TEXAS AMBULATORY SURGERY CENTERS SOCIETYANNUAL CONFERENCENOVEMBER 8, 2013

Review of the 83rd Legislature and the

Start of the 2014 Elections

44 freshmen in the Texas HouseSpeaker Joe Straus easily re-elected Speaker95 Republicans – 55 Democrats

NOVEMBER 2012 ELECTIONS

Lt. Gov. David Dewhurst back in the Senate – or was he?

6 freshmen in the Texas Senate19 Republicans – 12 Democrats

And 6 PHYSICIANS elected to the Texas Legislature3 in the Senate and 3 in the HouseAnd 1 OR nurse

NOVEMBER 2012 ELECTIONSSen. Bob Deuell MD (R-Greenville)(Primary Care)

Sen. Charles Schwertner MD (R-Georgetown)(Orthopedic Surgeon)

Sen. Donna Campbell (R-New Braunfels)(ER)Rep. John Zerwas MD (R-Fulshear)(Anesthesiologist)

Rep. Greg Bonnen MD (R-Friendswood)(Neurosurgeon)Rep. JD Sheffield MD (R-Gatesville)(Primary Care)

Rep. Susan King RN (R-Abilene)

140 days - January 8 to May 27, 2013

83RD REGULAR LEGISLATIVE SESSION

WaterEducationTransportation

PEACE, LOVE AND UNDERSTANDINGDiscussion of bills based on the meritsVoting on the bills based on the meritsLocal communities and citizens are the

winners

ASCs, Out-of-Network, Prior Authorizations, Silent PPOs, Prompt Pay, Price Transparency, Cost Comparison, Preferred Provider Networks, Exclusive Provider Networks and Balance Billing

HEALTH INSURANCE

ASC OON

HB 1901 by Rep. Craig Eiland (D-Galveston) would define ASC OON payments as usual and customary

HB 3269 by Rep. John Smithee (R-Amarillo) would define ASC OON payments as 99 percentile in Fair Health database for HOPD

Both bills failed to pass for multiple reasons

INSURANCE PLAN BILLS

HB 3270 by Rep. John Smithee (R-Amarillo) attacked balance billing

SB 1197 by Sen. Larry Taylor (R-Friendswood) was the health plans “Trojan horse”

TASCS helped kill both bills

PRIOR AUTHORIZATIONS

SB 644 by Sen. Joan Huffman (R-Houston) and Rep. John Zerwas MD (R-Fulshear) creates a standardized prior authorization form for prescription drugs

SB 1216 by Sen. Kevin Eltife (R-Tyler) and Rep. Sarah Davis (R-Houston) creates a standardized prior authorization form for health care services

SILENT PPOS

SB 822 by Sen. Charles Schwertner MD (R-Georgetown) and Rep. Craig Eiland (D-Galveston)

SB 822 will end the plans and TPAs use of your privately contracted discounts without express permission from you

PROMPT PAY FOR MEDICAID HMOS

SB 1150 by Sen. Juan “Chuy” Hinojosa (D-McAllen) and Rep. Bobby Guerra (D-Mission) provides prompt pay protections for physicians in the Medicaid HMO networks

ATTACK ON PROMPT PAY RIGHTS

SB 257 by Sen. Bob Deuell MD (R-Greenville) would have reduced the statute of limitations for filing a claim/lawsuit for no payment, underpayment, and/or delayed payment of claims from 4 years to 6 months

TASCS helped kill SB 257, very diplomatically!

PRICE AND COST TRANSPARENCY

HB 2359, HB 2360 and HB 2700 by Rep. Greg Bonnen MD (R-Friendswood)

HB 2838 by Rep. John Smithee (R-Amarillo) HB 3020 by Rep. JD Sheffield MD (R-

Gatesville) TASCS helped kill HB 2838 and HB 3020,

and helped improve Rep. Bonnen’s bills – none passed

DSHS sought HUGE penalty increase on ASCs and ESRDs

DSHS ADMINISTRATIVE PENALTIES

ASC PENALTY AMOUNTS

SB 153 by Sen. Jane Nelson (R-Lewisville) sought to increase the amount of penalties DSHS could assess against Texas ASCs from a maximum of $1,000 per day per violation to a maximum of $25,000 per day per violation

SB 153 did not pass, failed to move out of the House Public Health Committee

“Sunsetting” THCIC

DATA REPORTING

DATA REPORTING HB 1394 by Rep. Susan King (R-Abilene)

placed the Texas Health Care Information Collection (THCIC) into the Sunset Review process this interim, with the report due before the 2015 session

HB 595 by Rep. Lois Kolkhorst (R-Brenham) expanded the data collection by the THCIC

TASCS successfully escorted HB 1394 into law, and stripped out the harmful language of HB 595

Revenue and Supplies Exemptions

STATE TAXES

ASC STATE TAX RELIEF EFFORT HB 1727 by Rep. Dwayne Bohac (R-Houston)

expanded the 50% exemption for Medicare, Medicaid, CHIP and Tricare revenue to 100% for health care facilities

Amended the 100% exemption on to HB 500 by Rep. Harvey Hilderbran (R-Kerrville)

SB 571 by Sen. Bob Deuell MD (R-Greenville) created a tax exemption for sales and use taxes on health care supplies

The 100% exemption was removed before final passage, and the Comptroller aggressively fought to kill SB 571

The Massachusetts’ Compounding Outbreak

COMPOUNDING

Texas Solution

TEXAS RESPONSE

SB 1100 by Sen. Leticia Van de Putte first sought to require all out-of-state compounders to be inspected and approved by the TSBP, but after compromise, passed to allow TSBP to acknowledge the inspection and approval of the home state of the compounding pharmacy

TASCS engaged in the discussions and offered a provider’s perspective to the importance of out-of-state compounding pharmacies

Medicaid Data Collection and Strategies to Reduce Unnecessary Services

IMAGING

IMAGING Radiologists claim to not be interested in

restricting your rights to own or use imaging SB 1059 by Sen. Jane Nelson (R-Lewisville)

and HB 1761 by Rep. Lois Kolkhorst (R-Brenham) required HHSC to implement appropriate use standards for imaging in Medicaid – did not pass

However Rider 61 in SB 1 authorizes HHSC to collect data regarding imaging use in Medicaid and implement strategies to reduce “unnecessary” imaging

HHSC

Rider 61 could not be avoided because it is related to state dollars, asks for data collection and strategies to reduce “unnecessary” services

Initial contact with HHSC has already occurred to stay abreast of the data collection and to weigh in on the strategies to reduce “unnecessary” services

Expanded Delegated Prescriptive Authority for PhysiciansAnd Identification Badges

SCOPE OF PRACTICE

DELEGATED PRESCRIPTIVE AUTHORITY

SB 406 by Sen. Jane Nelson (R-Lewisville) and Rep. Lois Kolkhorst (R-Brenham) was an agreed-to bill between TMA, TAFP, TAPA and a coalition of nurse organizations

SB 406 expands a physician’s delegated prescriptive authority from 4 to 7 PAs and/or APRNs

SB 406 expands a physician’s delegated prescriptive authority to Schedule II in hospital in-patient, ER and hospice settings

ID BADGES

SB 945 by Sen. Jane Nelson (R-Lewisville) and Rep. Sarah Davis (R-Houston) mandates that all licensed health care providers in hospital settings wear identification badges which include name and type of license

Efforts were made to require the new id badges in the ASC setting – TASCS objected to the inclusion of ASCs

Texas Budget GrowsHealth Care Dollars Increase

MEDICAID

THE BUDGET – SB 1

SB 1 budget numbers 2014 – 2015 biennium

All Funds (state/federal) = $196,951,273,067

Article II (health and human services) = $73,904,937,403

Article II = 37.5% of total budget

ARTICLE II

SB 1 by Sen. Tommy Williams (R-The Woodlands) and Rep. Jim Pitts (R-Waxahachie) significantly increased funding for women’s health care, mental health care, and GME residency programs and slots

SB 1 did not reduce physician Medicaid rates

But SB 1 did not increase physician Medicaid rates

OPPORTUNITY

SB 1542 by Sen. Leticia Van de Putte R.Ph (D-San Antonio) requires HHSC identify clinical initiatives to improve quality of care and cost effectiveness in Medicaid

TASCS has met with HHSC to discuss the idea of an ASC initiative

MEDICAID EXPANSION – YOU DECIDE

Medicaid expansion efforts were attempted through virtually every legislative mechanism available, but to no avail

Governor Rick Perry and his supporters in the House and Senate stopped every effort to pass Medicaid expansion

Good or Bad??

From the Dark Ages to the Electronic Age

CONTROLLED SUBSTANCE REGISTRATION

DPS TO TMB

HB 1803 by Rep. Bill Callegari and Sen. Joan Huffman moves your controlled substance registration out of DPS and into the Texas Medical Board

HB 1803 also provides that TMB will include your controlled substance registration with your electronic medical license renewal every two years

Our Historic Reforms Remain Protected and Improved

MEDICAL LIABILITY REFORM

PROTECTED AND IMPROVED

There were several improvements to the procedural aspect of medical malpractice lawsuits, improving what many believe to already be the “best” medical liability laws in the nation

All legislation attempting to erode our historic medical liability reforms from 2003 (HB 4, HJR 3 and Prop 12) were killed

A RISING CONCERN

HB 2644 by Rep. Chris Turner (D-Arlington) was introduced and heard in committee, but did not pass

HB 2644 attempted to reverse a Texas Supreme Court ruling which some believe extended our medical liability reforms beyond the Legislature’s intent

ASC Facility Requirements for Abortion Facilities

ABORTION LAW

HB 2

HB 2 by Rep. Jodie Laubenberg (R-Parker) passed the new abortion law which bans abortions after 20 weeks, requires admitting privileges by the physicians, requires abortion facilities to meet ASC facility standards and many other requirements

TASCS worked very hard to make sure ASCs were not burdened by the new law, yet helpful to the legislators and the elected officials without taking a position and staying out of the press as much as possible!

Money Money Money $$$Republican Cannibalism or Purification ???

2014 CAMPAIGN SEASON BEGINSDemocrats Dreaming BIG

Wendy Davis Running for GovernorRecruiting for the Statewide Ballot

ODE TO GOV. RICK PERRY

Our longest serving governor, Gov. Rick Perry, decided not to run for re-election

Gov. Perry’s decision triggered a spectacular domino effect

Coupled with the cannibalistic, purification efforts of certain factions, the Republican primary (March 4, 2014) is going to be the best Reality TV we have ever seen

And expensive!

STATEWIDE IS HOT HOT HOT The Governor’s race will be in the national spotlight and

draw national money The Lt. Gov.’s race has already drawn 4 real candidates,

and rumors of more The Attorney General’s race has already drawn 3 real

candidates, and rumors of more The Comptroller’s race has already drawn 2, and rumors

of more The Bush family returns in the Land Commissioner race And the Agricultural Commissioner race may be the most

entertaining race of all – Baseball, Fast Cars, Drugs and Rock n Roll – and its only November!

THE LEGISLATURE Budget SHOCK 14 Senators up for re-election, 3 open seats 9 House Chairmen and 4 other House members

have already announced they are retiring or seeking higher office – more to come?

Key losses – 4 key committees with 35 different legislators: 4 not seeking re-election, 2 rumored to not file for re-election, and 8 already have announced opponents

Democrats running against Republicans – yes shocking

PROTECT YOUR ASCPROTECT YOUR PATIENTSPROTECT YOUR FUTURE

YOUR VOICEYOUR TEXAS ASC PAC

Capelo Law Firm401 West 15th Street #870Austin, Texas 78701512.469.9898 o512.626.6763 cjc@capelolaw.com

JAIME CAPELOLOBBYIST – TEXAS AMBULATORY SURGERY CENTER SOCIETY