• Support revisions to Medicaid DSH policy to include dual-eligible patients in state DSH cap calculation. Discuss support for the 340B Drug Pricing Program with Congressional staff and oppose certain changes. Advocate for proposals to provide direct financial support to safety net hospitals with Congressional staff. Discuss opposition to site-neutral payment policies with Congressional staff. Discuss hospital and health care provisions included in the Consolidated Appropriations Act of 2023 with Congressional staff. Discuss the following legislative proposals with Congressional staff to stabilize long-term care and post-acute care providers: establish a temporary per diem Medicare payment to ease capacity issues and address financial challenges from slow discharges (support); make permanent three-day hospital stay waiver (support) and other COVID-19 PHE regulatory flexibilities. Discuss telehealth issues with Congressional staff and support the permanent extension of PHE telehealth flexibilities. Support additional extension of the Acute Hospital Care at Home waiver. Educate Congressional staff on hospital price transparency federal rule (84 FR 65602). Support Medicare Advantage prior authorization reforms and pass Improving Seniors Timely Access to Care Act (support). Discuss Medicare Graduate Medical Education (GME) provisions in the Consolidated Appropriations Act (CAA), 2021 and CAA, 2023 with HHS staff. Discuss with Congressional staff support for Medicare GME expansion: the Resident Physician Shortage Reduction Act, the Pathway to Practice Act of 2021, the Substance Use Disorder Workforce Act; additional GME slots in CAA, 2021 and CAA, 2023. Discuss legislative recommendations from Senate HELP Committee RFI response letter on workforce shortages for nursing and ancillary health care workforce with Congressional staff: faculty recruitment and retention, additional financial support for supervision and precepting students, testing new workforce models, establishing incentives and early recruitment strategies, providing funding for clinical training site, and immigration reforms that expedite entry for foreign health care workers. Discuss Making Care Primary model with CMMI staff. Discuss Medicare payment for nursing and allied health with Senate Finance Committee staff. Discuss community benefit standard and tax-exempt status of non-profit hospitals with Congressional staff. Respond to Senate RFI on 340B Drug Pricing Program - SUSTAIN 340B Act discussion draft. Discuss opposition to FDA Proposed Rulemaking on Laboratory Developed Tests (88 FR 68006) with Congressional staff. Meet with Congressional staff to discuss H.R. 5378, the Lower Costs, More Transparency Act of 2023, and comment on following proposals in bill: support for delay of Medicaid DSH cut, codification and expansion of Federal price transparency rule, oppose National Provider Identifier requirements for hospital outpatient departments, oppose changes to 340B drug pricing program, support reauthorization of Community Health Centers, support reauthorization of National Health Service Corps, support reauthorization of Teaching Health Center Graduate Medical Education funding. Oppose Medicare site-neutral cuts, sequester cuts, and national provider identifier proposals in H.R. 4822, the Health Care Price Transparency Act of 2023. Oppose H.R. 4509 to require a separate unique health identifier for hospital outpatient departments. Discuss H.R. 3561, the PATIENT Act, with Congressional staff and comment on following proposals within bill: opposition to Medicare site-neutral policies for drug administration services, opposition to attestation requirements for hospital outpatient departments, opposition to changes to 340B drug pricing program, support for delay of Medicaid DSH cuts, support for Medicare Advantage plan reporting requirements, support for Community Health Center Fund and National Health Service Corps reauthorization. Comment on legislative proposals in S.2840, the Primary Care and Health Workforce Expansion Act: oppose eliminating facility fees, oppose requiring a separate identification number for off-campus hospital outpatient departments. Discuss S.3430, the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, with Congressional staff. Discuss legislative proposals to regulate the use of artificial intelligence in health care delivery with Congressional staff. Discuss Further Continuing Appropriations and Other Extensions Act, 2024 (H.R. 6363); Continuing Appropriations Act, 2024 and Other Extensions Act (H.R. 5860); and Extension of Continuing Appropriations and Other Matters Act, 2024 (H.R. 7463) with Congressional staff and express support for funding extensions for: Community Health Centers, Teaching Health Center Graduate Medical Education funding, National Health Service Corps; support delay of Medicaid DSH cut in H.R. 6363, H.R. 5860, and H.R. 7463. Support public health extenders and elimination of Medicaid DSH cut in Consolidated Appropriations Act, 2024 (H.R. 4366). Meet with CMS staff to discuss behavioral health coverage for commercial insurers. Discussion with CMS Regional Administrator and Regional Health Coordinator on opioid access, 340B final rule, and Medicare Advantage utilization management practices. Meet with Congressional staff to discuss technical amendment to Section 131 of the Consolidated Appropriations Act of 2021. Meet with Congressional staff to discuss proposals for financial relief for hospitals affected by the Change Healthcare cyberattack. Discuss federal legislative proposals for sepsis reporting with Congressional staff. Discuss Earned Income Tax Credit and opposition to ERTC proposal in the Tax Relief for American Families and Workers Act of 2024 with Congressional staff. Discuss military graduate medical education (GME) with Congressional staff. Support passage of the Safety from Violence for Healthcare Employees (SAVE) Act to create legal penalties for individuals who assault or intimidate hospital employees. Oppose legislative proposals to impose financial penalties on hospitals relating to minimum cybersecurity standards. Discuss FEMA COVID-19 Public Assistance payouts with Congressional staff.
• Meet with Congressional staff and discuss support for Medicare graduate medical education (GME) funding, including support for the Resident Physician Shortage Reduction Act, the Opioid Workforce Act, Substance Use Disorder Workforce Act, the Pathway to Practice program proposal, and the Presidents FY 2025 budget request. Discuss Medicare and Medicaid issues with HHS staff. Oppose CMS proposed rule CMS-4332-P to establish minimum nurse staffing in Medicare- and Medicaid-certified long-term care facilities. Support delay of Medicaid DSH cut and advocate for two-year elimination of Medicaid DSH cut. Support revisions to Medicaid DSH policy to include dual-eligible patients in state DSH cap calculation. Discuss Medicaid waiver proposal with Congressional staff and HHS. Discuss telehealth issues with Congressional staff and support for the permanent extension of COVID-19 PHE telehealth flexibilities. Discuss Acute Hospital Care at Home waiver and support for extension. Discuss legislation to provide financial support for safety net hospitals. Discuss issues concerning DSH hospitals with the Executive Branch. Meet with CMS Innovation Center to discuss CMMI models of care. Discuss proposals that stabilize long-term care and post-acute care providers: establish a temporary per diem Medicare payment to ease capacity issues and address financial challenges from slow discharges (support), make permanent three-day hospital stay waiver (support) and other COVID-19 PHE regulatory flexibilities. Discuss opposition of site-neutral payment policies with Congressional staff. Discuss telehealth issues with Congressional staff and support the permanent extension of PHE telehealth flexibilities. Support Medicare Advantage prior authorization reforms and pass Improving Seniors Timely Access to Care Act (support). Discuss Making Care Primary model with CMMI staff. Discuss Medicaid waiver application with CMS staff. Discuss CMMI initiatives on global budgets and primary care in NYS Medicaid waiver application. Meet with CMS staff regarding Medicare managed care. Discuss Medicare payment for nursing and allied health with Senate Finance Committee staff. Discuss Medicaid IMD exclusion policies with Congressional staff. Discuss with Congressional staff support for revisions to FY 2024 IPPS proposed rule to increase payment update to hospitals. Meet with Congressional staff to discuss H.R. 5378, the Lower Costs, More Transparency Act of 2023, and comment on following proposals in bill: support for delay of Medicaid DSH cut, codification and expansion of Federal price transparency rule, oppose changes to 340B drug pricing program, support reauthorization of Community Health Centers, support reauthorization of National Health Service Corps, support reauthorization of Teaching Health Center Graduate Medical Education funding. Oppose Medicare site-neutral cuts, sequester cuts, and national provider identifier proposals in H.R. 4822, the Health Care Price Transparency Act of 2023. Oppose H.R. 4509 to require a separate unique health identifier for hospital outpatient departments. Discuss H.R. 3561, the PATIENT Act, with Congressional staff and comment on following proposals within bill: opposition to Medicare site-neutral policies, opposition to attestation requirements for hospital outpatient departments, opposition to changes to 340B drug pricing program, support for delay of Medicaid DSH cuts, support for Medicare Advantage plan reporting requirements, support for Community Health Center Fund and National Health Service Corps reauthorization. Discussion with congressional staff regarding Medicare Disproportionate Share Hospital (DSH) rulemaking. Discussion with CMS on the interpretation of Sec. 131 in the Consolidated Appropriations Act, 2021, and resetting of GME caps pertaining to Sec. 131 in the Consolidated Appropriations Act, 2021. Discuss technical amendment to Consolidated Appropriations Act, 2021 Sec. 131 pertaining to Medicare GME with Congressional staff. Discuss CMS requirement to report telehealth provider home addresses with HHS staff. Meet with CMS to discuss Inpatient Prospective Payment Systems (IPPS) policies and Medicare payments. Support elimination of Medicaid DSH cut in Consolidated Appropriations Act, 2024 (H.R. 4366). Meet with CMS Regional Administrator to discuss the behavioral health care workforce. Meet with CMS staff and CMS Regional Administrator to discuss Medicare Advantage (MA) plans and MA utilization management practices. Meet with CMS to discuss 340B remedy final rule. Meet with CMS to discuss hospital price transparency regulations. Brief Congressional staff on GME for foreign medical graduates. Support revisions to Conrad 30 waiver program to increase the number of foreign physicians that may remain in the US after completing GME.
• Discuss Medicare GME funding in Consolidated Appropriations Act, 2023 with Congressional staff and HHS staff. Discuss Medicare Nursing and Allied Health Education Payment Policies in Consolidated Appropriations Act, 2023 Section 4143 Implementation with House Ways and Means staff. Meeting with House Ways and Means Committee staff to discuss safety net hospital funding issues and payments for safety net hospitals. Meeting with CMS Regional Administration to discuss safety net funding issues.

Duration: January 1, 2008 to present

General Issues: Health Issues, Medicare/Medicaid, Budget/Appropriations, Taxation/Internal Revenue Code, Pharmacy, Immigration, Insurance, Disaster Planning/Emergencies, Labor Issues/Antitrust/Workplace, Veterans, Housing, Torts, Retirement

Spending: about $25,880,000 (But it's complicated. Here's why.)

It can be tricky to figure out how much an organization spent on a particular lobbying engagement. The law only requires lobbyists to report the amount they were paid for federal lobbying each quarter rounded to the nearest $10,000—and if it's less than $3,000 in a given quarter (or less than $13,000 for organizations with in-house lobbyists), they don't have to disclose it at all. Plus, some organizations include spending that doesn’t belong in the report—for instance, money spent lobbying state governments or other legal work.

Agencies lobbied since 2008: U.S. Senate, House of Representatives, Centers For Medicare and Medicaid Services (CMS), Federal Emergency Management Agency (FEMA), Executive Office of the President (EOP), Health & Human Services - Dept of (HHS), Health Resources & Services Administration (HRSA), White House Office, Congressional Budget Office (CBO), Food & Drug Administration (FDA), Office of Management & Budget (OMB), Medicare Payment Advisory Commission (MedPAC), Substance Abuse & Mental Health Services Administration (SAMHSA), President of the U.S., Federal Bureau of Investigation (FBI), Defense - Dept of (DOD), Small Business Administration (SBA), Federal Trade Commission (FTC), Centers For Disease Control & Prevention (CDC), Homeland Security - Dept of (DHS), Drug Enforcement Administration (DEA), Environmental Protection Agency (EPA), Health & Human Services - Dept of (HHS), Centers For Medicare and Medicaid Services (CMS), Housing & Urban Development - Dept of (HUD), Internal Revenue Service (IRS), U.S. Citizenship & Immigration Services (USCIS)