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Review of the 83 rd Legislature and the Start of the 2014 Elections.

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2 Review of the 83 rd Legislature and the Start of the 2014 Elections

3 44 freshmen in the Texas House Speaker Joe Straus easily re-elected Speaker 95 Republicans – 55 Democrats Lt. Gov. David Dewhurst back in the Senate – or was he? 6 freshmen in the Texas Senate 19 Republicans – 12 Democrats

4 And 6 PHYSICIANS elected to the Texas Legislature 3 in the Senate and 3 in the House And 1 OR nurse 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)

5 140 days - January 8 to May 27, 2013

6 Water Education Transportation Discussion of bills based on the merits Voting on the bills based on the merits Local communities and citizens are the winners

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

8  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

9  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

10  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

11  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

12  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

13  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!

14  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

15 DSHS sought HUGE penalty increase on ASCs and ESRDs

16  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

17 “Sunsetting” THCIC

18  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

19 Revenue and Supplies Exemptions

20  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

21 The Massachusetts’ Compounding Outbreak Texas Solution

22  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

23 Medicaid Data Collection and Strategies to Reduce Unnecessary Services

24  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

25  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

26 Expanded Delegated Prescriptive Authority for Physicians And Identification Badges

27  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

28  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

29 Texas Budget Grows Health Care Dollars Increase

30  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

31  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

32  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

33  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??

34 From the Dark Ages to the Electronic Age

35  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

36 Our Historic Reforms Remain Protected and Improved

37  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

38  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

39 ASC Facility Requirements for Abortion Facilities

40  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!

41 Money Money Money $$$ Republican Cannibalism or Purification ??? Democrats Dreaming BIG Wendy Davis Running for Governor Recruiting for the Statewide Ballot

42  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!

43  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!

44  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


46 Capelo Law Firm 401 West 15 th Street #870 Austin, Texas 78701 512.469.9898 o 512.626.6763 c

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