VY OXMAN

ACPs 2026 Second Quarter Lobbying Disclosure Report Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. The Provider Reimbursement Stability Act of 2026. H.R. 8163 would raise the budget neutrality threshold from $20 million to $54.3 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every 5 years. ACP supported the Medicare Physician Data-Drive Performance Payment System Act of 2026. This critical legislation seeks to modernize Medicare payments by reducing administrative burdens, improving patient care, and supporting small/rural practices through a more practical, data-driven approach. Dr. William Fox, Chair Emeritus of ACPs Board of Regents, testified before the House Energy and Commerce Committees Health Subcommittee on policy reforms to improve the Medicare Physician Fee Schedule and the Medicare Access and CHIP Reauthorization Act (MACRA) on behalf of ACP. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Provided comments to the House Energy and Commerce Committees markup, which includes the Lower Cost, More Transparency Act, H.R. 9393, and the Improving Seniors Timely Access to Care Act, H.R. 3514. The two bills would enhance price transparency across health care entities and streamline unnecessary administrative burden, respectively. ACP also supported several policies included in bills slated for markup that would reform Medicare Advantage practices to ensure accountability and safeguard market competition. ACP strongly supports pricing transparency in health care. ACP supported the passage of the Lower Costs, More Transparency Act, which passed the House in the 118th Congress, and we continue to support its reintroduction and passage in this Congress under H.R. 9393. ACP supported provisions within the Medicare Advantage Cost Transparency Act, H.R. 9392, led by Ranking Member DeGette and Dr. Joyce, which would provide greater oversight by requiring that Medicare Advantage (MA) plans report to the Centers for Medicare & Medicaid Services (CMS) on encounter data, including the allowed amount that a plan agreed to pay for a service in total and the total out-of-pocket costs the patient pays for a service. The College has repeatedly voiced support for the Improving Seniors' Timely Access to Care Act, led by Reps. Kelly and DelBene, which would protect patients from unnecessary delays in care and reduce administrative burden on physicians by streamlining MAs prior authorization approval processes. We urge Congress to pass H.R. 3514 to ensure that our patients will get the care they need, when they need it most. FY2026 Appropriations/Agency Restructuring: For FY2027, ACP is urged appropriations committees that funding be either maintained or increased for the following proven programs: 1) Health Resources Services Administration (HRSA), $10.5 billion, including: 2) Health Workforce, National Health Service Corps (NHSC), $915.6 million in total program funding; 3) Primary Care Training and Enhancement (PCTE), $71 million; 4) Title X Family Planning Program, $390 million; 5) Agency for Healthcare Research and Quality (AHRQ), $500 million; 6) Centers for Disease Control and Prevention (CDC) Injury Prevention and Control, $11.6 billion, including: 7) Firearm Injury and Mortality Prevention Research, $35 million; 8) Chronic Disease Prevention and Health Promotion, Social Determinants of Health, $100 million; 9) National Institutes of Health (NIH), $51.3 billion, including: 10) Office of the Director, Firearms Research, $25 million; 11) Centers for Medicare and Medicaid Services (CMS) and Government Accountability Office (GAO); and 12) Report language to ensure primary care physicians are receiving Medicare physician revaluations. We urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. ACP urged appropriators to provide $35 million for the U.S. Centers for Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention. Primary Care and the Physician Workforce: ACP urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. ACP supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Scope of Practice: ACP provided comments urging the House Ways and Means Committee during markup to oppose the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Expand Patient Access: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans).

ACPs 2026 Second Quarter Lobbying Disclosure Report Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. The Provider Reimbursement Stability Act of 2026. H.R. 8163 would raise the budget neutrality threshold from $20 million to $54.3 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every 5 years. ACP supported the Medicare Physician Data-Drive Performance Payment System Act of 2026. This critical legislation seeks to modernize Medicare payments by reducing administrative burdens, improving patient care, and supporting small/rural practices through a more practical, data-driven approach. Dr. William Fox, Chair Emeritus of ACPs Board of Regents, testified before the House Energy and Commerce Committees Health Subcommittee on policy reforms to improve the Medicare Physician Fee Schedule and the Medicare Access and CHIP Reauthorization Act (MACRA) on behalf of ACP. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Provided comments to the House Energy and Commerce Committees markup, which includes the Lower Cost, More Transparency Act, H.R. 9393, and the Improving Seniors Timely Access to Care Act, H.R. 3514. The two bills would enhance price transparency across health care entities and streamline unnecessary administrative burden, respectively. ACP also supported several policies included in bills slated for markup that would reform Medicare Advantage practices to ensure accountability and safeguard market competition. ACP strongly supports pricing transparency in health care. ACP supported the passage of the Lower Costs, More Transparency Act, which passed the House in the 118th Congress, and we continue to support its reintroduction and passage in this Congress under H.R. 9393. ACP supported provisions within the Medicare Advantage Cost Transparency Act, H.R. 9392, led by Ranking Member DeGette and Dr. Joyce, which would provide greater oversight by requiring that Medicare Advantage (MA) plans report to the Centers for Medicare & Medicaid Services (CMS) on encounter data, including the allowed amount that a plan agreed to pay for a service in total and the total out-of-pocket costs the patient pays for a service. The College has repeatedly voiced support for the Improving Seniors' Timely Access to Care Act, led by Reps. Kelly and DelBene, which would protect patients from unnecessary delays in care and reduce administrative burden on physicians by streamlining MAs prior authorization approval processes. We urge Congress to pass H.R. 3514 to ensure that our patients will get the care they need, when they need it most. FY2026 Appropriations/Agency Restructuring: For FY2027, ACP is urged appropriations committees that funding be either maintained or increased for the following proven programs: 1) Health Resources Services Administration (HRSA), $10.5 billion, including: 2) Health Workforce, National Health Service Corps (NHSC), $915.6 million in total program funding; 3) Primary Care Training and Enhancement (PCTE), $71 million; 4) Title X Family Planning Program, $390 million; 5) Agency for Healthcare Research and Quality (AHRQ), $500 million; 6) Centers for Disease Control and Prevention (CDC) Injury Prevention and Control, $11.6 billion, including: 7) Firearm Injury and Mortality Prevention Research, $35 million; 8) Chronic Disease Prevention and Health Promotion, Social Determinants of Health, $100 million; 9) National Institutes of Health (NIH), $51.3 billion, including: 10) Office of the Director, Firearms Research, $25 million; 11) Centers for Medicare and Medicaid Services (CMS) and Government Accountability Office (GAO); and 12) Report language to ensure primary care physicians are receiving Medicare physician revaluations. We urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. ACP urged appropriators to provide $35 million for the U.S. Centers for Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention. Primary Care and the Physician Workforce: ACP urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. ACP supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Scope of Practice: ACP provided comments urging the House Ways and Means Committee during markup to oppose the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Expand Patient Access: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans).

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 Second Quarter Lobbying Disclosure Report Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. The Provider Reimbursement Stability Act of 2026. H.R. 8163 would raise the budget neutrality threshold from $20 million to $54.3 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every 5 years. ACP supported the Medicare Physician Data-Drive Performance Payment System Act of 2026. This critical legislation seeks to modernize Medicare payments by reducing administrative burdens, improving patient care, and supporting small/rural practices through a more practical, data-driven approach. Dr. William Fox, Chair Emeritus of ACPs Board of Regents, testified before the House Energy and Commerce Committees Health Subcommittee on policy reforms to improve the Medicare Physician Fee Schedule and the Medicare Access and CHIP Reauthorization Act (MACRA) on behalf of ACP. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Provided comments to the House Energy and Commerce Committees markup, which includes the Lower Cost, More Transparency Act, H.R. 9393, and the Improving Seniors Timely Access to Care Act, H.R. 3514. The two bills would enhance price transparency across health care entities and streamline unnecessary administrative burden, respectively. ACP also supported several policies included in bills slated for markup that would reform Medicare Advantage practices to ensure accountability and safeguard market competition. ACP strongly supports pricing transparency in health care. ACP supported the passage of the Lower Costs, More Transparency Act, which passed the House in the 118th Congress, and we continue to support its reintroduction and passage in this Congress under H.R. 9393. ACP supported provisions within the Medicare Advantage Cost Transparency Act, H.R. 9392, led by Ranking Member DeGette and Dr. Joyce, which would provide greater oversight by requiring that Medicare Advantage (MA) plans report to the Centers for Medicare & Medicaid Services (CMS) on encounter data, including the allowed amount that a plan agreed to pay for a service in total and the total out-of-pocket costs the patient pays for a service. The College has repeatedly voiced support for the Improving Seniors' Timely Access to Care Act, led by Reps. Kelly and DelBene, which would protect patients from unnecessary delays in care and reduce administrative burden on physicians by streamlining MAs prior authorization approval processes. We urge Congress to pass H.R. 3514 to ensure that our patients will get the care they need, when they need it most. FY2026 Appropriations/Agency Restructuring: For FY2027, ACP is urged appropriations committees that funding be either maintained or increased for the following proven programs: 1) Health Resources Services Administration (HRSA), $10.5 billion, including: 2) Health Workforce, National Health Service Corps (NHSC), $915.6 million in total program funding; 3) Primary Care Training and Enhancement (PCTE), $71 million; 4) Title X Family Planning Program, $390 million; 5) Agency for Healthcare Research and Quality (AHRQ), $500 million; 6) Centers for Disease Control and Prevention (CDC) Injury Prevention and Control, $11.6 billion, including: 7) Firearm Injury and Mortality Prevention Research, $35 million; 8) Chronic Disease Prevention and Health Promotion, Social Determinants of Health, $100 million; 9) National Institutes of Health (NIH), $51.3 billion, including: 10) Office of the Director, Firearms Research, $25 million; 11) Centers for Medicare and Medicaid Services (CMS) and Government Accountability Office (GAO); and 12) Report language to ensure primary care physicians are receiving Medicare physician revaluations. We urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. ACP urged appropriators to provide $35 million for the U.S. Centers for Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention. Primary Care and the Physician Workforce: ACP urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. ACP supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Scope of Practice: ACP provided comments urging the House Ways and Means Committee during markup to oppose the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Expand Patient Access: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans).

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 Second Quarter Lobbying Disclosure Report Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. The Provider Reimbursement Stability Act of 2026. H.R. 8163 would raise the budget neutrality threshold from $20 million to $54.3 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every 5 years. ACP supported the Medicare Physician Data-Drive Performance Payment System Act of 2026. This critical legislation seeks to modernize Medicare payments by reducing administrative burdens, improving patient care, and supporting small/rural practices through a more practical, data-driven approach. Dr. William Fox, Chair Emeritus of ACPs Board of Regents, testified before the House Energy and Commerce Committees Health Subcommittee on policy reforms to improve the Medicare Physician Fee Schedule and the Medicare Access and CHIP Reauthorization Act (MACRA) on behalf of ACP. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Provided comments to the House Energy and Commerce Committees markup, which includes the Lower Cost, More Transparency Act, H.R. 9393, and the Improving Seniors Timely Access to Care Act, H.R. 3514. The two bills would enhance price transparency across health care entities and streamline unnecessary administrative burden, respectively. ACP also supported several policies included in bills slated for markup that would reform Medicare Advantage practices to ensure accountability and safeguard market competition. ACP strongly supports pricing transparency in health care. ACP supported the passage of the Lower Costs, More Transparency Act, which passed the House in the 118th Congress, and we continue to support its reintroduction and passage in this Congress under H.R. 9393. ACP supported provisions within the Medicare Advantage Cost Transparency Act, H.R. 9392, led by Ranking Member DeGette and Dr. Joyce, which would provide greater oversight by requiring that Medicare Advantage (MA) plans report to the Centers for Medicare & Medicaid Services (CMS) on encounter data, including the allowed amount that a plan agreed to pay for a service in total and the total out-of-pocket costs the patient pays for a service. The College has repeatedly voiced support for the Improving Seniors' Timely Access to Care Act, led by Reps. Kelly and DelBene, which would protect patients from unnecessary delays in care and reduce administrative burden on physicians by streamlining MAs prior authorization approval processes. We urge Congress to pass H.R. 3514 to ensure that our patients will get the care they need, when they need it most. FY2026 Appropriations/Agency Restructuring: For FY2027, ACP is urged appropriations committees that funding be either maintained or increased for the following proven programs: 1) Health Resources Services Administration (HRSA), $10.5 billion, including: 2) Health Workforce, National Health Service Corps (NHSC), $915.6 million in total program funding; 3) Primary Care Training and Enhancement (PCTE), $71 million; 4) Title X Family Planning Program, $390 million; 5) Agency for Healthcare Research and Quality (AHRQ), $500 million; 6) Centers for Disease Control and Prevention (CDC) Injury Prevention and Control, $11.6 billion, including: 7) Firearm Injury and Mortality Prevention Research, $35 million; 8) Chronic Disease Prevention and Health Promotion, Social Determinants of Health, $100 million; 9) National Institutes of Health (NIH), $51.3 billion, including: 10) Office of the Director, Firearms Research, $25 million; 11) Centers for Medicare and Medicaid Services (CMS) and Government Accountability Office (GAO); and 12) Report language to ensure primary care physicians are receiving Medicare physician revaluations. We urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. ACP urged appropriators to provide $35 million for the U.S. Centers for Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention. Primary Care and the Physician Workforce: ACP urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. ACP supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Scope of Practice: ACP provided comments urging the House Ways and Means Committee during markup to oppose the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Expand Patient Access: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans).

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 Second Quarter Lobbying Disclosure Report Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. The Provider Reimbursement Stability Act of 2026. H.R. 8163 would raise the budget neutrality threshold from $20 million to $54.3 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every 5 years. ACP supported the Medicare Physician Data-Drive Performance Payment System Act of 2026. This critical legislation seeks to modernize Medicare payments by reducing administrative burdens, improving patient care, and supporting small/rural practices through a more practical, data-driven approach. Dr. William Fox, Chair Emeritus of ACPs Board of Regents, testified before the House Energy and Commerce Committees Health Subcommittee on policy reforms to improve the Medicare Physician Fee Schedule and the Medicare Access and CHIP Reauthorization Act (MACRA) on behalf of ACP. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Provided comments to the House Energy and Commerce Committees markup, which includes the Lower Cost, More Transparency Act, H.R. 9393, and the Improving Seniors Timely Access to Care Act, H.R. 3514. The two bills would enhance price transparency across health care entities and streamline unnecessary administrative burden, respectively. ACP also supported several policies included in bills slated for markup that would reform Medicare Advantage practices to ensure accountability and safeguard market competition. ACP strongly supports pricing transparency in health care. ACP supported the passage of the Lower Costs, More Transparency Act, which passed the House in the 118th Congress, and we continue to support its reintroduction and passage in this Congress under H.R. 9393. ACP supported provisions within the Medicare Advantage Cost Transparency Act, H.R. 9392, led by Ranking Member DeGette and Dr. Joyce, which would provide greater oversight by requiring that Medicare Advantage (MA) plans report to the Centers for Medicare & Medicaid Services (CMS) on encounter data, including the allowed amount that a plan agreed to pay for a service in total and the total out-of-pocket costs the patient pays for a service. The College has repeatedly voiced support for the Improving Seniors' Timely Access to Care Act, led by Reps. Kelly and DelBene, which would protect patients from unnecessary delays in care and reduce administrative burden on physicians by streamlining MAs prior authorization approval processes. We urge Congress to pass H.R. 3514 to ensure that our patients will get the care they need, when they need it most. FY2026 Appropriations/Agency Restructuring: For FY2027, ACP is urged appropriations committees that funding be either maintained or increased for the following proven programs: 1) Health Resources Services Administration (HRSA), $10.5 billion, including: 2) Health Workforce, National Health Service Corps (NHSC), $915.6 million in total program funding; 3) Primary Care Training and Enhancement (PCTE), $71 million; 4) Title X Family Planning Program, $390 million; 5) Agency for Healthcare Research and Quality (AHRQ), $500 million; 6) Centers for Disease Control and Prevention (CDC) Injury Prevention and Control, $11.6 billion, including: 7) Firearm Injury and Mortality Prevention Research, $35 million; 8) Chronic Disease Prevention and Health Promotion, Social Determinants of Health, $100 million; 9) National Institutes of Health (NIH), $51.3 billion, including: 10) Office of the Director, Firearms Research, $25 million; 11) Centers for Medicare and Medicaid Services (CMS) and Government Accountability Office (GAO); and 12) Report language to ensure primary care physicians are receiving Medicare physician revaluations. We urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. ACP urged appropriators to provide $35 million for the U.S. Centers for Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention. Primary Care and the Physician Workforce: ACP urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. ACP supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Scope of Practice: ACP provided comments urging the House Ways and Means Committee during markup to oppose the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Expand Patient Access: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans).

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 Second Quarter Lobbying Disclosure Report Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. The Provider Reimbursement Stability Act of 2026. H.R. 8163 would raise the budget neutrality threshold from $20 million to $54.3 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every 5 years. ACP supported the Medicare Physician Data-Drive Performance Payment System Act of 2026. This critical legislation seeks to modernize Medicare payments by reducing administrative burdens, improving patient care, and supporting small/rural practices through a more practical, data-driven approach. Dr. William Fox, Chair Emeritus of ACPs Board of Regents, testified before the House Energy and Commerce Committees Health Subcommittee on policy reforms to improve the Medicare Physician Fee Schedule and the Medicare Access and CHIP Reauthorization Act (MACRA) on behalf of ACP. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Provided comments to the House Energy and Commerce Committees markup, which includes the Lower Cost, More Transparency Act, H.R. 9393, and the Improving Seniors Timely Access to Care Act, H.R. 3514. The two bills would enhance price transparency across health care entities and streamline unnecessary administrative burden, respectively. ACP also supported several policies included in bills slated for markup that would reform Medicare Advantage practices to ensure accountability and safeguard market competition. ACP strongly supports pricing transparency in health care. ACP supported the passage of the Lower Costs, More Transparency Act, which passed the House in the 118th Congress, and we continue to support its reintroduction and passage in this Congress under H.R. 9393. ACP supported provisions within the Medicare Advantage Cost Transparency Act, H.R. 9392, led by Ranking Member DeGette and Dr. Joyce, which would provide greater oversight by requiring that Medicare Advantage (MA) plans report to the Centers for Medicare & Medicaid Services (CMS) on encounter data, including the allowed amount that a plan agreed to pay for a service in total and the total out-of-pocket costs the patient pays for a service. The College has repeatedly voiced support for the Improving Seniors' Timely Access to Care Act, led by Reps. Kelly and DelBene, which would protect patients from unnecessary delays in care and reduce administrative burden on physicians by streamlining MAs prior authorization approval processes. We urge Congress to pass H.R. 3514 to ensure that our patients will get the care they need, when they need it most. FY2026 Appropriations/Agency Restructuring: For FY2027, ACP is urged appropriations committees that funding be either maintained or increased for the following proven programs: 1) Health Resources Services Administration (HRSA), $10.5 billion, including: 2) Health Workforce, National Health Service Corps (NHSC), $915.6 million in total program funding; 3) Primary Care Training and Enhancement (PCTE), $71 million; 4) Title X Family Planning Program, $390 million; 5) Agency for Healthcare Research and Quality (AHRQ), $500 million; 6) Centers for Disease Control and Prevention (CDC) Injury Prevention and Control, $11.6 billion, including: 7) Firearm Injury and Mortality Prevention Research, $35 million; 8) Chronic Disease Prevention and Health Promotion, Social Determinants of Health, $100 million; 9) National Institutes of Health (NIH), $51.3 billion, including: 10) Office of the Director, Firearms Research, $25 million; 11) Centers for Medicare and Medicaid Services (CMS) and Government Accountability Office (GAO); and 12) Report language to ensure primary care physicians are receiving Medicare physician revaluations. We urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. ACP urged appropriators to provide $35 million for the U.S. Centers for Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention. Primary Care and the Physician Workforce: ACP urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. ACP supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Scope of Practice: ACP provided comments urging the House Ways and Means Committee during markup to oppose the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Expand Patient Access: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans).

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 Second Quarter Lobbying Disclosure Report Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. The Provider Reimbursement Stability Act of 2026. H.R. 8163 would raise the budget neutrality threshold from $20 million to $54.3 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every 5 years. ACP supported the Medicare Physician Data-Drive Performance Payment System Act of 2026. This critical legislation seeks to modernize Medicare payments by reducing administrative burdens, improving patient care, and supporting small/rural practices through a more practical, data-driven approach. Dr. William Fox, Chair Emeritus of ACPs Board of Regents, testified before the House Energy and Commerce Committees Health Subcommittee on policy reforms to improve the Medicare Physician Fee Schedule and the Medicare Access and CHIP Reauthorization Act (MACRA) on behalf of ACP. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Provided comments to the House Energy and Commerce Committees markup, which includes the Lower Cost, More Transparency Act, H.R. 9393, and the Improving Seniors Timely Access to Care Act, H.R. 3514. The two bills would enhance price transparency across health care entities and streamline unnecessary administrative burden, respectively. ACP also supported several policies included in bills slated for markup that would reform Medicare Advantage practices to ensure accountability and safeguard market competition. ACP strongly supports pricing transparency in health care. ACP supported the passage of the Lower Costs, More Transparency Act, which passed the House in the 118th Congress, and we continue to support its reintroduction and passage in this Congress under H.R. 9393. ACP supported provisions within the Medicare Advantage Cost Transparency Act, H.R. 9392, led by Ranking Member DeGette and Dr. Joyce, which would provide greater oversight by requiring that Medicare Advantage (MA) plans report to the Centers for Medicare & Medicaid Services (CMS) on encounter data, including the allowed amount that a plan agreed to pay for a service in total and the total out-of-pocket costs the patient pays for a service. The College has repeatedly voiced support for the Improving Seniors' Timely Access to Care Act, led by Reps. Kelly and DelBene, which would protect patients from unnecessary delays in care and reduce administrative burden on physicians by streamlining MAs prior authorization approval processes. We urge Congress to pass H.R. 3514 to ensure that our patients will get the care they need, when they need it most. FY2026 Appropriations/Agency Restructuring: For FY2027, ACP is urged appropriations committees that funding be either maintained or increased for the following proven programs: 1) Health Resources Services Administration (HRSA), $10.5 billion, including: 2) Health Workforce, National Health Service Corps (NHSC), $915.6 million in total program funding; 3) Primary Care Training and Enhancement (PCTE), $71 million; 4) Title X Family Planning Program, $390 million; 5) Agency for Healthcare Research and Quality (AHRQ), $500 million; 6) Centers for Disease Control and Prevention (CDC) Injury Prevention and Control, $11.6 billion, including: 7) Firearm Injury and Mortality Prevention Research, $35 million; 8) Chronic Disease Prevention and Health Promotion, Social Determinants of Health, $100 million; 9) National Institutes of Health (NIH), $51.3 billion, including: 10) Office of the Director, Firearms Research, $25 million; 11) Centers for Medicare and Medicaid Services (CMS) and Government Accountability Office (GAO); and 12) Report language to ensure primary care physicians are receiving Medicare physician revaluations. We urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. ACP urged appropriators to provide $35 million for the U.S. Centers for Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention. Primary Care and the Physician Workforce: ACP urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. ACP supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Scope of Practice: ACP provided comments urging the House Ways and Means Committee during markup to oppose the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Expand Patient Access: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans).

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 Second Quarter Lobbying Disclosure Report Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. The Provider Reimbursement Stability Act of 2026. H.R. 8163 would raise the budget neutrality threshold from $20 million to $54.3 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every 5 years. ACP supported the Medicare Physician Data-Drive Performance Payment System Act of 2026. This critical legislation seeks to modernize Medicare payments by reducing administrative burdens, improving patient care, and supporting small/rural practices through a more practical, data-driven approach. Dr. William Fox, Chair Emeritus of ACPs Board of Regents, testified before the House Energy and Commerce Committees Health Subcommittee on policy reforms to improve the Medicare Physician Fee Schedule and the Medicare Access and CHIP Reauthorization Act (MACRA) on behalf of ACP. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Provided comments to the House Energy and Commerce Committees markup, which includes the Lower Cost, More Transparency Act, H.R. 9393, and the Improving Seniors Timely Access to Care Act, H.R. 3514. The two bills would enhance price transparency across health care entities and streamline unnecessary administrative burden, respectively. ACP also supported several policies included in bills slated for markup that would reform Medicare Advantage practices to ensure accountability and safeguard market competition. ACP strongly supports pricing transparency in health care. ACP supported the passage of the Lower Costs, More Transparency Act, which passed the House in the 118th Congress, and we continue to support its reintroduction and passage in this Congress under H.R. 9393. ACP supported provisions within the Medicare Advantage Cost Transparency Act, H.R. 9392, led by Ranking Member DeGette and Dr. Joyce, which would provide greater oversight by requiring that Medicare Advantage (MA) plans report to the Centers for Medicare & Medicaid Services (CMS) on encounter data, including the allowed amount that a plan agreed to pay for a service in total and the total out-of-pocket costs the patient pays for a service. The College has repeatedly voiced support for the Improving Seniors' Timely Access to Care Act, led by Reps. Kelly and DelBene, which would protect patients from unnecessary delays in care and reduce administrative burden on physicians by streamlining MAs prior authorization approval processes. We urge Congress to pass H.R. 3514 to ensure that our patients will get the care they need, when they need it most. FY2026 Appropriations/Agency Restructuring: For FY2027, ACP is urged appropriations committees that funding be either maintained or increased for the following proven programs: 1) Health Resources Services Administration (HRSA), $10.5 billion, including: 2) Health Workforce, National Health Service Corps (NHSC), $915.6 million in total program funding; 3) Primary Care Training and Enhancement (PCTE), $71 million; 4) Title X Family Planning Program, $390 million; 5) Agency for Healthcare Research and Quality (AHRQ), $500 million; 6) Centers for Disease Control and Prevention (CDC) Injury Prevention and Control, $11.6 billion, including: 7) Firearm Injury and Mortality Prevention Research, $35 million; 8) Chronic Disease Prevention and Health Promotion, Social Determinants of Health, $100 million; 9) National Institutes of Health (NIH), $51.3 billion, including: 10) Office of the Director, Firearms Research, $25 million; 11) Centers for Medicare and Medicaid Services (CMS) and Government Accountability Office (GAO); and 12) Report language to ensure primary care physicians are receiving Medicare physician revaluations. We urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. ACP urged appropriators to provide $35 million for the U.S. Centers for Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention. Primary Care and the Physician Workforce: ACP urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. ACP supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Scope of Practice: ACP provided comments urging the House Ways and Means Committee during markup to oppose the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Expand Patient Access: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans).

ACPs 2026 First Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: ACP advocated that Congress enacts FY2026 appropriations bills for funding Labor-HHS and several other federal agencies. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. ACP focused on countering Surgeons on MPFS Final Rule Efficiency Adjustment -action alert and lobbying outreach. Extensive advocacy support for 2.5% reduction in the intra-service portion of practice expense for efficiency adjustment in Centers for Medicare and Medicaid Services 2026 final fee schedule rule. Primary care is excluded from adjustment. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported the Consolidated Appropriations Act, 2026 (CAA) (H.R. 7148), signed into law on February 3, 2026, that provides comprehensive funding for federal agencies through September 30, 2026. This legislation included PBM reforms. The reforms center on rebate pass‑through, increased transparency, standardized reporting, and expanded federal oversight. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. Urged Congress to include the enhanced PTCs in the CAA. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2026 Second Quarter Lobbying Disclosure Report Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. The Provider Reimbursement Stability Act of 2026. H.R. 8163 would raise the budget neutrality threshold from $20 million to $54.3 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every 5 years. ACP supported the Medicare Physician Data-Drive Performance Payment System Act of 2026. This critical legislation seeks to modernize Medicare payments by reducing administrative burdens, improving patient care, and supporting small/rural practices through a more practical, data-driven approach. Dr. William Fox, Chair Emeritus of ACPs Board of Regents, testified before the House Energy and Commerce Committees Health Subcommittee on policy reforms to improve the Medicare Physician Fee Schedule and the Medicare Access and CHIP Reauthorization Act (MACRA) on behalf of ACP. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Provided comments to the House Energy and Commerce Committees markup, which includes the Lower Cost, More Transparency Act, H.R. 9393, and the Improving Seniors Timely Access to Care Act, H.R. 3514. The two bills would enhance price transparency across health care entities and streamline unnecessary administrative burden, respectively. ACP also supported several policies included in bills slated for markup that would reform Medicare Advantage practices to ensure accountability and safeguard market competition. ACP strongly supports pricing transparency in health care. ACP supported the passage of the Lower Costs, More Transparency Act, which passed the House in the 118th Congress, and we continue to support its reintroduction and passage in this Congress under H.R. 9393. ACP supported provisions within the Medicare Advantage Cost Transparency Act, H.R. 9392, led by Ranking Member DeGette and Dr. Joyce, which would provide greater oversight by requiring that Medicare Advantage (MA) plans report to the Centers for Medicare & Medicaid Services (CMS) on encounter data, including the allowed amount that a plan agreed to pay for a service in total and the total out-of-pocket costs the patient pays for a service. The College has repeatedly voiced support for the Improving Seniors' Timely Access to Care Act, led by Reps. Kelly and DelBene, which would protect patients from unnecessary delays in care and reduce administrative burden on physicians by streamlining MAs prior authorization approval processes. We urge Congress to pass H.R. 3514 to ensure that our patients will get the care they need, when they need it most. FY2026 Appropriations/Agency Restructuring: For FY2027, ACP is urged appropriations committees that funding be either maintained or increased for the following proven programs: 1) Health Resources Services Administration (HRSA), $10.5 billion, including: 2) Health Workforce, National Health Service Corps (NHSC), $915.6 million in total program funding; 3) Primary Care Training and Enhancement (PCTE), $71 million; 4) Title X Family Planning Program, $390 million; 5) Agency for Healthcare Research and Quality (AHRQ), $500 million; 6) Centers for Disease Control and Prevention (CDC) Injury Prevention and Control, $11.6 billion, including: 7) Firearm Injury and Mortality Prevention Research, $35 million; 8) Chronic Disease Prevention and Health Promotion, Social Determinants of Health, $100 million; 9) National Institutes of Health (NIH), $51.3 billion, including: 10) Office of the Director, Firearms Research, $25 million; 11) Centers for Medicare and Medicaid Services (CMS) and Government Accountability Office (GAO); and 12) Report language to ensure primary care physicians are receiving Medicare physician revaluations. We urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. ACP urged appropriators to provide $35 million for the U.S. Centers for Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention. Primary Care and the Physician Workforce: ACP urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. ACP supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Scope of Practice: ACP provided comments urging the House Ways and Means Committee during markup to oppose the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Expand Patient Access: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans).

ACPs 2026 Second Quarter Lobbying Disclosure Report Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. The Provider Reimbursement Stability Act of 2026. H.R. 8163 would raise the budget neutrality threshold from $20 million to $54.3 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every 5 years. ACP supported the Medicare Physician Data-Drive Performance Payment System Act of 2026. This critical legislation seeks to modernize Medicare payments by reducing administrative burdens, improving patient care, and supporting small/rural practices through a more practical, data-driven approach. Dr. William Fox, Chair Emeritus of ACPs Board of Regents, testified before the House Energy and Commerce Committees Health Subcommittee on policy reforms to improve the Medicare Physician Fee Schedule and the Medicare Access and CHIP Reauthorization Act (MACRA) on behalf of ACP. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Provided comments to the House Energy and Commerce Committees markup, which includes the Lower Cost, More Transparency Act, H.R. 9393, and the Improving Seniors Timely Access to Care Act, H.R. 3514. The two bills would enhance price transparency across health care entities and streamline unnecessary administrative burden, respectively. ACP also supported several policies included in bills slated for markup that would reform Medicare Advantage practices to ensure accountability and safeguard market competition. ACP strongly supports pricing transparency in health care. ACP supported the passage of the Lower Costs, More Transparency Act, which passed the House in the 118th Congress, and we continue to support its reintroduction and passage in this Congress under H.R. 9393. ACP supported provisions within the Medicare Advantage Cost Transparency Act, H.R. 9392, led by Ranking Member DeGette and Dr. Joyce, which would provide greater oversight by requiring that Medicare Advantage (MA) plans report to the Centers for Medicare & Medicaid Services (CMS) on encounter data, including the allowed amount that a plan agreed to pay for a service in total and the total out-of-pocket costs the patient pays for a service. The College has repeatedly voiced support for the Improving Seniors' Timely Access to Care Act, led by Reps. Kelly and DelBene, which would protect patients from unnecessary delays in care and reduce administrative burden on physicians by streamlining MAs prior authorization approval processes. We urge Congress to pass H.R. 3514 to ensure that our patients will get the care they need, when they need it most. FY2026 Appropriations/Agency Restructuring: For FY2027, ACP is urged appropriations committees that funding be either maintained or increased for the following proven programs: 1) Health Resources Services Administration (HRSA), $10.5 billion, including: 2) Health Workforce, National Health Service Corps (NHSC), $915.6 million in total program funding; 3) Primary Care Training and Enhancement (PCTE), $71 million; 4) Title X Family Planning Program, $390 million; 5) Agency for Healthcare Research and Quality (AHRQ), $500 million; 6) Centers for Disease Control and Prevention (CDC) Injury Prevention and Control, $11.6 billion, including: 7) Firearm Injury and Mortality Prevention Research, $35 million; 8) Chronic Disease Prevention and Health Promotion, Social Determinants of Health, $100 million; 9) National Institutes of Health (NIH), $51.3 billion, including: 10) Office of the Director, Firearms Research, $25 million; 11) Centers for Medicare and Medicaid Services (CMS) and Government Accountability Office (GAO); and 12) Report language to ensure primary care physicians are receiving Medicare physician revaluations. We urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. ACP urged appropriators to provide $35 million for the U.S. Centers for Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention. Primary Care and the Physician Workforce: ACP urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. ACP supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Scope of Practice: ACP provided comments urging the House Ways and Means Committee during markup to oppose the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Expand Patient Access: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans).

ACPs 2026 Second Quarter Lobbying Disclosure Report Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. The Provider Reimbursement Stability Act of 2026. H.R. 8163 would raise the budget neutrality threshold from $20 million to $54.3 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every 5 years. ACP supported the Medicare Physician Data-Drive Performance Payment System Act of 2026. This critical legislation seeks to modernize Medicare payments by reducing administrative burdens, improving patient care, and supporting small/rural practices through a more practical, data-driven approach. Dr. William Fox, Chair Emeritus of ACPs Board of Regents, testified before the House Energy and Commerce Committees Health Subcommittee on policy reforms to improve the Medicare Physician Fee Schedule and the Medicare Access and CHIP Reauthorization Act (MACRA) on behalf of ACP. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Provided comments to the House Energy and Commerce Committees markup, which includes the Lower Cost, More Transparency Act, H.R. 9393, and the Improving Seniors Timely Access to Care Act, H.R. 3514. The two bills would enhance price transparency across health care entities and streamline unnecessary administrative burden, respectively. ACP also supported several policies included in bills slated for markup that would reform Medicare Advantage practices to ensure accountability and safeguard market competition. ACP strongly supports pricing transparency in health care. ACP supported the passage of the Lower Costs, More Transparency Act, which passed the House in the 118th Congress, and we continue to support its reintroduction and passage in this Congress under H.R. 9393. ACP supported provisions within the Medicare Advantage Cost Transparency Act, H.R. 9392, led by Ranking Member DeGette and Dr. Joyce, which would provide greater oversight by requiring that Medicare Advantage (MA) plans report to the Centers for Medicare & Medicaid Services (CMS) on encounter data, including the allowed amount that a plan agreed to pay for a service in total and the total out-of-pocket costs the patient pays for a service. The College has repeatedly voiced support for the Improving Seniors' Timely Access to Care Act, led by Reps. Kelly and DelBene, which would protect patients from unnecessary delays in care and reduce administrative burden on physicians by streamlining MAs prior authorization approval processes. We urge Congress to pass H.R. 3514 to ensure that our patients will get the care they need, when they need it most. FY2026 Appropriations/Agency Restructuring: For FY2027, ACP is urged appropriations committees that funding be either maintained or increased for the following proven programs: 1) Health Resources Services Administration (HRSA), $10.5 billion, including: 2) Health Workforce, National Health Service Corps (NHSC), $915.6 million in total program funding; 3) Primary Care Training and Enhancement (PCTE), $71 million; 4) Title X Family Planning Program, $390 million; 5) Agency for Healthcare Research and Quality (AHRQ), $500 million; 6) Centers for Disease Control and Prevention (CDC) Injury Prevention and Control, $11.6 billion, including: 7) Firearm Injury and Mortality Prevention Research, $35 million; 8) Chronic Disease Prevention and Health Promotion, Social Determinants of Health, $100 million; 9) National Institutes of Health (NIH), $51.3 billion, including: 10) Office of the Director, Firearms Research, $25 million; 11) Centers for Medicare and Medicaid Services (CMS) and Government Accountability Office (GAO); and 12) Report language to ensure primary care physicians are receiving Medicare physician revaluations. We urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. ACP urged appropriators to provide $35 million for the U.S. Centers for Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention. Primary Care and the Physician Workforce: ACP urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. ACP supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Scope of Practice: ACP provided comments urging the House Ways and Means Committee during markup to oppose the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Expand Patient Access: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans).

ACPs 2026 Second Quarter Lobbying Disclosure Report Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Supported and urged Congress to pass H.R. 8163, the Provider Reimbursement Stability Act, to enhance Medicare reimbursement stability for physicians by modernizing the Medicare Physician Fee Schedule. The Provider Reimbursement Stability Act of 2026. H.R. 8163 would raise the budget neutrality threshold from $20 million to $54.3 million and would use cumulative increases in the Medicare Economic Index (MEI) to update the threshold every 5 years. ACP supported the Medicare Physician Data-Drive Performance Payment System Act of 2026. This critical legislation seeks to modernize Medicare payments by reducing administrative burdens, improving patient care, and supporting small/rural practices through a more practical, data-driven approach. Dr. William Fox, Chair Emeritus of ACPs Board of Regents, testified before the House Energy and Commerce Committees Health Subcommittee on policy reforms to improve the Medicare Physician Fee Schedule and the Medicare Access and CHIP Reauthorization Act (MACRA) on behalf of ACP. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Provided comments to the House Energy and Commerce Committees markup, which includes the Lower Cost, More Transparency Act, H.R. 9393, and the Improving Seniors Timely Access to Care Act, H.R. 3514. The two bills would enhance price transparency across health care entities and streamline unnecessary administrative burden, respectively. ACP also supported several policies included in bills slated for markup that would reform Medicare Advantage practices to ensure accountability and safeguard market competition. ACP strongly supports pricing transparency in health care. ACP supported the passage of the Lower Costs, More Transparency Act, which passed the House in the 118th Congress, and we continue to support its reintroduction and passage in this Congress under H.R. 9393. ACP supported provisions within the Medicare Advantage Cost Transparency Act, H.R. 9392, led by Ranking Member DeGette and Dr. Joyce, which would provide greater oversight by requiring that Medicare Advantage (MA) plans report to the Centers for Medicare & Medicaid Services (CMS) on encounter data, including the allowed amount that a plan agreed to pay for a service in total and the total out-of-pocket costs the patient pays for a service. The College has repeatedly voiced support for the Improving Seniors' Timely Access to Care Act, led by Reps. Kelly and DelBene, which would protect patients from unnecessary delays in care and reduce administrative burden on physicians by streamlining MAs prior authorization approval processes. We urge Congress to pass H.R. 3514 to ensure that our patients will get the care they need, when they need it most. FY2026 Appropriations/Agency Restructuring: For FY2027, ACP is urged appropriations committees that funding be either maintained or increased for the following proven programs: 1) Health Resources Services Administration (HRSA), $10.5 billion, including: 2) Health Workforce, National Health Service Corps (NHSC), $915.6 million in total program funding; 3) Primary Care Training and Enhancement (PCTE), $71 million; 4) Title X Family Planning Program, $390 million; 5) Agency for Healthcare Research and Quality (AHRQ), $500 million; 6) Centers for Disease Control and Prevention (CDC) Injury Prevention and Control, $11.6 billion, including: 7) Firearm Injury and Mortality Prevention Research, $35 million; 8) Chronic Disease Prevention and Health Promotion, Social Determinants of Health, $100 million; 9) National Institutes of Health (NIH), $51.3 billion, including: 10) Office of the Director, Firearms Research, $25 million; 11) Centers for Medicare and Medicaid Services (CMS) and Government Accountability Office (GAO); and 12) Report language to ensure primary care physicians are receiving Medicare physician revaluations. We urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills. Also urged Congress to include report language in the FY2027 Labor HHS appropriations bill directing a study on extent G2211 add on codes and increases in fee schedule for primary care are being retained by hiring entities (hospitals, ACOs, private equity) versus the physicians. ACP urged appropriators to provide $35 million for the U.S. Centers for Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention. Primary Care and the Physician Workforce: ACP urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. ACP supported legislation for the H-1Bs for Physicians and Healthcare Workforce Act, H.R. 7961. The bill's primary goal is to exempt healthcare professionals from a $100,000 H-1B visa filing fee. Scope of Practice: ACP provided comments urging the House Ways and Means Committee during markup to oppose the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Expand Patient Access: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. ACP conducted a Hill Briefing on using scientifically driven, evidenced-based vaccines. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans).

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

Expand Patient Access and Telehealth: We urge Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. We urge Congress to reintroduce and to pass the Connect for Health Act to permanently expand access to essential telehealth services including expanding originating sites and lifting geographic requirements for telehealth services and allowing FQHCs and RHCs to continue to provide telehealth services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a two percent payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act,which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

Expand Patient Access and Telehealth: We urge Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. We urge Congress to reintroduce and to pass the Connect for Health Act to permanently expand access to essential telehealth services including expanding originating sites and lifting geographic requirements for telehealth services and allowing FQHCs and RHCs to continue to provide telehealth services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a two percent payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act,which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

Expand Patient Access and Telehealth: We urge Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. We urge Congress to reintroduce and to pass the Connect for Health Act to permanently expand access to essential telehealth services including expanding originating sites and lifting geographic requirements for telehealth services and allowing FQHCs and RHCs to continue to provide telehealth services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a two percent payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act,which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

Expand Patient Access and Telehealth: We urge Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. We urge Congress to reintroduce and to pass the Connect for Health Act to permanently expand access to essential telehealth services including expanding originating sites and lifting geographic requirements for telehealth services and allowing FQHCs and RHCs to continue to provide telehealth services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a two percent payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act,which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

Expand Patient Access and Telehealth: We urge Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. We urge Congress to reintroduce and to pass the Connect for Health Act to permanently expand access to essential telehealth services including expanding originating sites and lifting geographic requirements for telehealth services and allowing FQHCs and RHCs to continue to provide telehealth services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a two percent payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act,which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

Expand Patient Access and Telehealth: We urge Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. We urge Congress to reintroduce and to pass the Connect for Health Act to permanently expand access to essential telehealth services including expanding originating sites and lifting geographic requirements for telehealth services and allowing FQHCs and RHCs to continue to provide telehealth services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a two percent payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act,which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

Expand Patient Access and Telehealth: We urge Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. We urge Congress to reintroduce and to pass the Connect for Health Act to permanently expand access to essential telehealth services including expanding originating sites and lifting geographic requirements for telehealth services and allowing FQHCs and RHCs to continue to provide telehealth services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a two percent payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act,which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

Expand Patient Access and Telehealth: We urge Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. We urge Congress to reintroduce and to pass the Connect for Health Act to permanently expand access to essential telehealth services including expanding originating sites and lifting geographic requirements for telehealth services and allowing FQHCs and RHCs to continue to provide telehealth services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a two percent payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act,which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Second Quarter Lobbying Disclosure Report H.R. 1 One Big Beautiful Bill (OBBB): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support of H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package to for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged members of Congress to reintroduce and pass the Resident Physician Shortage Reduction Act, which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

ACPs 2025 Fourth Quarter Lobbying Disclosure Report Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians: Met with House Doctors Caucus about Medicare payment reform, including draft language to be included in bills for a Medicare Economic Index inflationary updated to the physician fee schedule for physician practices. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. We supported efforts of Senators Wyden and Crapo of Senate Finance for PBM reform. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language and hope Congress will pass the FY26 Labor HHS bills Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

H.R. 1 One Big Beautiful Law (OBBL): ACP advocated against several provisions in the OBBB. We targeted the Senate Finance and HELP Committees and House Ways and Means, Energy and Commerce, Agriculture and Education and Workforce to oppose provisions related to: 1) imposing work requirements on Medicaid expansion state recipients; 2) imposing cost sharing with states based upon error rates for SNAP assistance; 3) capping federal education loans for medical students to $200,000 and changing terms for loan repayment and forgiveness; 4) rolling back clean energy incentives under the Inflation Reduction Act. We urged Congress to revise its support of Medicare physician payment based on limited MEI update to support H.R. 879, which includes 2% MEI and 2.83% adjustment to account for the cut in Medicare caused in 2025 by budget neutrality. We also requested that Congress retain current law to allow practices structured as pass through entities to continue their full state and local tax deductions. Our efforts included lobbying, letters, coalition efforts, and grassroots advocacy. Senate Finance Committee Hearing: Shared our views regarding the Committees Hearing on the Presidents 2026 Health Agenda featuring Health and Human Services (HHS) Secretary Robert Kennedy. We urged the Senate to work in a bipartisan fashion on several health measures that are set to expire at the end of September or by the end of the year. These measures include advancing flexibilities for the use of telehealth, extending premium tax credits in the individual health insurance market, and reauthorizing and funding the National Health Service Corps and the Teaching Health Center Graduate Medical Education programs. We urged Congress to advance PBM reform legislation, reform prior authorization in Medicare Advantage plans and for President Trump and Congress to replace Robert F. Kennedy, Jr. as Secretary of the Department of Health and Human Services to protect public health. Expand Patient Access and Telehealth: We urged Congress to reintroduce and pass the Chronic Care Management Improvement Act. This legislation would have removed the cost sharing requirement for patients to access chronic care management services. We also support allowing the physician that performs chronic care management services to waive the requirement that the patient pay the 20 percent coinsurance fee associated with this service. Supported extending Pandemic-related telehealth flexibilities in the Continuing Resolution that passed Congress. Supported S. 1261, Connect for Health Act of 2025, to expand telehealth services under Medicare, by removing certain geographic restrictions starting October 1, 2025. Also supported H.R. 1899, Audio-Only Telehealth Access Act of 2025, to modify payment rules for certain covered medical items and services. We also supported the Protecting Rural Telehealth Access Act, a bill that would ensure that seniors may continue to access audio-only telehealth consults with their physician after this option expired in 2024. We supported the Preserving Telehealth, Hospital, and Ambulance Access Act, which would extend these flexibilities for two years until the end of 2026. ACP urged Members of Congress to preserve Medicaid from possible cuts to pay for the extension of the Trump tax cuts. We advocated making the Medicaid program work for both internal medicine physicians and their patients. This includes advocating to ensure that Medicaid reimbursement rates are adequate to reimburse physicians for the cost of providing services. We also believe that Medicaid minimum eligibility standards should be uniform on a national basis and policymakers should refrain from enacting policy changes that would result in vulnerable persons being dropped from Medicaid coverage. We urged Congress to protect the public health infrastructure, recognize evidence-based science and preserve healthcare agency staffing to inform and protect the public from infectious disease and other health emergencies. Incidences of previously well-controlled, vaccine-preventable diseases, such as pertussis (whooping cough) and measles, are increasing in the United States. Vaccines are vital to our ability to prevent diseases that threaten public health, including novel diseases and future pandemics. We urged Congress to utilize the best possible scientific evidence to guide public health legislation. It is critical that public health leaders support evidence-based medicine, including the use of vaccines and other effective public health strategies that protect the public. Medicare Payments to Physicians (H.R. 879): Urged Congress to pass H.R. 879, the Medicare Patient Access and Practice Stabilization Act, recently introduced by Representatives Greg Murphy, MD (R-NC), Jimmy Panetta (D-CA), Mariannette Miller-Meeks, MD (R-IA), and Kim Schrier, MD (D-WA), along with several other bipartisan House members, prospectively stops the entirety of the current reimbursement reduction of 2.83 percent and helps account for rising inflationary costs with a 2% payment increase. Support Value-Based Care: Urged reintroduction and support of the Value in Health Care Act of 2024. The bill provides a multi-year commitment to reforming care delivery by extending MACRAs 5 percent advanced alternative payment models (APM) incentives that expired at the end of 2024. ACP supported the Preserving Patient Access to Accountable Care Act which aligns with Colleges policy to support the transition to value-based payments through alternative payment models (APMs) that can accommodate a wide range of specialties, practice sizes, and unique patient populations. ACP supported this legislation as it would extend the incentive payments for qualifying physicians and other clinicians to participate in Medicare advanced APMs through payment year 2027 at an increased amount of 3.53 percent and would freeze the scheduled increase in qualifying thresholds. Pricing Transparency/Consolidation: Supported reintroducing and passing the Lower Costs, More Transparency Act, which are consistent with our policy and would improve access to and affordability of health care for patients. This legislation required disclosure of changes in hospital or health facility ownership to reveal when private equity firms acquire hospitals, larger physician practices or nursing homes, promoted price transparency among hospitals, health plans and pharmacy benefit managers and promoted site neutrality for Medicare and Medicare beneficiaries. We supported legislation to improve transparency, accountability and competition regarding the business practices of PBMs including how they determine the price and cost of prescription drugs. In the last Congress, legislation, the Modernizing and Ensuring PBM Accountability (MEPA) Act, was introduced that would have set out new requirements for PBMs to annually report drug prices and other information to Part D plan sponsors and to the Secretary of HHS. PBMs would have been required to include information related to several categories, such as information related to covered Part D drugs, drug dispensing, drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, financial arrangements with consultants, and potential PBM conflicts of interest. Urged Congress to include Medicare physician payment in the Continuing Resolution that passed Congress. Also supported Senator Wydens healthcare package for PBM reform which failed on a unanimous consent vote. The Affordable Care Act (ACA) (P.L. 111-148, P.L. 111-152): Urged legislation to extend permanently the premium tax subsidies afforded under the ACA. Supported legislation by Senators Jeanne Shaheen and Tammy Baldwin, along with U.S. Congresswoman Lauren Underwood, the Health Care Affordability Act-bicameral legislation making permanent the ACAs enhanced premium tax credits for Marketplace coverage as extended through the Inflation Reduction Act. The law provides consumers with subsidies (premium tax credits) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level (FPL). It expands the Medicaid program to cover all adults with income below 138 percent of the FPL. Urged Congress to include an extension of premium tax credits in OBBB. FY2026 Appropriations/Agency Restructuring: Urged Congress to support funding for the Centers for Disease Control and Prevention's programs in the FY 2026 Labor, Health and Human Services, Education and Related Agencies Appropriations bill as well as funding shared evenly between the U.S. Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to conduct public health research into firearm morbidity and mortality prevention. Advocated for funding for the Health Resources Services Administration (HRSA); Title Vi, Section 747, Primary Care Training and Enhancement (PCTE), Health Resources and Services Administration (HRSA); National Health Service Corps (NHSC); Agency for Healthcare Research and Quality (AHRQ); the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). We urged that after two years of tight statutory caps on non-defense discretionary funding that House and Senate Appropriations Committees provide the Subcommittees with an FY 2026 allocation at a level that at least reverses past cuts to provide for the necessary services and programs the subcommittee oversees. We also urged Congress to reject any efforts to restructure or reorganize federal agencies either through the appropriations process or unilateral administrative action. This includes codifying cuts to staff and programs unilaterally made by the Department of Government Efficiency (DOGE). Urged Congress to include report language in the FY2026 Labor HHS appropriations bill to direct the GAO to conduct a study encompassing the last decade of CMS estimates of new and revised code utilizations. ACP believes CMS has overestimated utilizations, thus adversely affecting available funds in the Medicare physician fee schedule for other code usage. While the House and Senate bills included language, we prefer the stronger House version language. Supported S.Res.343, Recognizing the Important Work of the United States Preventive Task Force (USPTF). This resolution highlights the important role of the USPTF in making evidence-based recommendations about health promotion and the effectiveness of preventive health services and urges HHS to ensure current members on the task force serve their four-year terms to completion. Also sent a letter to House and Senate leadership urging the protection of the integrity of the United States Preventive Services Task Force (USPSTF), supported by the Agency for Healthcare Research and Quality (AHRQ). Women's Health: Urged HHS to support Title X funding and ensure unencumbered access to affordable, comprehensive, evidence-based reproductive health care; eliminate medically unnecessary restrictions and inappropriate political interference in the patient-physician relationship; and protect funding for and ensures consistent treatment of qualified service sites. Supported H.R. 459 and S. 323, the Secure Access for Essential Reproductive (SAFER) Health Act. This legislation would strengthen current health privacy laws to ensure that abortion-related health data cannot be shared without patient consent. It prohibits health care providers and insurance plans from disclosing in legal proceedings an individual's personal health information related to an abortion or pregnancy without the individual's valid authorization. The prohibition applies to federal, state, local, and tribal proceedings, including civil, criminal, administrative, and legislative proceedings. The bill provides limited exceptions such as if the information is necessary to investigate physical harm to the individual. We support the Senate Title X spending for pregnancy and family planning over the Houses bill, which eliminates funding in its bill. Primary Care and the Physician Workforce: Urged Congress to support the Resident Physician Shortage Reduction Act of 2025 (S. 2439/ H.R. 4731), which would increase the number of Medicare supported direct graduate medical education (DGME) and indirect medical education (IME) positions by 14,000 over seven years. ACP supported the Conrad State 30 and Physician Access Reauthorization Act, S. 709 and H.R. 1585, to allow states to sponsor foreign-trained physicians to work in medically underserved areas in exchange for a waiver of the physicians' two-year foreign residence requirement. We supported the Resident Education Deferred Interest (REDI) Act (S 942/HR 2028) that, if passed, will allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. We supported the reauthorization and funding increases included for the Teaching Health Center Graduate Medical Education program, Community Health Center program and National Health Service Corps in the Continuing Resolution that was extended by Congress to September 30, 2025, and urged Congress for funding beyond the current extension. We urged Congress to note the success and importance of the Public Service Loan Forgiveness (PSLF) program and urged its preservation. Congress recognized the importance of recruiting and retaining highly qualified public service professionals when it enacted PSLF with bipartisan support. Prescription Drug Reform: Supported the Capping Prescription Costs Act, introduced by Senator Raphael Warnock. The legislation would lower prescription drug costs for millions of Americans by placing annual caps on out-of-pocket costs for prescription drugs at $2,000 for individuals and $4,000 for families with private insurance. Supported bipartisan Drug-price Transparency for Consumers (DTC) Act, a bill that would require price disclosures on advertisements for prescription drugs in order to empower patients and reduce Americans colossal spending on medications. The bill was introduced by Senators Dick Durbin and Chuck Grassley. ACP also supported the Saving Seniors Money on Prescriptions Act, H.R. 950, which aims to drive down the rising costs of prescription drugs for patients on Medicare by improving price transparency in Pharmacy Benefit Managers (PBMs) business practices. Urged Congress to reintroduce and pass: 1) the Lowering Drug Costs for American Families Act, to expand the number of prescription drugs which Medicare can negotiate under the Inflation Reduction Act from 20 to 50 starting in 2029; 2) the Medicare PBM Accountability Act, legislation aimed at lowering the costs of prescription drugs for seniors covered by Medicare Part D and Medicare Advantage plans; 3) the Increasing Access to Biosimilars Act of 2023, legislation which would encourage adoption of biosimilars in Medicare and improve biosimilar accessibility, by establishing a new pilot program - a voluntary, shared savings demonstration program - for providers of biosimilars in Medicare Part B; 4) the Cutting Copays Act, legislation which would eliminate cost-sharing for generic drugs for LIS beneficiaries, helping to incentivize the use of generic drugs; and the Drug Shortage Prevention Act of 2023, which would require that manufacturers of over-the-counter and prescription drugs notify Food & Drug Administration when they are unlikely to meet demand. ACP supported legislation, Drug-price Transparency for Consumers (DTC) Act, by Senators. Durbin and Grassley that requires Direct-to-Consumer advertisements for prescription drugs and biological products paid for by Medicare and Medicaid to include the list price or Wholesale Acquisition Cost (WAC) for a 30-month supply-which is the price set by manufacturers (and which is paid by uninsured patients, as well as the 50 percent of patients with high-deductible plans). ACP opposed H.R. 238, the Healthy Technology Act of 2025 (HTA). That Act would amend current law to clarify that artificial intelligence (AI) and machine learning technologies can qualify as a practitioner eligible to prescribe drugs if authorized by the state involved and approved, cleared, or authorized by the Food and Drug Administration. Family Caregiving: ACP supported the Family Caregiver Awareness, Resources, and Education (CARE) Partnerships Act, introduced by Rep. Dingell. This legislation would promote the health and well-being of family caregivers - those who provide the majority of long-term services and support (LTSS) in the United States - so that they can maintain their own health and their ability to continue providing essential care to patients who require LTSS. Social Determinants of Healthcare/DEI: Urged Congress to oppose measures, such as those contained in President Trumps recent Executive Orders to dismantle DEI programs. Opposed the Educate Act, that will amend the Higher Education Act of 1965 to prohibit graduate medical schools from receiving Federal financial assistance if such schools adopt certain policies and requirements relating to diversity, equity, and inclusion. Administrative Burden: Urged Congress to reintroduce and pass the Improving Seniors' Timely Access to Care Act. This bipartisan legislation nearly passed last Congress and would reduce burdens associated with prior authorization in Medicare Advantage (MA) by: l) protecting beneficiaries from any disruptions in care due to prior authorization requirements as they transition between MA plans; 2) requiring all MA plans adopt electronic prior authorization capabilities to streamline the process for prior authorization approval; and 3) standardizing the process and procedures for reporting electronic prior authorization criteria to MA plans. Scope of Practice: Opposed the Equitable Community Access to Pharmacist Services Act, which would expand Medicare coverage to permanently include select services provided by a pharmacist. Clinical Labs: Supported the provision in H.R. 6366 that would delay payment reductions and data reporting periods for the Clinical Laboratory Fee Schedule under the Protecting Access to Medicare Act (PAMA). Legislation could improve patient access to laboratory tests used to diagnose, monitor, prevent, and manage diseases for Medicare beneficiaries. Cures 2.0: Reviewed and supported Cures 2.0 legislation.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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