Texas Ambulatory surgery centers Society - PowerPoint Presentation

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Texas Ambulatory surgery centers Society Annual ConferenceNovember 8, 2013

Review of the 83

rd

Legislature

and the

Start of the 2014 Elections

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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 Senate

19 Republicans – 12 Democrats

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And 6 PHYSICIANS elected to the Texas Legislature3 in the Senate and 3 in the HouseAnd 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)

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140 days - January 8 to May 27, 2013

83

rd

Regular legislative session

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WaterEducationTransportation

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

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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

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ASC OONHB 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

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Insurance plan billsHB 3270 by Rep. John Smithee (R-Amarillo) attacked balance billing

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

T

rojan horse”

TASCS helped kill both bills

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Prior authorizationsSB 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

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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

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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

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Attack on Prompt pay rightsSB 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!

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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

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DSHS sought HUGE penalty increase on ASCs and ESRDsDSHS Administrative Penalties

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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

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“Sunsetting” THCIC

Data reporting

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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

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Revenue and Supplies Exemptions State Taxes

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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

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The Massachusetts’ Compounding Outbreakcompounding

Texas Solution

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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

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Medicaid Data Collection and Strategies to Reduce Unnecessary Services

imaging

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imagingRadiologists 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

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HHSCRider 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

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Expanded Delegated Prescriptive Authority for PhysiciansAnd Identification Badges

Scope of practice

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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

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Id BadgesSB 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

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Texas Budget GrowsHealth Care Dollars Increase

medicaid

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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

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Article IISB 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

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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

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Medicaid expansion – You decideMedicaid 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??

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From the Dark Ages to the Electronic AgeControlled Substance Registration

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DPS to TMBHB 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

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Our Historic Reforms Remain Protected and Improved

Medical liability reform

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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

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A rising concernHB 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

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ASC Facility Requirements for Abortion Facilities

Abortion law

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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!

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Money Money Money $$$

Republican Cannibalism or Purification ???

2014 campaign season begins

Democrats Dreaming BIG

Wendy Davis Running for Governor

Recruiting for the Statewide Ballot

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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!

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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!

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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

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PROTECT YOUR ASCPROTECT YOUR PATIENTS

PROTECT YOUR FUTURE

Your voice

your

texas

asc

PAC

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Capelo Law Firm401 W

est 15

th

Street #870Austin,

T

exas 78701

512.469.9898 o

512.626.6763 c

jc@capelolaw.com

Jaime

capelo

lobbyist –

texas

ambulatory surgery center society