Lobbying Disclosure Act of 1995 (Section 5) - All Filers Are Required to Complete This Page

9. Check if this filing amends a previously filed version of this report

LOBBYING ACTIVITY. Select as many codes as necessary to reflect the general issue areas in which the registrant engaged in lobbying on behalf of the client during the reporting period. Using a separate page for each code, provide information as requested. Add additional page(s) as needed.

15. General issue area code MMM

16. Specific lobbying issues

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

17. House(s) of Congress and Federal agencies Check if None

U.S. SENATE, U.S. HOUSE OF REPRESENTATIVES, Centers For Medicare and Medicaid Services (CMS), Health & Human Services - Dept of (HHS), Medicare Payment Advisory Commission (MedPAC), Office of Natl Drug Control Policy (NDCP), White House Office

18. Name of each individual who acted as a lobbyist in this issue area

19. Interest of each foreign entity in the specific issues listed on line 16 above Check if None

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LOBBYING ACTIVITY. Select as many codes as necessary to reflect the general issue areas in which the registrant engaged in lobbying on behalf of the client during the reporting period. Using a separate page for each code, provide information as requested. Add additional page(s) as needed.

15. General issue area code HCR

16. Specific lobbying issues

S. 3565, Affordable Connectivity Program Extension Act of 2024, all provisions; Draft Bill, Sustain 340B Program Discussion Draft, Issues pertaining to 340B Program access; S. 1302/H.R. 2389, Resident Physician Shortage Reduction Act of 2023, all provisions; S. 3679/H.R. 7153, Dr. Lorna Breen Health Care Provider Protection Reauthorization Act, all provisions; S.2415, Preventing Maternal Deaths Reauthorization Act, all provisions; H.R. 7931, Preserving Emergency Access in Key Sites Act (PEAKS) , all provisions; H.R. 8245, Rural Hospital Stabilization Act , all provisions; H.R. 8246, Second Chances for Rural Hospitals Act, all provisions; S.940/ H.R. 1711, Rural America Health Corps Act, all provisions; S.665 / H.R. 4942, Conrad State 30 and Physician Access Reauthorization Act, all provisions; S. 3211/ H.R. 6205, Healthcare Workforce Resilience Act, all provisions; S. 3765 / H.R. 6960, Emergency Medical Services for Children Reauthorization Act of 2024, all provisions; H.R. 7635, The 340B PATIENTS Act, all provisions; H.R.8574, the 340B Affording Care for Communities and Ensuring a Strong Safety-net (340B ACCESS) Act, Issues pertaining to 340B Program access; S. 2364, Mapping Americas Pharmaceutical Supply Act, all provisions; S. 1961, Pharmaceutical Supply Chain Risk Assessment Act of 2023, all provisions; S. 2510, RAPID Reserve Act, all provisions; S. 2362, Drug Shortage Prevention Act, all provisions; Draft Bill, the Drug Shortage Prevention and Mitigation Act, Issues pertaining to proposed solutions to address generic drug shortages; S. 862, Restoring America's Health Care Workforce and Readiness Act, all provisions; HR 2584/ S.2768, Safety From Violence for Healthcare Employees (SAVE) Act, all provisions; S.4079/H.R. 8383, Rural Obstetrics Readiness Act , all provisions; H.R. 8186, Healthy Affordable Housing Act, all provisions; S. 4289, Medical Debt Cancellation Act, all provisions; S. 4054, Health Care Cybersecurity Improvement Act of 2024, all provisions; S. 3770/ H.R. 7266, "The Future Advancement of Academic Nursing (FAAN Act)", all provisions; S. 1176 / H.R. 2663, Workplace Violence Prevention for Health Care and Social Service Workers Act, all provisions; H.R. 977/S. 470, Patient Access to Higher Quality Care Act, all provisions; Draft Bill, Family Health Affordability Act, all provisions; Draft Bill, HEALTH for MOM Act, all provisions; U.S. Department of Labor, Health Plan Accountability, health plan accountability; Office of the U.S. Trade Representative, Section 301 Tariffs, Issues related to tariffs on health care products manufactured in China; Federal Emergency Management Agency (FEMA), Public Assistance for COVID expenses, Issues related to distribution of public assistance funds to hospitals; Administration for Strategic Preparation & Response (ASPR / HHS), Pediatric Emergencies, Issues related to Pediatric Disaster Care Centers of Excellence; U.S. Department of State Immigration, Issues related to visas for foreign-trained health care workers; Immediate Office of the Secretary (IOS - HHS), Medical Debt, Issues related to how hospitals address medical debt; Cyber Security, Issues pertaining to Change Health Care cyber attack, breach notifications and ongoing cyber risks to the health care field; Lab Developed Tests (LDTs), Issues related to proposed regulatory oversight of Lab Developed Tests (LDTs); Employment Retirement Income Security Act (ERISA), ERISA improvements; Artificial Intelligence (AI), AI use in health care; Rural Health Care Access, Issues to protect access to rural health care; Prescription drug shortages, Issues pertaining to Drug shortages, supply chains; Hospital mergers and acquisitions, Issues pertaining to hospital consolidation, mergers an acquisition, community benefit, physician practice acquisition; Workforce nurse staffing mandate, workforce development programs; Maternal Health and Child Health, Access to maternal and child health care and addressing related workforce shortages; Behavioral Health, Related to expanding access to care and reducing regulatory barriers; Price Transparency, Issues related to hospital price transparency; Health Plan Accountability, Issues specific to prior authorization, patient access to care, adequate provider networks, inappropriate denials, reducing account receivables, prompt pay and cost-based reimbursement for critical access hospitals under Medicare Advantage; Medical Debt, Issues specific to medical debt incurred by patients and hospital billing and collection practices; Physician Owned Hospitals, Physician-owned hospitals; Tax-exempt status, not-for-profit hospitals' tax exempt status; Health Professions Diversity, Increasing health professionals of color, National health service corps; centers of excellence; health careers opportunity programs.

17. House(s) of Congress and Federal agencies Check if None

U.S. SENATE, U.S. HOUSE OF REPRESENTATIVES, Centers For Medicare and Medicaid Services (CMS), Health & Human Services - Dept of (HHS), Health Resources & Services Administration (HRSA), Labor - Dept of (DOL), Office of Management & Budget (OMB), U.S. Trade Representative (USTR), Federal Emergency Management Agency (FEMA), Government Accountability Office (GAO), State - Dept of (DOS), Natl Security Council (NSC), Homeland Security - Dept of (DHS)

18. Name of each individual who acted as a lobbyist in this issue area

19. Interest of each foreign entity in the specific issues listed on line 16 above Check if None

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LOBBYING ACTIVITY. Select as many codes as necessary to reflect the general issue areas in which the registrant engaged in lobbying on behalf of the client during the reporting period. Using a separate page for each code, provide information as requested. Add additional page(s) as needed.

15. General issue area code BUD

16. Specific lobbying issues

Draft Bill, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2025, FY25 Appropriations priorities pertaining to CHGME, Behavioral Health, maternal/child health, workforce and loan repayment programs, public health, unique patient identifier; Cyber Security, FY25 President's Budget Proposal, Issues pertaining to health care cyber mandates in President's FY25 Budget.

17. House(s) of Congress and Federal agencies Check if None

U.S. SENATE, U.S. HOUSE OF REPRESENTATIVES, Natl Security Council (NSC)

18. Name of each individual who acted as a lobbyist in this issue area

19. Interest of each foreign entity in the specific issues listed on line 16 above Check if None

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Information Update Page - Complete ONLY where registration information has changed.

20. Client new address

21. Client new principal place of business (if different than line 20)

22. New General description of client’s business or activities

LOBBYIST UPDATE

23. Name of each previously reported individual who is no longer expected to act as a lobbyist for the client

ISSUE UPDATE

24. General lobbying issue that no longer pertains

AFFILIATED ORGANIZATIONS

25. Add the following affiliated organization(s)

Internet Address:

26. Name of each previously reported organization that is no longer affiliated with the registrant or client

FOREIGN ENTITIES

27. Add the following foreign entities:

28. Name of each previously reported foreign entity that no longer owns, or controls, or is affiliated with the registrant, client or affiliated organization

CONVICTIONS DISCLOSURE

29. Have any of the lobbyists listed on this report been convicted in a Federal or State Court of an offense involving bribery, extortion, embezzlement, an illegal kickback, tax evasion, fraud, a conflict of interest, making a false statement, perjury, or money laundering?
No Yes