NISSA SHAFFI

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. 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 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 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. 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 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 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. 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 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. 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 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 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 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. 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 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 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 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. 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 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 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 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. 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 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. 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 Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics; prescription drug costs; risk adjustment; 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 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. 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); 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 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. 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); 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 Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics; prescription drug costs; risk adjustment; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. 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. 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); 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 Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics; prescription drug costs; risk adjustment; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. 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. 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); 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 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. 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); 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 Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics; prescription drug costs; risk adjustment; 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 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. 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); 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 Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics; prescription drug costs; risk adjustment; 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 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. 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); 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 Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics; prescription drug costs; risk adjustment; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. 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. 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); 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 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. 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); 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 Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics; prescription drug costs; risk adjustment; and transparency of Pharmacy Benefit Managers (PBMs). Medicaid: Advocated on Medicaid redeterminations; presumptive eligibility; and auto-enrollment. 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. 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); 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 Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; third-party marketing tactics; prescription drug costs; risk adjustment; 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 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. 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); 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 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. 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); 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 Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Advocated for allowing MA organizations to use a 24-month look-back period to supplement 2020 data for the calculation of 2021 risk scores. Telehealth - Allow more clinicians to provide virtual care, ensure all telehealth encounters, including audio-only, are eligible for risk adjustment. Audio-only advocacy included support for H.R. 2166/S.150, the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021. Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Advocated for addressing the cost of out of network COVID-19 testing, further guidance, changes to Medicare reimbursement and public funding for COVID testing. Advocated for government to continue financing cost of COVID vaccines, including boosters. Advocated for interim guidance to Medicare contractors for Aduhelm and limited Medicare coverage of Aduhelm under National Coverage Determination. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibility granted to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations. Advocated for greater standardization for SDOH-related data collection efforts; supported section 4302 efforts to standardize race, ethnicity, and language data collection; advocated for greater data sharing between states and plans throughout COVID-19 vaccine and booster rollout to assess disparities in access for communities of color.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Telehealth - Allow more clinicians to provide virtual care, ensure all telehealth encounters, including audio-only, are eligible for risk adjustment. Audio-only advocacy included support for H.R. 2166/S.150, the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021. Advocated in support of extending the Acute Hospital Care at Home waiver to allow seniors to receive inpatient-level care at home beyond the public health emergency, including support for the "Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053). Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Prior Authorization: Advocated for any legislation/regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care and create a standard for electronic prior authorization across all lines of business; Advocated for ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated for interim guidance to Medicare contractors for Aduhelm and limited Medicare coverage of Aduhelm under National Coverage Determination. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibility granted to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Advocated for allowing MA organizations to use a 24-month look-back period to supplement 2020 data for the calculation of 2021 risk scores. Telehealth - Allow more clinicians to provide virtual care, ensure all telehealth encounters, including audio-only, are eligible for risk adjustment. Audio-only advocacy included support for H.R. 2166/S.150, the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021. Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Advocated for addressing the cost of out of network COVID-19 testing, further guidance, changes to Medicare reimbursement and public funding for COVID testing. Advocated for government to continue financing cost of COVID vaccines, including boosters. Advocated for interim guidance to Medicare contractors for Aduhelm and limited Medicare coverage of Aduhelm under National Coverage Determination. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibility granted to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations. Advocated for greater standardization for SDOH-related data collection efforts; supported section 4302 efforts to standardize race, ethnicity, and language data collection; advocated for greater data sharing between states and plans throughout COVID-19 vaccine and booster rollout to assess disparities in access for communities of color.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Advocated for extending all COVID-19 related telehealth Medicare regulatory flexibilities for two years post-public health emergency (H.R. 4040). Advocated in support of extending the Acute Hospital Care at Home waiver to allow seniors to receive inpatient-level care at home beyond the public health emergency, including support for the "Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053). Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Prior Authorization: Advocated for any legislation/regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care and create a standard for electronic prior authorization across all lines of business; Advocated for ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibility granted to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations. Advocated for reimbursement of food security interventions (e.g., Food Farmacies, Medically Tailored Meals) in publicly sponsored programs.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Telehealth - Allow more clinicians to provide virtual care, ensure all telehealth encounters, including audio-only, are eligible for risk adjustment. Audio-only advocacy included support for H.R. 2166/S.150, the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021. Advocated in support of extending the Acute Hospital Care at Home waiver to allow seniors to receive inpatient-level care at home beyond the public health emergency, including support for the "Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053). Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Prior Authorization: Advocated for any legislation/regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care and create a standard for electronic prior authorization across all lines of business; Advocated for ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated for interim guidance to Medicare contractors for Aduhelm and limited Medicare coverage of Aduhelm under National Coverage Determination. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibility granted to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations.

Advocated for addressing the cost of out of network COVID-19 testing, further guidance and public funding for COVID-19 testing, and vaccine availability. Advocated in support of S. 2411, the Stop COVID-19 Test Surprise Medical Bills Act of 2021. Advocated for health care affordability measures included in the Build Back Better Act, including permanent extension of the enhanced Advanced Premium Tax Credits including in the American Rescue Plan Act and continuous coverage for children in state Childrens Health Insurance Plans (CHIP). Advocated for making COVID-19 related telehealth regulatory flexibilities permanent. Advocated for repeal of the in-person requirement for tele-mental health visits (H.R. 4058/S. 2061)) Advocated on mental and behavioral health including support for integration, collaborative care and access to mental and behavioral health services. Advocated for more prominent display of quality metrics on the Federal Employee Health Benefits Program plan comparison tool. Advocated for the passage of HR 3076 - Postal Service Reform Act of 2022.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Advocated for extending all COVID-19 related telehealth Medicare regulatory flexibilities for two years post-public health emergency (H.R. 4040). Advocated in support of extending the Acute Hospital Care at Home waiver to allow seniors to receive inpatient-level care at home beyond the public health emergency, including support for the "Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053). Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Prior Authorization: Advocated for any legislation/regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care and create a standard for electronic prior authorization across all lines of business; Advocated for ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibility granted to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations. Advocated for reimbursement of food security interventions (e.g., Food Farmacies, Medically Tailored Meals) in publicly sponsored programs.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; third-party marketing tactics; prescription drug costs; benchmark reform; and program integrity audits. Advocated for extending all COVID-19 related telehealth Medicare regulatory flexibilities for two years post-public health emergency (H.R. 4040). Advocated in support of extending the Acute Hospital Care at Home waiver to allow seniors to receive inpatient-level care at home beyond the public health emergency, including support for the "Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053). Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Prior Authorization: Advocated for any legislation/regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care and create a standard for electronic prior authorization across all lines of business; Advocated for ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibilities, including texting, to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations. Advocated for reimbursement of food security interventions (e.g., Food Farmacies, Medically Tailored Meals) in publicly sponsored programs.

Advocated for addressing the cost of out of network COVID-19 testing, further guidance and public funding for COVID-19 testing, and vaccine availability. Advocated in support of S. 2411, the Stop COVID-19 Test Surprise Medical Bills Act of 2021. Advocated for health care affordability measures included in the Build Back Better Act, including permanent extension of the enhanced Advanced Premium Tax Credits including in the American Rescue Plan Act and continuous coverage for children in state Childrens Health Insurance Plans (CHIP). Advocated for making COVID-19 related telehealth regulatory flexibilities permanent. Advocated for repeal of the in-person requirement for tele-mental health visits (H.R. 4058/S. 2061)) Advocated on mental and behavioral health including support for integration, collaborative care and access to mental and behavioral health services. Advocated for more prominent display of quality metrics on the Federal Employee Health Benefits Program plan comparison tool. Advocated for the passage of HR 3076 - Postal Service Reform Act of 2022.

Advocated for health care affordability measures, including permanent extension of the enhanced Advanced Premium Tax Credits including in the American Rescue Plan Act and continuous coverage for children in state Childrens Health Insurance Plans (CHIP). Advocated for making COVID-19 related telehealth regulatory flexibilities permanent. Advocated for repeal of the in-person requirement for tele-mental health visits (H.R. 4058/S. 2061)) Advocated on mental and behavioral health including support for integration, collaborative care and access to mental and behavioral health services. Advocated for reimbursement of food security interventions (e.g., Food Farmacies, Medically Tailored Meals) in publicly sponsored programs.

Advocated for health care affordability measures, including continuous coverage for children in state Childrens Health Insurance Plans (CHIP) and 12-month post-partum coverage for pregnant women. Advocated for making COVID-19 related telehealth regulatory flexibilities permanent. Advocated for repeal of the in-person requirement for tele-mental health visits (H.R. 4058/S. 2061)) Mental and Behavioral Health: advocated in support of integration, collaborative care and access to mental and behavioral health services; advocated for mental health parity and greater access to mental and behavioral health services overall. Advocated for reimbursement of food security interventions (e.g., Food Farmacies, Medically Tailored Meals) in publicly sponsored programs.

Advocated in support of S. 2411, the Stop COVID-19 Test Surprise Medical Bills Act of 2021. Advocated for health care affordability measures included in the Build Back Better Act, including permanent extension of the enhanced Advanced Premium Tax Credits including in the American Rescue Plan Act and continuous coverage for children in state Childrens Health Insurance Plans (CHIP). Advocated for making COVID-19 related telehealth regulatory flexibilities permanent. Advocated for repeal of the in-person requirement for tele-mental health visits (H.R. 4058/S. 2061)) Advocated on mental and behavioral health including support for integration, collaborative care and access to mental and behavioral health services.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Telehealth - Allow more clinicians to provide virtual care, ensure all telehealth encounters, including audio-only, are eligible for risk adjustment. Audio-only advocacy included support for H.R. 2166/S.150, the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021. Advocated in support of extending the Acute Hospital Care at Home waiver to allow seniors to receive inpatient-level care at home beyond the public health emergency, including support for the "Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053). Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Prior Authorization: Advocated for any legislation/regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care and create a standard for electronic prior authorization across all lines of business; Advocated for ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated for interim guidance to Medicare contractors for Aduhelm and limited Medicare coverage of Aduhelm under National Coverage Determination. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibility granted to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Advocated for extending all COVID-19 related telehealth Medicare regulatory flexibilities for two years post-public health emergency (H.R. 4040). Advocated in support of extending the Acute Hospital Care at Home waiver to allow seniors to receive inpatient-level care at home beyond the public health emergency, including support for the "Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053). Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Prior Authorization: Advocated for any legislation/regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care and create a standard for electronic prior authorization across all lines of business; Advocated for ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibility granted to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations. Advocated for reimbursement of food security interventions (e.g., Food Farmacies, Medically Tailored Meals) in publicly sponsored programs.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; third-party marketing tactics; prescription drug costs; benchmark reform; and program integrity audits. Advocated for extending all COVID-19 related telehealth Medicare regulatory flexibilities for two years post-public health emergency (H.R. 4040). Advocated in support of extending the Acute Hospital Care at Home waiver to allow seniors to receive inpatient-level care at home beyond the public health emergency, including support for the "Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053). Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Prior Authorization: Advocated for any legislation/regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care and create a standard for electronic prior authorization across all lines of business; Advocated for ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibilities, including texting, to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations. Advocated for reimbursement of food security interventions (e.g., Food Farmacies, Medically Tailored Meals) in publicly sponsored programs.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Advocated for allowing MA organizations to use a 24-month look-back period to supplement 2020 data for the calculation of 2021 risk scores. Telehealth - Allow more clinicians to provide virtual care, ensure all telehealth encounters, including audio-only, are eligible for risk adjustment. Audio-only advocacy included support for H.R. 2166/S.150, the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021. Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Advocated for addressing the cost of out of network COVID-19 testing, further guidance, changes to Medicare reimbursement and public funding for COVID testing. Advocated for government to continue financing cost of COVID vaccines, including boosters. Advocated for interim guidance to Medicare contractors for Aduhelm and limited Medicare coverage of Aduhelm under National Coverage Determination. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibility granted to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations. Advocated for greater standardization for SDOH-related data collection efforts; supported section 4302 efforts to standardize race, ethnicity, and language data collection; advocated for greater data sharing between states and plans throughout COVID-19 vaccine and booster rollout to assess disparities in access for communities of color.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Telehealth - Allow more clinicians to provide virtual care, ensure all telehealth encounters, including audio-only, are eligible for risk adjustment. Audio-only advocacy included support for H.R. 2166/S.150, the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021. Advocated in support of extending the Acute Hospital Care at Home waiver to allow seniors to receive inpatient-level care at home beyond the public health emergency, including support for the "Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053). Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Prior Authorization: Advocated for any legislation/regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care and create a standard for electronic prior authorization across all lines of business; Advocated for ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated for interim guidance to Medicare contractors for Aduhelm and limited Medicare coverage of Aduhelm under National Coverage Determination. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibility granted to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations.

Advocated in support of S. 2411, the Stop COVID-19 Test Surprise Medical Bills Act of 2021. Advocated for health care affordability measures included in the Build Back Better Act, including permanent extension of the enhanced Advanced Premium Tax Credits including in the American Rescue Plan Act and continuous coverage for children in state Childrens Health Insurance Plans (CHIP). Advocated for making COVID-19 related telehealth regulatory flexibilities permanent. Advocated for repeal of the in-person requirement for tele-mental health visits (H.R. 4058/S. 2061)) Advocated on mental and behavioral health including support for integration, collaborative care and access to mental and behavioral health services.

Advocated for health care affordability measures, including continuous coverage for children in state Childrens Health Insurance Plans (CHIP) and 12-month post-partum coverage for pregnant women. Advocated for making COVID-19 related telehealth regulatory flexibilities permanent. Advocated for repeal of the in-person requirement for tele-mental health visits (H.R. 4058/S. 2061)) Mental and Behavioral Health: advocated in support of integration, collaborative care and access to mental and behavioral health services; advocated for mental health parity and greater access to mental and behavioral health services overall. Advocated for reimbursement of food security interventions (e.g., Food Farmacies, Medically Tailored Meals) in publicly sponsored programs.

Advocated for addressing the cost of out of network COVID-19 testing, further guidance and public funding for COVID-19 testing, and vaccine availability. Advocated in support of S. 2411, the Stop COVID-19 Test Surprise Medical Bills Act of 2021. Advocated for health care affordability measures included in the Build Back Better Act, including permanent extension of the enhanced Advanced Premium Tax Credits including in the American Rescue Plan Act and continuous coverage for children in state Childrens Health Insurance Plans (CHIP). Advocated for making COVID-19 related telehealth regulatory flexibilities permanent. Advocated for repeal of the in-person requirement for tele-mental health visits (H.R. 4058/S. 2061)) Advocated on mental and behavioral health including support for integration, collaborative care and access to mental and behavioral health services. Advocated for more prominent display of quality metrics on the Federal Employee Health Benefits Program plan comparison tool. Advocated for the passage of HR 3076 - Postal Service Reform Act of 2022.

Advocated for health care affordability measures, including permanent extension of the enhanced Advanced Premium Tax Credits including in the American Rescue Plan Act and continuous coverage for children in state Childrens Health Insurance Plans (CHIP). Advocated for making COVID-19 related telehealth regulatory flexibilities permanent. Advocated for repeal of the in-person requirement for tele-mental health visits (H.R. 4058/S. 2061)) Advocated on mental and behavioral health including support for integration, collaborative care and access to mental and behavioral health services. Advocated for reimbursement of food security interventions (e.g., Food Farmacies, Medically Tailored Meals) in publicly sponsored programs.

Advocated for addressing the cost of out of network COVID-19 testing, further guidance and public funding for COVID-19 testing, and vaccine availability. Advocated in support of S. 2411, the Stop COVID-19 Test Surprise Medical Bills Act of 2021. Advocated for health care affordability measures included in the Build Back Better Act, including permanent extension of the enhanced Advanced Premium Tax Credits including in the American Rescue Plan Act and continuous coverage for children in state Childrens Health Insurance Plans (CHIP). Advocated for making COVID-19 related telehealth regulatory flexibilities permanent. Advocated for repeal of the in-person requirement for tele-mental health visits (H.R. 4058/S. 2061)) Advocated on mental and behavioral health including support for integration, collaborative care and access to mental and behavioral health services. Advocated for more prominent display of quality metrics on the Federal Employee Health Benefits Program plan comparison tool. Advocated for the passage of HR 3076 - Postal Service Reform Act of 2022.

Advocated in support of S. 2411, the Stop COVID-19 Test Surprise Medical Bills Act of 2021. Advocated for health care affordability measures included in the Build Back Better Act, including permanent extension of the enhanced Advanced Premium Tax Credits including in the American Rescue Plan Act and continuous coverage for children in state Childrens Health Insurance Plans (CHIP). Advocated for making COVID-19 related telehealth regulatory flexibilities permanent. Advocated for repeal of the in-person requirement for tele-mental health visits (H.R. 4058/S. 2061)) Advocated on mental and behavioral health including support for integration, collaborative care and access to mental and behavioral health services.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; third-party marketing tactics; prescription drug costs; benchmark reform; and program integrity audits. Advocated for extending all COVID-19 related telehealth Medicare regulatory flexibilities for two years post-public health emergency (H.R. 4040). Advocated in support of extending the Acute Hospital Care at Home waiver to allow seniors to receive inpatient-level care at home beyond the public health emergency, including support for the "Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053). Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Prior Authorization: Advocated for any legislation/regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care and create a standard for electronic prior authorization across all lines of business; Advocated for ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibilities, including texting, to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations. Advocated for reimbursement of food security interventions (e.g., Food Farmacies, Medically Tailored Meals) in publicly sponsored programs.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Advocated for extending all COVID-19 related telehealth Medicare regulatory flexibilities for two years post-public health emergency (H.R. 4040). Advocated in support of extending the Acute Hospital Care at Home waiver to allow seniors to receive inpatient-level care at home beyond the public health emergency, including support for the "Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053). Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Prior Authorization: Advocated for any legislation/regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care and create a standard for electronic prior authorization across all lines of business; Advocated for ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibility granted to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations. Advocated for reimbursement of food security interventions (e.g., Food Farmacies, Medically Tailored Meals) in publicly sponsored programs.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Telehealth - Allow more clinicians to provide virtual care, ensure all telehealth encounters, including audio-only, are eligible for risk adjustment. Audio-only advocacy included support for H.R. 2166/S.150, the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021. Advocated in support of extending the Acute Hospital Care at Home waiver to allow seniors to receive inpatient-level care at home beyond the public health emergency, including support for the "Hospital Inpatient Services Modernization Act (S. 3792/H.R. 7053). Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Prior Authorization: Advocated for any legislation/regulation addressing electronic prior authorization to improve consumers access to appropriate care in a timely fashion, reduce instance of inappropriate or low-value care and create a standard for electronic prior authorization across all lines of business; Advocated for ensuring that health plans and providers share equally in the development and implementation of electronic prior authorization requirements. Advocated for interim guidance to Medicare contractors for Aduhelm and limited Medicare coverage of Aduhelm under National Coverage Determination. Advocated in favor of addressing Social Determinants of Health (SDOH), including maternal health and health equity, across Medicaid and Medicare. Advocated for Medicaid redeterminations to be conducted in chronological order, with added safeguards for mothers and children to ensure continuity of coverage; advocated for increased time granted to states to conduct redeterminations and ample lead time for plans to help assist enrollment efforts; advocated for increased flexibility granted to plans to conduct outreach for enrollees at risk of losing coverage during the redetermination process; advocated for additional time granted to plans to help transition Medicaid enrollees to other forms of coverage; advocated for phasing out of the enhanced FMAP upon the end of the PHE to help states with funding and staffing support as they conduct redeterminations.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Advocated in support of keeping expansion of dental, hearing and vision benefits in fee-for-service Medicare within the Medicare Advantage benchmark calculation. Advocated for allowing MA organizations to use a 24-month look-back period to supplement 2020 data for the calculation of 2021 risk scores. Telehealth - Allow more clinicians to provide virtual care, ensure all telehealth encounters, including audio-only, are eligible for risk adjustment. Audio-only advocacy included support for H.R. 2166/S.150, the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021. Medicaid - Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Prescription Drugs - Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Advocated for addressing the cost of out of network COVID-19 testing, further guidance, changes to Medicare reimbursement and public funding for COVID testing. Advocated for government to continue financing cost of COVID vaccines, including boosters. Advocated for reduced burden from health data requirements, including implementation of No Surprises Act and Consolidated Appropriations Act of 2020. Advocated for interim guidance to Medicare contractors for Aduhelm. Social Determinants of Health (SDOH) - advocated in favor of addressing SDOH, including maternal health and health equity, across Medicaid and Medicare.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Advocated in support of keeping expansion of dental, hearing and vision benefits in fee-for-service Medicare within the Medicare Advantage benchmark calculation. Advocated for allowing MA organizations to use a 24-month look-back period to supplement 2020 data for the calculation of 2021 risk scores. Telehealth - Allow more clinicians to provide virtual care, ensure all telehealth encounters, including audio-only, are eligible for risk adjustment. Audio-only advocacy included support for H.R. 2166/S.150, the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021. Medicaid - Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Prescription Drugs - Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Advocated for addressing the cost of out of network COVID-19 testing, further guidance, changes to Medicare reimbursement and public funding for COVID testing. Advocated for government to continue financing cost of COVID vaccines, including boosters. Advocated for reduced burden from health data requirements, including implementation of No Surprises Act and Consolidated Appropriations Act of 2020. Advocated for interim guidance to Medicare contractors for Aduhelm. Social Determinants of Health (SDOH) - advocated in favor of addressing SDOH, including maternal health and health equity, across Medicaid and Medicare.

Medicare Advantage (Part C) and Prescription Drug (Part D) programs including: quality measures and star ratings; quality bonus payments; prescription drug costs; benchmark reform, and program integrity audits. Advocated in support of keeping expansion of dental, hearing and vision benefits in fee-for-service Medicare within the Medicare Advantage benchmark calculation. Advocated for allowing MA organizations to use a 24-month look-back period to supplement 2020 data for the calculation of 2021 risk scores. Telehealth - Allow more clinicians to provide virtual care, ensure all telehealth encounters, including audio-only, are eligible for risk adjustment. Audio-only advocacy included support for H.R. 2166/S.150, the Ensuring Parity in MA and PACE for Audio-Only Telehealth Act of 2021. Medicaid - Advocated in support of improving Medicaid access and coverage, including 12-month coverage for post-partum and continuous eligibility for children in CHIP and Medicaid; advocated to strengthen and expand home- and community-based services (HCBS). Prescription Drugs - Advocated to allow Medicare to negotiate prescription drug prices as outlined in HR 3 and the budget reconciliation package; advocated for an out-of-pocket cap for seniors in Medicare Part D and to lessen the financial liability of health plans. Advocated for addressing the cost of out of network COVID-19 testing, further guidance, changes to Medicare reimbursement and public funding for COVID testing. Advocated for government to continue financing cost of COVID vaccines, including boosters. Advocated for reduced burden from health data requirements, including implementation of No Surprises Act and Consolidated Appropriations Act of 2020. Advocated for interim guidance to Medicare contractors for Aduhelm. Social Determinants of Health (SDOH) - advocated in favor of addressing SDOH, including maternal health and health equity, across Medicaid and Medicare.

Advocated for addressing the cost of out of network COVID-19 testing, further guidance and public funding for COVID-19 testing, and vaccine availability. Advocated in support of S. 2411, the Stop COVID-19 Test Surprise Medical Bills Act of 2021. Advocated for permanent subsidies for the ACA insurance exchanges. Advocated for making COVID-19 related telehealth regulatory flexibilities permanent. Advocated for more prominent display of quality metrics on the Federal Employee Health Benefits Program plan comparison tool.