Texas Ambulatory surgery centers Society Annual Conference November 8, 2013

1. Review of the 83rd Legislature and the Start of the 2014 Elections Texas Ambulatory surgery centers Society Annual ConferenceNovember 8, 2013

2. 44 freshmen in the Texas House Speaker Joe Straus easily re-elected Speaker 95 Republicans – 55 Democrats November 2012 Elections • Lt. Gov. David Dewhurst back in the Senate – or was he? • 6 freshmen in the Texas Senate • 19 Republicans – 12 Democrats

3. And 6 PHYSICIANS elected to the Texas Legislature 3 in the Senate and 3 in the House And 1 OR nurse November 2012 Elections • Sen. 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)

4. 140 days -January 8 to May 27, 2013 83rd Regular legislative session

5. Water Education Transportation Peace, love and understanding • Discussion of bills based on the merits • Voting on the bills based on the merits • Local communities and citizens are the winners

6. 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

7. 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 passfor multiple reasons ASC OON

8. 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 Insurance plan bills

9. 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 Prior authorizations

10. 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 Silent PPOs

11. 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 Prompt pay formedicaidhmos

12. 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! Attack on Prompt pay rights

13. 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 Price and cost transparency

14. DSHS sought HUGE penalty increase on ASCs and ESRDs DSHS Administrative Penalties

15. 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 ASC Penalty amounts

16. “Sunsetting” THCIC Data reporting

17. 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 Data reporting

18. Revenue and Supplies Exemptions State Taxes

19. 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 Asc state tax relief effort

20. The Massachusetts’ Compounding Outbreak compounding Texas Solution

21. 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 Texas response

22. Medicaid Data Collection and Strategiesto Reduce Unnecessary Services imaging

23. 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 imaging

24. 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 HHSC

25. Expanded Delegated Prescriptive Authority for Physicians And Identification Badges Scope of practice

26. 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 Delegated prescriptive authority

27. SB 945 by Sen. Jane Nelson (R-Lewisville) and Rep. Sarah Davis (R-Houston) mandates that all licensed health care providers in hospitalsettings 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 Id Badges

28. Texas Budget Grows Health Care Dollars Increase medicaid

29. 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 The budget – sb 1

30. 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 Article II

31. SB 1542 by Sen. Leticia Van de PutteR.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 Opportunity

32. 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?? Medicaid expansion – You decide

33. From the Dark Ages to the Electronic Age Controlled Substance Registration

34. 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 DPS to TMB

35. Our Historic Reforms Remain Protected and Improved Medical liability reform

36. 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 Protected and improved

37. 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 A rising concern

38. ASC Facility Requirements for Abortion Facilities Abortion law

39. 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! HB 2

40. Money MoneyMoney $$$ Republican Cannibalism or Purification ??? 2014 campaign season begins • Democrats Dreaming BIG • Wendy Davis Running for Governor • Recruiting for the Statewide Ballot

41. 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! Ode to Gov. Rick Perry

42. 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! Statewide is hot hothot

43. 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 The legislature

44. PROTECT YOUR ASC PROTECT YOUR PATIENTS PROTECT YOUR FUTURE Your voiceyour texasasc PAC

45. Capelo Law Firm 401 West 15th Street #870 Austin, Texas 78701 512.469.9898 o 512.626.6763 c jc@capelolaw.com Jaime capelolobbyist – texas ambulatory surgery center society