Verified MHAs willingness to be quoted in a press release from the members office. - Responded to a request from a member of the Missouri congressional delegation regarding Missouri Hospital Association support for proposed legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Provided and discussed advocacy materials on the following topics: (1) replacement of the sustainable growth rate formula used in calculating Medicare payments to physicians; (2) support for H.R. 1479 regarding the Medicare average wage index component of Medicare hospital payments; (3) support for legislation to promote and advance comprehensive reform of the Medicare Recovery Audit Contractor program (4) description of the potential effect of the U.S. Supreme Courts decision in King v. Burwell on health insurance coverage of Missourians (5) H.R. 876, relating to notification requirements for hospitals regarding outpatient observation services delivered to Medicare patients (6) oppose legislative efforts to curtail the scope of the Medicaid 340B prescription drug discount initiative (7) support for H.R. 1343 and S. 688, concerning adjustment of readmissions penalties to reflect the socio-economic status of Medicare patients (8) Support for H.R. 169/S. 258 and H.R. 1611 and S. 257, relating to critical access hospitals (9) a profile of the characteristics of Missouri hospitals - Discussed with several members of the Missouri congressional delegation the wording and implications of H.R. 876 for Missouri hospitals - Provided information to a member of the Missouri congressional delegation regarding Medicare payments to hospitals in the members congressional district - Provided information regarding H.R. 2156 in response to a request from a member of the Missouri congressional delegation - Provided information to a member of the Missouri congressional delegation regarding H.R. 1343 - Contacted the Centers for Medicare & Medicaid Services regarding the potential for extending the duration of the Medicaid Emergency Psychiatric Demonstration - Contacted selected members of the Missouri congressional delegation to express opposition to a proposed amendment to the 21st Century Cures Act regarding the 340B drug discount program - Provided the members of the Missouri congressional delegation a summary of state legislative action in the 2015 session of the Missouri General Assembly regarding health care and hospital-related issues - Responded to requests for information regarding the deadline for Missouris Medicaid program to make Upper Payment Limit payments to Missouri hospitals - Responded to a request from a member of the Missouri congressional delegation regarding a possible suspension of the Medicare Recovery Audit Contractor program pending the awarding of new contracts to vendors to administer the program - Expressed opposition to a member of the Missouri congressional delegation regarding pending legislative amendments that would loosen federal statutory restrictions on physician self-referral to hospitals involving Medicare and Medicaid patients - Contacted a member of the Missouri congressional delegation to express thanks for the members responsiveness to the Missouri Hospital Associations concerns about pending legislative proposals to loosen restrictions on physician self-referral to hospitals - Contacted a member of the Missouri congressional delegation about the possibility of pressing for a CMS response to a written query regarding the deadline for state Medicaid programs to make Upper Payment Limit payments to eligible hospitals - Invited members of the Missouri congressional delegation to join a telephone conference to monitor a Missouri summit on the potential effects of the U.S. Supreme Courts decision in King v. Burwell - Responded to a query from a member of the Missouri congressional delegation regarding enrollment in Missouris federally-subsidized health insurance exchange - Asked a member of the Missouri congressional delegation to co-sponsor S. 1135 - Provided information to a member of the Missouri congressional delegation regarding the performance of the Medicare Recovery Audit Contractor program - Provided and discussed documents with staff of a Senate committee regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services - Provided comments to a member of the Missouri congressional delegation regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Responded to a request from U.S. Senate committee staff for the Missouri Hospital Associations assessment of a proposed CMS regulation - Responded to a request from U.S House of Representatives staff for the Missouri Hospital Associations analysis of H.R. 1201 of the 113th Congress and its implications for Missouri hospitals - Sent information to a staff of the U.S. House of Representatives regarding projections of the future supply of and demand for physicians - Sent a letter of endorsement of H.R 1784, the Making Education for Nurses Dependable for Schools Act, to the bills sponsor and the members of the Missouri congressional delegation - Responded to a request from U.S. House of Representatives staff for an analysis of H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 - Provided information to member hospitals for use in congressional advocacy on medical education projections, H.R. 876 of the 114th Congress, H.R. 1479 of the 114th Congress, H.R. 169/S.258 of the 114th Congress, H.R. 1611/S. 257 of the 114th Congress, H.R. 688/H.R. 1343 of the 114th Congress - Responded to a request from U.S. Senate staff for data and analysis regarding the implications for Missouri hospitals of increases in the price of specific drugs used in medical treatment procedures.

- Contacted members of the Missouri congressional delegation asking them to consider endorsing a letter to CMS regarding deadlines for state Medicaid programs to make upper payment limit payments to eligible hospitals - Contacted a member of the Missouri congressional delegation regarding the use and implications of hospital outpatient services on Medicare beneficiaries and hospitals - Responded to a request from a member of the Missouri congressional delegation to review and comment on a draft of legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Contacted members of the Missouri congressional delegation to coordinate logistics for visits to congressional offices to discuss federal policy issues affecting hospitals - Responded to a request from a member of the Missouri congressional delegation for information about a DHHS Office of Inspector General audit of the Missouri Medicaid program regarding collection of National Drug Code data - Provided a letter of endorsement to a member of the Missouri congressional delegation regarding the version of the Hospital Payment Fairness Act to be introduced in the 114th Congress. Verified MHAs willingness to be quoted in a press release from the members office. - Responded to a request from a member of the Missouri congressional delegation regarding Missouri Hospital Association support for proposed legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Provided and discussed advocacy materials on the following topics: (1) replacement of the sustainable growth rate formula used in calculating Medicare payments to physicians; (2) support for H.R. 1479 regarding the Medicare average wage index component of Medicare hospital payments; (3) support for legislation to promote and advance comprehensive reform of the Medicare Recovery Audit Contractor program (4) description of the potential effect of the U.S. Supreme Courts decision in King v. Burwell on health insurance coverage of Missourians (5) H.R. 876, relating to notification requirements for hospitals regarding outpatient observation services delivered to Medicare patients (6) oppose legislative efforts to curtail the scope of the Medicaid 340B prescription drug discount initiative (7) support for H.R. 1343 and S. 688, concerning adjustment of readmissions penalties to reflect the socio-economic status of Medicare patients (8) Support for H.R. 169/S. 258 and H.R. 1611 and S. 257, relating to critical access hospitals (9) a profile of the characteristics of Missouri hospitals - Discussed with several members of the Missouri congressional delegation the wording and implications of H.R. 876 for Missouri hospitals - Provided information to a member of the Missouri congressional delegation regarding Medicare payments to hospitals in the members congressional district - Provided information regarding H.R. 2156 in response to a request from a member of the Missouri congressional delegation - Provided information to a member of the Missouri congressional delegation regarding H.R. 1343 - Contacted the Centers for Medicare & Medicaid Services regarding the potential for extending the duration of the Medicaid Emergency Psychiatric Demonstration - Contacted selected members of the Missouri congressional delegation to express opposition to a proposed amendment to the 21st Century Cures Act regarding the 340B drug discount program - Provided the members of the Missouri congressional delegation a summary of state legislative action in the 2015 session of the Missouri General Assembly regarding health care and hospital-related issues - Responded to requests for information regarding the deadline for Missouris Medicaid program to make Upper Payment Limit payments to Missouri hospitals - Responded to a request from a member of the Missouri congressional delegation regarding a possible suspension of the Medicare Recovery Audit Contractor program pending the awarding of new contracts to vendors to administer the program - Expressed opposition to a member of the Missouri congressional delegation regarding pending legislative amendments that would loosen federal statutory restrictions on physician self-referral to hospitals involving Medicare and Medicaid patients - Contacted a member of the Missouri congressional delegation to express thanks for the members responsiveness to the Missouri Hospital Associations concerns about pending legislative proposals to loosen restrictions on physician self-referral to hospitals - Contacted a member of the Missouri congressional delegation about the possibility of pressing for a CMS response to a written query regarding the deadline for state Medicaid programs to make Upper Payment Limit payments to eligible hospitals - Invited members of the Missouri congressional delegation to join a telephone conference to monitor a Missouri summit on the potential effects of the U.S. Supreme Courts decision in King v. Burwell - Responded to a query from a member of the Missouri congressional delegation regarding enrollment in Missouris federally-subsidized health insurance exchange - Asked a member of the Missouri congressional delegation to co-sponsor S. 1135 - Provided information to a member of the Missouri congressional delegation regarding the performance of the Medicare Recovery Audit Contractor program - Provided and discussed documents with staff of a Senate committee regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services - Provided comments to a member of the Missouri congressional delegation regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services

- Responded to a request from U.S. Senate committee staff for the Missouri Hospital Associations assessment of a proposed CMS regulation - Responded to a request from U.S House of Representatives staff for the Missouri Hospital Associations analysis of H.R. 1201 of the 113th Congress and its implications for Missouri hospitals - Sent information to a staff of the U.S. House of Representatives regarding projections of the future supply of and demand for physicians - Sent a letter of endorsement of H.R 1784, the Making Education for Nurses Dependable for Schools Act, to the bills sponsor and the members of the Missouri congressional delegation - Responded to a request from U.S. House of Representatives staff for an analysis of H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 - Provided information to member hospitals for use in congressional advocacy on medical education projections, H.R. 876 of the 114th Congress, H.R. 1479 of the 114th Congress, H.R. 169/S.258 of the 114th Congress, H.R. 1611/S. 257 of the 114th Congress, H.R. 688/H.R. 1343 of the 114th Congress - Responded to a request from U.S. Senate staff for data and analysis regarding the implications for Missouri hospitals of increases in the price of specific drugs used in medical treatment procedures.

- Contacted members of the Missouri congressional delegation asking them to consider endorsing a letter to CMS regarding deadlines for state Medicaid programs to make upper payment limit payments to eligible hospitals - Contacted a member of the Missouri congressional delegation regarding the use and implications of hospital outpatient services on Medicare beneficiaries and hospitals - Responded to a request from a member of the Missouri congressional delegation to review and comment on a draft of legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Contacted members of the Missouri congressional delegation to coordinate logistics for visits to congressional offices to discuss federal policy issues affecting hospitals - Responded to a request from a member of the Missouri congressional delegation for information about a DHHS Office of Inspector General audit of the Missouri Medicaid program regarding collection of National Drug Code data - Provided a letter of endorsement to a member of the Missouri congressional delegation regarding the version of the Hospital Payment Fairness Act to be introduced in the 114th Congress. Verified MHAs willingness to be quoted in a press release from the members office. - Responded to a request from a member of the Missouri congressional delegation regarding Missouri Hospital Association support for proposed legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Provided and discussed advocacy materials on the following topics: (1) replacement of the sustainable growth rate formula used in calculating Medicare payments to physicians; (2) support for H.R. 1479 regarding the Medicare average wage index component of Medicare hospital payments; (3) support for legislation to promote and advance comprehensive reform of the Medicare Recovery Audit Contractor program (4) description of the potential effect of the U.S. Supreme Courts decision in King v. Burwell on health insurance coverage of Missourians (5) H.R. 876, relating to notification requirements for hospitals regarding outpatient observation services delivered to Medicare patients (6) oppose legislative efforts to curtail the scope of the Medicaid 340B prescription drug discount initiative (7) support for H.R. 1343 and S. 688, concerning adjustment of readmissions penalties to reflect the socio-economic status of Medicare patients (8) Support for H.R. 169/S. 258 and H.R. 1611 and S. 257, relating to critical access hospitals (9) a profile of the characteristics of Missouri hospitals - Discussed with several members of the Missouri congressional delegation the wording and implications of H.R. 876 for Missouri hospitals - Provided information to a member of the Missouri congressional delegation regarding Medicare payments to hospitals in the members congressional district - Provided information regarding H.R. 2156 in response to a request from a member of the Missouri congressional delegation - Provided information to a member of the Missouri congressional delegation regarding H.R. 1343 - Contacted the Centers for Medicare & Medicaid Services regarding the potential for extending the duration of the Medicaid Emergency Psychiatric Demonstration - Contacted selected members of the Missouri congressional delegation to express opposition to a proposed amendment to the 21st Century Cures Act regarding the 340B drug discount program - Provided the members of the Missouri congressional delegation a summary of state legislative action in the 2015 session of the Missouri General Assembly regarding health care and hospital-related issues - Responded to requests for information regarding the deadline for Missouris Medicaid program to make Upper Payment Limit payments to Missouri hospitals - Responded to a request from a member of the Missouri congressional delegation regarding a possible suspension of the Medicare Recovery Audit Contractor program pending the awarding of new contracts to vendors to administer the program - Expressed opposition to a member of the Missouri congressional delegation regarding pending legislative amendments that would loosen federal statutory restrictions on physician self-referral to hospitals involving Medicare and Medicaid patients - Contacted a member of the Missouri congressional delegation to express thanks for the members responsiveness to the Missouri Hospital Associations concerns about pending legislative proposals to loosen restrictions on physician self-referral to hospitals - Contacted a member of the Missouri congressional delegation about the possibility of pressing for a CMS response to a written query regarding the deadline for state Medicaid programs to make Upper Payment Limit payments to eligible hospitals - Invited members of the Missouri congressional delegation to join a telephone conference to monitor a Missouri summit on the potential effects of the U.S. Supreme Courts decision in King v. Burwell - Responded to a query from a member of the Missouri congressional delegation regarding enrollment in Missouris federally-subsidized health insurance exchange - Asked a member of the Missouri congressional delegation to co-sponsor S. 1135 - Provided information to a member of the Missouri congressional delegation regarding the performance of the Medicare Recovery Audit Contractor program - Provided and discussed documents with staff of a Senate committee regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services - Provided comments to a member of the Missouri congressional delegation regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Sent documents and data describing and presenting the impetus for a Missouri initiative on standards for the prescribing of opioids to health staff of the Missouri congressional delegation - Received a query from a Missouri congressional office regarding hospitals reactions to the quality of care components of a discussion draft of legislation (the Hospital Improvements for Payment Act of 2014.) - Coordinated a response to a query from staffers for the Permanent Subcommittee on Investigations of the U.S. Senate Homeland Security and Governmental Affairs Committee. The query concerned price increases for two pharmaceutical products, Isuprel and Nitropress. - Discussed the potential sponsorship by a member of the Missouri congressional delegation of legislation regarding Medicare Recovery Audit Contractors. - Researched S. 2107, the Building a Health Care Workforce for the Future Act, which is co-sponsored by a member of the Missouri congressional delegation. - Responded to a query from the staff of a member of the Missouri congressional delegation for a list of issues to be discussed during upcoming congressional visits. - Met with selected members of the Missouri congressional delegation. Briefing papers addressed the following topics: 1) a profile of Missouris hospitals; 2) legislation to reform the Medicare Recovery Audit Contractor program (H.R. 2156); 3) Medicare DSH payment reform (H.R. 3288); 4) changes to the Medicare wage index system (H.R. 1479, S. 1135); 5) legislative proposals affecting rural hospitals (H.R. 3225, H.R. 2948, H.R. 2066, H.R. 169, S. 258, H.R. 1611, S. 257, section 3021 of H.R. 6); 6) protection of the 340B drug discount program administered by the Health Resources and Services Administration of the Department of Health and Human Services; 7) legislation affecting behavioral health (S. 599, H.R. 2646, S. 1945, S. 1893, S. 2166); 8) regulatory standards of the Centers for Medicare & Medicaid Services Comprehensive Care for Joint Replacement Initiative; 9) the need for risk-adjustment of data used in the Medicare hospital readmissions program (S. 688 and H.R. 1343). - Corresponded with staff of the Missouri congressional delegation regarding the logistics of meetings of hospital executives and selected members of the Missouri congressional delegation - Responded to a query from a member of the Missouri congressional delegation regarding legislation to change the payment formulas used by the Medicare Disproportionate Share Hospital program. - Responded to a query from a member of the Missouri congressional delegation regarding legislation to revise payment formulas used by the Medicare Disproportionate Share Hospital program. - Requested that members of the U.S. Senate representing Missouri contact Senate leaders to express support for inclusion of legislation to revise the Medicare wage index (H.R. 1479) in legislation to enact a continuing resolution to authorize federal budgetary expenditures. - Collaborated with staff of the U.S. Senate Special Committee on Aging regarding a January 2016 committee hearing to be held in Jefferson City, Missouri. The agenda of the hearing is the abuse and misuse of opioids used for pain control in the elderly. - Corresponded with the staff of a member of the Missouri congressional delegation regarding a change in staffing responsibilities in that congressional office.

- Contacted members of the Missouri congressional delegation asking them to consider endorsing a letter to CMS regarding deadlines for state Medicaid programs to make upper payment limit payments to eligible hospitals - Contacted a member of the Missouri congressional delegation regarding the use and implications of hospital outpatient services on Medicare beneficiaries and hospitals - Responded to a request from a member of the Missouri congressional delegation to review and comment on a draft of legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Contacted members of the Missouri congressional delegation to coordinate logistics for visits to congressional offices to discuss federal policy issues affecting hospitals - Responded to a request from a member of the Missouri congressional delegation for information about a DHHS Office of Inspector General audit of the Missouri Medicaid program regarding collection of National Drug Code data - Provided a letter of endorsement to a member of the Missouri congressional delegation regarding the version of the Hospital Payment Fairness Act to be introduced in the 114th Congress. Verified MHAs willingness to be quoted in a press release from the members office. - Responded to a request from a member of the Missouri congressional delegation regarding Missouri Hospital Association support for proposed legislation regarding rural hospitals and the Medicare Recovery Audit Contractor program - Provided and discussed advocacy materials on the following topics: (1) replacement of the sustainable growth rate formula used in calculating Medicare payments to physicians; (2) support for H.R. 1479 regarding the Medicare average wage index component of Medicare hospital payments; (3) support for legislation to promote and advance comprehensive reform of the Medicare Recovery Audit Contractor program (4) description of the potential effect of the U.S. Supreme Courts decision in King v. Burwell on health insurance coverage of Missourians (5) H.R. 876, relating to notification requirements for hospitals regarding outpatient observation services delivered to Medicare patients (6) oppose legislative efforts to curtail the scope of the Medicaid 340B prescription drug discount initiative (7) support for H.R. 1343 and S. 688, concerning adjustment of readmissions penalties to reflect the socio-economic status of Medicare patients (8) Support for H.R. 169/S. 258 and H.R. 1611 and S. 257, relating to critical access hospitals (9) a profile of the characteristics of Missouri hospitals - Discussed with several members of the Missouri congressional delegation the wording and implications of H.R. 876 for Missouri hospitals - Provided information to a member of the Missouri congressional delegation regarding Medicare payments to hospitals in the members congressional district - Provided information regarding H.R. 2156 in response to a request from a member of the Missouri congressional delegation - Provided information to a member of the Missouri congressional delegation regarding H.R. 1343 - Contacted the Centers for Medicare & Medicaid Services regarding the potential for extending the duration of the Medicaid Emergency Psychiatric Demonstration - Contacted selected members of the Missouri congressional delegation to express opposition to a proposed amendment to the 21st Century Cures Act regarding the 340B drug discount program - Provided the members of the Missouri congressional delegation a summary of state legislative action in the 2015 session of the Missouri General Assembly regarding health care and hospital-related issues - Responded to requests for information regarding the deadline for Missouris Medicaid program to make Upper Payment Limit payments to Missouri hospitals - Responded to a request from a member of the Missouri congressional delegation regarding a possible suspension of the Medicare Recovery Audit Contractor program pending the awarding of new contracts to vendors to administer the program - Expressed opposition to a member of the Missouri congressional delegation regarding pending legislative amendments that would loosen federal statutory restrictions on physician self-referral to hospitals involving Medicare and Medicaid patients - Contacted a member of the Missouri congressional delegation to express thanks for the members responsiveness to the Missouri Hospital Associations concerns about pending legislative proposals to loosen restrictions on physician self-referral to hospitals - Contacted a member of the Missouri congressional delegation about the possibility of pressing for a CMS response to a written query regarding the deadline for state Medicaid programs to make Upper Payment Limit payments to eligible hospitals - Invited members of the Missouri congressional delegation to join a telephone conference to monitor a Missouri summit on the potential effects of the U.S. Supreme Courts decision in King v. Burwell - Responded to a query from a member of the Missouri congressional delegation regarding enrollment in Missouris federally-subsidized health insurance exchange - Asked a member of the Missouri congressional delegation to co-sponsor S. 1135 - Provided information to a member of the Missouri congressional delegation regarding the performance of the Medicare Recovery Audit Contractor program - Provided and discussed documents with staff of a Senate committee regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services - Provided comments to a member of the Missouri congressional delegation regarding the use of hospital outpatient observations services and the role of the Medicare Recovery Audit Contractors in promoting the use of those services

- Responded to a request from U.S. Senate committee staff for the Missouri Hospital Associations assessment of a proposed CMS regulation - Responded to a request from U.S House of Representatives staff for the Missouri Hospital Associations analysis of H.R. 1201 of the 113th Congress and its implications for Missouri hospitals - Sent information to a staff of the U.S. House of Representatives regarding projections of the future supply of and demand for physicians - Sent a letter of endorsement of H.R 1784, the Making Education for Nurses Dependable for Schools Act, to the bills sponsor and the members of the Missouri congressional delegation - Responded to a request from U.S. House of Representatives staff for an analysis of H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 - Provided information to member hospitals for use in congressional advocacy on medical education projections, H.R. 876 of the 114th Congress, H.R. 1479 of the 114th Congress, H.R. 169/S.258 of the 114th Congress, H.R. 1611/S. 257 of the 114th Congress, H.R. 688/H.R. 1343 of the 114th Congress - Responded to a request from U.S. Senate staff for data and analysis regarding the implications for Missouri hospitals of increases in the price of specific drugs used in medical treatment procedures.

Promoted Missouri congressional delegation discussion of a backlog in processing of Administrative Law Judge review of appeals of Medicare payment and benefit decision, as well as Recovery Audit Contractor reform legislation (H.R. 1250 and S. 1012) with Secretary of Health and Human Services nominee Sylvia BurwellPromoted enactment of H.R. 1250 and S. 1012 Responded to a congressional office request for information about Missouri hospitals which may be applying for a grant under CMS Medicare Care Choices Model project Responded to a congressional office request for information about litigation challenging the backlog in Administrative Law Judge review of Medicaid payment and benefit decision Provided information to selected members of the Missouri congressional delegation regarding another states actions regarding the decision of CMS to extend the imputed wage index floor for that state Distributed information to the Missouri congressional delegation regarding Missouri hospitals participation in the federal Partnership for Patients/Hospital Engagement Network initiative. Promoted enactment of S. 183 and H.R. 2053 Provided advocacy information to the Missouri congressional delegation regarding: - a profile of the characteristics of Missouri hospitals - changes in the schedule of implementation of federal statutory reductions in Medicaid disproportionate share hospital payments - federal payment reductions for Missouri hospitals by Medicare, including Medicare sequestration and Medicaid disproportionate share hospital payments - Missouri state and district-specific analyses of the characteristics and health care utilization of the uninsured - the role and benefits of the 340B prescription drug purchasing discount program for participating Missouri hospitals - expected debate of legislation regarding Medicare payment and standards for post-acute health care providers, reflected in a bicameral draft of the Improving Medicare Post-Acute Care Transformation Act of 2014. Promoted enactment of H.R. 4188 or expected companion Senate legislation Provided to the Missouri congressional delegation the Missouri Hospital Associations comments regarding CMS proposed regulation governing the payment of premiums on behalf of health insurance exchange enrollees Discussed potential topics for future health policy briefings with the Missouri congressional delegation

Promoted Missouri congressional delegation discussion of a backlog in processing of Administrative Law Judge review of appeals of Medicare payment and benefit decision, as well as Recovery Audit Contractor reform legislation (H.R. 1250 and S. 1012) with Secretary of Health and Human Services nominee Sylvia BurwellPromoted enactment of H.R. 1250 and S. 1012 Responded to a congressional office request for information about Missouri hospitals which may be applying for a grant under CMS Medicare Care Choices Model project Responded to a congressional office request for information about litigation challenging the backlog in Administrative Law Judge review of Medicaid payment and benefit decision Provided information to selected members of the Missouri congressional delegation regarding another states actions regarding the decision of CMS to extend the imputed wage index floor for that state Distributed information to the Missouri congressional delegation regarding Missouri hospitals participation in the federal Partnership for Patients/Hospital Engagement Network initiative. Promoted enactment of S. 183 and H.R. 2053 Provided advocacy information to the Missouri congressional delegation regarding: - a profile of the characteristics of Missouri hospitals - changes in the schedule of implementation of federal statutory reductions in Medicaid disproportionate share hospital payments - federal payment reductions for Missouri hospitals by Medicare, including Medicare sequestration and Medicaid disproportionate share hospital payments - Missouri state and district-specific analyses of the characteristics and health care utilization of the uninsured - the role and benefits of the 340B prescription drug purchasing discount program for participating Missouri hospitals - expected debate of legislation regarding Medicare payment and standards for post-acute health care providers, reflected in a bicameral draft of the Improving Medicare Post-Acute Care Transformation Act of 2014. Promoted enactment of H.R. 4188 or expected companion Senate legislation Provided to the Missouri congressional delegation the Missouri Hospital Associations comments regarding CMS proposed regulation governing the payment of premiums on behalf of health insurance exchange enrollees Discussed potential topics for future health policy briefings with the Missouri congressional delegation

- Communicated with the Missouri congressional delegation regarding the Department of Health and Human Services decision to suspend most new requests for Administrative Law Judge hearings of appeals of Medicare payment denials because of a backlog of cases. The issue was linked to H.R. 1250 and S. 1012.- Met with Missouri congressional offices to discuss trends in Medicare and Medicaid hospital finance, H.R. 1250 and S. 1012, and the need for equity and predictability in applying therapy caps and an associated exception process to different care settings. - Provided requested information to a congressional office regarding Medicare and Medicaid payment reductions. - Provided requested information regarding the amount of federal revenue foregone in 2014 by virtue of the Missouri General Assemblys failure to enact in 2013 the expansion of Medicaid eligibility standards authorized by the Patient Protection and Affordable Care Act of 2010. - Discussed the potential involvement of a Missouri federal legislator in news conferences to promote H.R. 1250 and S. 1012. - Encouraged members of the Missouri congressional delegation in the House of Representatives to endorse a joint letter to Secretary of Health and Human Services regarding the Medicare Recovery Audit Contractor program and H.R. 1250 and S. 1012. - Contacted the Missouri congressional delegation in support of S. 183 and H. R. 2053. - Contacted offices of Missouri Senators asking them to consider discussing endorsement of a joint letter to CMS Director Marilyn Tavenner regarding reimbursement of inpatient rehabilitation hospitals and hospital units. - Voiced support for the Establishing Beneficiary Equity in the Hospital Readmission Program Act of Rep. Renacci. - Responded to a legislators request for MHAs stance regarding emerging legislation to postpone payment reductions to Medicare physicians as required by the Sustainable Growth Rate Formula. - Urged the Missouri congressional delegation to oppose legislative efforts to reduce hospital Medicare or Medicaid payments as an offset to the cost of a temporary delay of payment cuts for physician services under the Medicare program.

Promoted H.R. 5227 Provided information on rural health care issues in Missouri in response to a congressional staff query Participated in a briefing for congressional staff regarding the Medicare wage index formulas used in computing Medicare payments to prospective payment system hospitals and discussed the potential for future legislation Queried Missouri congressional staff for topics of interest in upcoming visits to congressional offices Invited a CMS staffer to speak to hospital officials in advance of congressional advocacy visits Promoted enactment of H.R. 1250 and S. 1012 Promoted enactment of S. 183 and H.R. 2053 Provided advocacy information to the Missouri congressional delegation regarding: - a profile of the characteristics of Missouri hospitals - federal payment reductions for Missouri hospitals by Medicare, including Medicare sequestration and Medicaid disproportionate share hospital payments - a pending settlement offer by CMS to address a backlog in appeals of Medicare payment denials - concerns raised by the current Medicare wage index formulas used to calculate Medicare payments to hospitals under the prospective payment system - the role and benefits of the 340B prescription drug purchasing discount program for participating Missouri hospitals - the expected effect of recently-enacted legislation regarding the Veterans Affairs health care system in providing access to private-sector providers - legislation regarding Medicare payment and standards for post-acute health care providers, pursuant to Improving Medicare Post-Acute Care Transformation Act of 2014.

Promoted Missouri congressional delegation discussion of a backlog in processing of Administrative Law Judge review of appeals of Medicare payment and benefit decision, as well as Recovery Audit Contractor reform legislation (H.R. 1250 and S. 1012) with Secretary of Health and Human Services nominee Sylvia BurwellPromoted enactment of H.R. 1250 and S. 1012 Responded to a congressional office request for information about Missouri hospitals which may be applying for a grant under CMS Medicare Care Choices Model project Responded to a congressional office request for information about litigation challenging the backlog in Administrative Law Judge review of Medicaid payment and benefit decision Provided information to selected members of the Missouri congressional delegation regarding another states actions regarding the decision of CMS to extend the imputed wage index floor for that state Distributed information to the Missouri congressional delegation regarding Missouri hospitals participation in the federal Partnership for Patients/Hospital Engagement Network initiative. Promoted enactment of S. 183 and H.R. 2053 Provided advocacy information to the Missouri congressional delegation regarding: - a profile of the characteristics of Missouri hospitals - changes in the schedule of implementation of federal statutory reductions in Medicaid disproportionate share hospital payments - federal payment reductions for Missouri hospitals by Medicare, including Medicare sequestration and Medicaid disproportionate share hospital payments - Missouri state and district-specific analyses of the characteristics and health care utilization of the uninsured - the role and benefits of the 340B prescription drug purchasing discount program for participating Missouri hospitals - expected debate of legislation regarding Medicare payment and standards for post-acute health care providers, reflected in a bicameral draft of the Improving Medicare Post-Acute Care Transformation Act of 2014. Promoted enactment of H.R. 4188 or expected companion Senate legislation Provided to the Missouri congressional delegation the Missouri Hospital Associations comments regarding CMS proposed regulation governing the payment of premiums on behalf of health insurance exchange enrollees Discussed potential topics for future health policy briefings with the Missouri congressional delegation

Promoted H.R. 5227 Provided information on rural health care issues in Missouri in response to a congressional staff query Participated in a briefing for congressional staff regarding the Medicare wage index formulas used in computing Medicare payments to prospective payment system hospitals and discussed the potential for future legislation Queried Missouri congressional staff for topics of interest in upcoming visits to congressional offices Invited a CMS staffer to speak to hospital officials in advance of congressional advocacy visits Promoted enactment of H.R. 1250 and S. 1012 Promoted enactment of S. 183 and H.R. 2053 Provided advocacy information to the Missouri congressional delegation regarding: - a profile of the characteristics of Missouri hospitals - federal payment reductions for Missouri hospitals by Medicare, including Medicare sequestration and Medicaid disproportionate share hospital payments - a pending settlement offer by CMS to address a backlog in appeals of Medicare payment denials - concerns raised by the current Medicare wage index formulas used to calculate Medicare payments to hospitals under the prospective payment system - the role and benefits of the 340B prescription drug purchasing discount program for participating Missouri hospitals - the expected effect of recently-enacted legislation regarding the Veterans Affairs health care system in providing access to private-sector providers - legislation regarding Medicare payment and standards for post-acute health care providers, pursuant to Improving Medicare Post-Acute Care Transformation Act of 2014.