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Income and expense are whole-filing amounts associated with this lobbyist, not personal compensation or an allocated share.
No topic inference: each bill number appears in source LDA issue text assigned to this lobbyist.
CONNECT for Health Act of 2023
Client: ALLIANCE OF COMMUNITY HEALTH PLANS, INC. · Firm: ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee; Advocated in support of allowing Medicaid Managed Care Organizations to assist enrollees during redeterminations Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities beyond December 31, 2024 (CONNECT for Health Act, S. 2016/H.R. 4189; the Telehealth Modernization Act, S. 3967/7623); Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act, S. 2061/H.R. 4058). Provider Directories: Advocated on ensuring accuracy of provider directories.
Specific issues are shown only where the LDA source assigned them to this lobbyist. Targets apply to the associated filing.
ALLIANCE OF COMMUNITY HEALTH PLANS, INC. via ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
2026 · third_quarter · Q3
General Health Care Issues: Prescription Drug Pricing: Advocated on prescription drug costs, including PBM transparency; advocated in support of the Fair Accountability and Innovative Research (FAIR) Act; advocated for patent reform and on access to and utilization of GLP-1 drugs; and advocated for elimination of the separate interchangeability designation for biosimilars. Mental and Behavioral Health: Advocated for improved access to mental and behavioral health services, including integrated care and tele-mental health; advocated on federal mental health parity requirements. Prior Authorization: Advocated for electronic prior authorization policies that reduce administrative burden, improve timely access to appropriate care and support patient safety; advocated for reciprocal requirements and accountability for health plans and providers to support effective adoption of electronic prior authorization; advocated for implementation timelines, technical standards and reporting requirements that recognize the operational and resource constraints of smaller, community-based health plans.
Source: Senate LDA
CONNECT for Health Act of 2023
Client: ALLIANCE OF COMMUNITY HEALTH PLANS, INC. · Firm: ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee; Advocated in support of allowing Medicaid Managed Care Organizations to assist enrollees during redeterminations Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities beyond December 31, 2024 (CONNECT for Health Act, S. 2016/H.R. 4189; the Telehealth Modernization Act, S. 3967/7623); Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act, S. 2061/H.R. 4058). Provider Directories: Advocated on ensuring accuracy of provider directories.
CONNECT for Health Act of 2023
Client: ALLIANCE OF COMMUNITY HEALTH PLANS, INC. · Firm: ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee; Advocated in support of allowing Medicaid Managed Care Organizations to assist enrollees during redeterminations Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities beyond December 31, 2024 (CONNECT for Health Act, S. 2016/H.R. 4189; the Telehealth Modernization Act, S. 3967/7623); Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act, S. 2061/H.R. 4058). Provider Directories: Advocated on ensuring accuracy of provider directories.
CONNECT for Health Act of 2023
Client: ALLIANCE OF COMMUNITY HEALTH PLANS, INC. · Firm: ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee; Advocated in support of allowing Medicaid Managed Care Organizations to assist enrollees during redeterminations Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities beyond December 31, 2024 (CONNECT for Health Act, S. 2016/H.R. 4189; the Telehealth Modernization Act, S. 3967/7623); Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act, S. 2061/H.R. 4058). Provider Directories: Advocated on ensuring accuracy of provider directories.
Telehealth Modernization Act
Client: ALLIANCE OF COMMUNITY HEALTH PLANS, INC. · Firm: ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee; Advocated in support of allowing Medicaid Managed Care Organizations to assist enrollees during redeterminations Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities beyond December 31, 2024 (CONNECT for Health Act, S. 2016/H.R. 4189; the Telehealth Modernization Act, S. 3967/7623); Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act, S. 2061/H.R. 4058). Provider Directories: Advocated on ensuring accuracy of provider directories.
Telehealth Modernization Act
Client: ALLIANCE OF COMMUNITY HEALTH PLANS, INC. · Firm: ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee; Advocated in support of allowing Medicaid Managed Care Organizations to assist enrollees during redeterminations Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities beyond December 31, 2024 (CONNECT for Health Act, S. 2016/H.R. 4189; the Telehealth Modernization Act, S. 3967/7623); Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act, S. 2061/H.R. 4058). Provider Directories: Advocated on ensuring accuracy of provider directories.
Telemental Health Care Access Act of 2021
Client: ALLIANCE OF COMMUNITY HEALTH PLANS, INC. · Firm: ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee; Advocated in support of allowing Medicaid Managed Care Organizations to assist enrollees during redeterminations Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities beyond December 31, 2024 (CONNECT for Health Act, S. 2016/H.R. 4189; the Telehealth Modernization Act, S. 3967/7623); Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act, S. 2061/H.R. 4058). Provider Directories: Advocated on ensuring accuracy of provider directories.
Telemental Health Care Access Act of 2021
Client: ALLIANCE OF COMMUNITY HEALTH PLANS, INC. · Firm: ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee; Advocated in support of allowing Medicaid Managed Care Organizations to assist enrollees during redeterminations Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities beyond December 31, 2024 (CONNECT for Health Act, S. 2016/H.R. 4189; the Telehealth Modernization Act, S. 3967/7623); Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act, S. 2061/H.R. 4058). Provider Directories: Advocated on ensuring accuracy of provider directories.
Telemental Health Care Access Act of 2021
Client: ALLIANCE OF COMMUNITY HEALTH PLANS, INC. · Firm: ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee; Advocated in support of allowing Medicaid Managed Care Organizations to assist enrollees during redeterminations Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities beyond December 31, 2024 (CONNECT for Health Act, S. 2016/H.R. 4189; the Telehealth Modernization Act, S. 3967/7623); Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act, S. 2061/H.R. 4058). Provider Directories: Advocated on ensuring accuracy of provider directories.
Telemental Health Care Access Act of 2021
Client: ALLIANCE OF COMMUNITY HEALTH PLANS, INC. · Firm: ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee; Advocated in support of allowing Medicaid Managed Care Organizations to assist enrollees during redeterminations Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities beyond December 31, 2024 (CONNECT for Health Act, S. 2016/H.R. 4189; the Telehealth Modernization Act, S. 3967/7623); Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act, S. 2061/H.R. 4058). Provider Directories: Advocated on ensuring accuracy of provider directories.
Medicare & Medicaid Issues: Medicare Advantage (Part C) and Prescription Drug (Part D): Advocated on quality measures and Star Ratings; third-party marketing practices and broker compensation; risk adjustment reform; modernization of network adequacy standards; reforms to Medicare Advantage benchmarks; and Medicare Part C and Part D reporting requirements. Medicaid: Advocated on implementation of Medicaid provisions in the One Big Beautiful Bill Act, including community engagement and eligibility requirements; advocated for states to use available data to verify eligibility, compliance and exemptions before requiring additional documentation from enrollees. Dual Eligibles: Advocated for greater integration of Medicare and Medicaid coverage for dual-eligible beneficiaries, including expanded access to and streamlined enrollment in integrated D-SNP models such as FIDE-SNPs and HIDE-SNPs. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on prescription drug models and initiatives being developed by the Center for Medicare & Medicaid Innovation; advocated for affordable access to cell and gene therapies, including creation of a national risk-pool model; advocated for patent reform to reduce barriers that delay lower-cost biosimilars and generics from entering the market; advocated for PBM transparency and reforms that increase visibility into fees, rebates and other compensation; advocated for restrictions on direct-to-consumer drug advertising, including ending tax deductions associated with such advertising; advocated for requirements that pharmaceutical manufacturers disclose wholesale acquisition costs in drug advertisements; and advocated for expanded FDA oversight of direct-to-consumer drug advertising. Prior Authorization: Advocated for electronic prior authorization policies that reduce administrative burden, improve timely access to appropriate care and support patient safety; advocated for reciprocal requirements and accountability for health plans and providers to support effective adoption of electronic prior authorization; advocated for implementation timelines, technical standards and reporting requirements that recognize the operational and resource constraints of smaller, community-based health plans. Telehealth: Advocated for permanent extension of Medicare telehealth flexibilities and continued access to virtual care; advocated for extension of the Acute Hospital Care at Home waiver program; advocated for removal of unnecessary in-person requirements that limit Medicare beneficiaries access to telehealth services, including behavioral health care. Provider Directories: Advocated for improved accuracy of provider directories, greater provider accountability for maintaining accurate information and development of a national provider directory at CMS.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
ALLIANCE OF COMMUNITY HEALTH PLANS, INC. via ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
2026 · second_quarter · Q2
Medicare & Medicaid Issues: Medicare Advantage (Part C) and Prescription Drug (Part D) programs including quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on the implementation of the Medicaid provisions in the One Big Beautiful Bill Act; Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee. Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model; advocated for an end to patent thickets which are a barrier to lower cost biosimilars and generics entering the market; advocated for a ban on direct-to-consumer advertisements of drugs, including an end to the tax breaks that pharmaceutical manufacturers receive associated with direct-to-consumer ads; advocated for increased transparency requirements on pharmaceutical manufactures to list wholesale acquisition costs in drug ads and for expanded authorities for the Food and Drug Administration to better conduct oversight of direct-to-consumer advertisements. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instances of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities, in support of the CONNECT for Health Act and Telehealth Modernization Act; Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act). Provider Directories: Advocated on ensuring accuracy of provider directories including the creation of a national provider directory at CMS.
General Health Care Issues: Advocated on prescription drugs costs, including advocating for the transparency of PBMs and support for the Fair Accountability and Innovative Research (FAIR) Act; Advocated for patent reform and educated on the utilization of GLP-1s drugs; Advocated for the elimination of the separate interchangeability designation for biosimilars. Mental and Behavioral Health: advocated in support of integration, collaborative care and access to mental and behavioral health services; advocated for greater access to mental and behavioral health services overall; advocated for greater access to tele-mental health services; advocated on mental health parity. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instances of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
ALLIANCE OF COMMUNITY HEALTH PLANS, INC. via ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
2026 · first_quarter · Q1
General Health Care Issues: Advocated on prescription drugs costs, including advocating for the transparency of PBMs and support for the Fair Accountability and Innovative Research (FAIR) Act; Advocated for patent reform and educated on the utilization of GLP-1s drugs; Advocated for the elimination of the separate interchangeability designation for biosimilars. Mental and Behavioral Health: advocated in support of integration, collaborative care and access to mental and behavioral health services; advocated for greater access to mental and behavioral health services overall; advocated for greater access to tele-mental health services; advocated on mental health parity. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instances of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans.
Medicare & Medicaid Issues: Medicare Advantage (Part C) and Prescription Drug (Part D) programs including quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on the implementation of the Medicaid provisions in the One Big Beautiful Bill Act; Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee. Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model; advocated for an end to patent thickets which are a barrier to lower cost biosimilars and generics entering the market; advocated for a ban on direct-to-consumer advertisements of drugs, including an end to the tax breaks that pharmaceutical manufacturers receive associated with direct-to-consumer ads; advocated for increased transparency requirements on pharmaceutical manufactures to list wholesale acquisition costs in drug ads and for expanded authorities for the Food and Drug Administration to better conduct oversight of direct-to-consumer advertisements. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instances of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities, in support of the CONNECT for Health Act and Telehealth Modernization Act; Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act). Provider Directories: Advocated on ensuring accuracy of provider directories including the creation of a national provider directory at CMS.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
ALLIANCE OF COMMUNITY HEALTH PLANS, INC. via ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
2025 · fourth_quarter · Q4
Medicare & Medicaid Issues: Medicare Advantage (Part C) and Prescription Drug (Part D) programs including quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated for a fully financed Medicaid program with no changes to eligibility or enrollment requirements; Advocated on the implementation of the Medicaid provisions in the One Big Beautiful Bill Act; Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee. Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model; advocated for an end to patent thickets which are a barrier to lower cost biosimilars and generics entering the market; advocated for a ban on direct-to-consumer advertisements of drugs, including an end to the tax breaks that pharmaceutical manufacturers receive associated with direct-to-consumer ads; advocated for increased transparency requirements on pharmaceutical manufactures to list wholesale acquisition costs in drug ads and for expanded authorities for the Food and Drug Administration to better conduct oversight of direct-to-consumer advertisements. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instances of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities, in support of the CONNECT for Health Act and Telehealth Modernization Act; Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act). Provider Directories: Advocated on ensuring accuracy of provider directories including the creation of a national provider directory at CMS.
General Health Care Issues: Advocated on prescription drugs costs, including advocating for the transparency of PBMs and support for the Fair Accountability and Innovative Research (FAIR) Act; Advocated for patent reform and educated on the utilization of GLP-1s drugs; Advocated for the elimination of the separate interchangeability designation for biosimilars. Mental and Behavioral Health: advocated in support of integration, collaborative care and access to mental and behavioral health services; advocated for greater access to mental and behavioral health services overall; advocated for greater access to tele-mental health services; advocated on mental health parity. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instances of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
ALLIANCE OF COMMUNITY HEALTH PLANS, INC. via ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
2025 · third_quarter · Q3
Medicare & Medicaid Issues: Medicare Advantage (Part C) and Prescription Drug (Part D) programs including quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated for a fully financed Medicaid program with no changes to eligibility or enrollment requirements; Advocated on the implementation of the Medicaid provisions in the One Big Beautiful Bill Act; Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee. Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model; advocated for an end to patent thickets which are a barrier to lower cost biosimilars and generics entering the market; advocated for a ban on direct-to-consumer advertisements of drugs, including an end to the tax breaks that pharmaceutical manufacturers receive associated with direct-to-consumer ads; advocated for increased transparency requirements on pharmaceutical manufactures to list wholesale acquisition costs in drug ads and for expanded authorities for the Food and Drug Administration to better conduct oversight of direct-to-consumer advertisements. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instances of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities, in support of the CONNECT for Health Act and Telehealth Modernization Act; Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act). Provider Directories: Advocated on ensuring accuracy of provider directories.
General Health Care Issues: Advocated on prescription drugs costs, including advocating for the transparency of PBMs and support for the Fair Accountability and Innovative Research (FAIR) Act; Advocated for patent reform and educated on the utilization of GLP-1s drugs. Mental and Behavioral Health: advocated in support of integration, collaborative care and access to mental and behavioral health services; advocated for greater access to mental and behavioral health services overall; advocated for greater access to tele-mental health services; advocated on mental health parity. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instances of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
ALLIANCE OF COMMUNITY HEALTH PLANS, INC. via ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
2025 · second_quarter · Q2
Medicare & Medicaid Issues: Medicare Advantage (Part C) and Prescription Drug (Part D) programs including quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated for a fully financed Medicaid program with no changes to eligibility or enrollment requirements. Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee. Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model; advocated for an end to patent thickets which are a barrier to lower cost biosimilars and generics entering the market; advocated for a ban on direct-to-consumer advertisements of drugs, including an end to the tax breaks that phramaceutical manufactuers receive associated with direct-to-consumer ads; advocated for increased transparency requirements on pharmaceutical manufactures to list wholesale acquisition costs in drug ads and for expanded authorities for the Food and Drug Administration to better conduct oversight of direct-to-consumer advertisements. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities beyond March 14, 2025 (CONNECT for Health Act, Telehealth Modernization Act); Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act). Provider Directories: Advocated on ensuring accuracy of provider directories.
ALLIANCE OF COMMUNITY HEALTH PLANS, INC. via ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
2025 · first_quarter · Q1
Medicare & Medicaid Issues: Medicare Advantage (Part C) and Prescription Drug (Part D) programs including quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated for a fully financed Medicaid program with no changes to eligibility or enrollment requirements. Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee. Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model; advocated for an end to patent thickets which are a barrier to lower cost biosimilars and generics entering the market; advocated for a ban on direct-to-consumer advertisements of drugs, including an end to the tax breaks that phramaceutical manufactuers receive associated with direct-to-consumer ads; advocated for increased transparency requirements on pharmaceutical manufactures to list wholesale acquisition costs in drug ads and for expanded authorities for the Food and Drug Administration to better conduct oversight of direct-to-consumer advertisements. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities beyond March 14, 2025 (CONNECT for Health Act, Telehealth Modernization Act); Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act). Provider Directories: Advocated on ensuring accuracy of provider directories.
ALLIANCE OF COMMUNITY HEALTH PLANS, INC. via ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
2024 · fourth_quarter · Q4
Advocated on prescription drugs costs, including advocating for the transparency of PBMs and support for the Fair Accountability and Innovative Research (FAIR) Act; Advocated for patent reform and educated on utilization of GLP-1s drugs; Advocated for the creation of a national risk-pool model for high-cost drugs and therapies. Mental and Behavioral Health: advocated in support of integration, collaborative care and access to mental and behavioral health services; advocated greater access to mental and behavioral health services overall; advocated for greater access to tele-mental health services; advocated on mental health parity. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans.
ALLIANCE OF COMMUNITY HEALTH PLANS, INC. via ALLIANCE OF COMMUNITY HEALTH PLANS, INC.
2024 · third_quarter · Q3
Advocated on prescription drugs costs, including advocating for the transparency of PBMs and support for the Fair Accountability and Innovative Research (FAIR) Act; Advocated for patent reform and educated on utilization of GLP-1s drugs; Advocated for the creation of a national risk-pool model for high-cost drugs and therapies. Mental and Behavioral Health: advocated in support of integration, collaborative care and access to mental and behavioral health services; advocated greater access to mental and behavioral health services overall; advocated for greater access to tele-mental health services; advocated on mental health parity. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans.
General Health Care Issues: Advocated on prescription drugs costs, including advocating for the transparency of PBMs and support for the Fair Accountability and Innovative Research (FAIR) Act; Advocated for patent reform and educated on utilization of GLP-1s drugs. Mental and Behavioral Health: advocated in support of integration, collaborative care and access to mental and behavioral health services; advocated greater access to mental and behavioral health services overall; advocated for greater access to tele-mental health services; advocated on mental health parity. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
General Health Care Issues: Advocated on prescription drugs costs, including advocating for the transparency of PBMs and support for the Fair Accountability and Innovative Research (FAIR) Act; Advocated for patent reform and educated on utilization of GLP-1s drugs. Mental and Behavioral Health: advocated in support of integration, collaborative care and access to mental and behavioral health services; advocated greater access to mental and behavioral health services overall; advocated for greater access to tele-mental health services; advocated on mental health parity. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee; Advocated in support of allowing Medicaid Managed Care Organizations to assist enrollees during redeterminations Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities beyond December 31, 2024 (CONNECT for Health Act, S. 2016/H.R. 4189; the Telehealth Modernization Act, S. 3967/7623); Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act, S. 2061/H.R. 4058). Provider Directories: Advocated on ensuring accuracy of provider directories.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE
Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics and broker compensation; prescription drug costs; risk adjustment; modernizing network composition and reforming benchmarks; advocated for differentiation in Medicare Part C and D reporting requirements; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. Advocated to ensure state Medicaid agencies use all forms of data available before requesting information from an enrollee; Advocated in support of allowing Medicaid Managed Care Organizations to assist enrollees during redeterminations Advocated in support of integration in Dual Eligible Special Needs Plans (D-SNPs) and advocated in support of redefinitions of HIDE-SNPs and FIDE-SNPs to ensure that states with behavioral health and LTSS carve-outs still qualify for the frailty adjustment. Prescription Drug Pricing: Advocated on implementation of Part D provisions of the Inflation Reduction Act; advocated on drug pricing models being developed by the Center for Medicare & Medicaid Innovation drug pricing models; advocated for affordable cell and gene therapy drugs including the creation of a national risk-pool model. Prior Authorization: Advocated on regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care; Advocated on ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated on prior authorization criteria requirements that are realistic for community-based health plans. Telehealth: Advocated in support of permanent extension of telehealth flexibilities beyond December 31, 2024 (CONNECT for Health Act, S. 2016/H.R. 4189; the Telehealth Modernization Act, S. 3967/7623); Advocated in support of an extension of the Acute Hospital Care at Home Program waivers; Advocated for legislation to repeal the requirement that doctors see Medicare beneficiaries in person within six months of being treated virtually for mental and behavioral health concerns (Telemental Health Care Access Act, S. 2061/H.R. 4058). Provider Directories: Advocated on ensuring accuracy of provider directories.
Filing targets: Centers For Medicare and Medicaid Services (CMS), Executive Office of the President (EOP), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), SENATE