KILL BILL: VOL.. 3 The Texas 83 rd Legislature

1. KILL BILL: VOL.. 3The Texas 83rd Legislature LeadingAge Texas Annual Meeting May 20, 2013 Alyse Migliaro, Public Policy Manager David Thomason, Consultant Norm Hood, Consultant http://www.youtube.com/watch?v=6OWBPyFbkPA

2. Today’s Presentation • 2012 General Election • Pre-session Advocacy • Pre-session Politics • THE BIG ISSUES • LeadingAge Texas Issues: • Priorities for the 83rd Legislature • Medicaid Reimbursement Rates • Budget Riders • STAR+PLUS Expansion • The future of PACE • KILL BILLS • Moving Bills • Federal Issues: Medicare and Medicaid • The Interim

3. 2012 General Election Breakdown • The Primaries • The most competitive races were in the primaries • Most conservative Republicans and most liberal Democrats winning elections. • Texas House • 44 new members elected • 95 Republicans – 55 Democrats • Over half of the House new over the last two elections • Texas Senate • 6 new members elected • 19 Republicans – 12 Democrats

4. Election Trends in the House

5. Pre-Session Advocacy • With over 50 new members elected in 2012, LeadingAge Texas got right to work! • Met with new members in the district. • Hosted meet & greets at member communities. • Educated on the issues. • Hosted a freshman breakfast at the Capitol. • Hosted a breakfast at 2013 Capitol Day. • Visted with key members to discuss our priorities for the 83rd legislative session.

6. Pre-Session Politics • The Budget • Estimated $8B in additional state revenue. • Agencies instructed to submit baseline spending requests and plans including 10% cuts. • Spending limited to $77.9B from $70B in 2012-2013. • Supplemental appropriation of $4.8B to Medicaid. • Public education and health care expected to top the agenda. • Tax policy, transportation and water planning predicted to be prominent discussions.

7. THE BIG ISSUES THIS SESSION • Education Funding - $3.2B on the table • Water Planning - $2B on the table • Rainy Day Fund Spending – voter approval vs. constitutional amendment • Medicaid Expansion – A Texas Solution • Transportation • Tax Cuts – Gov. calls for $1.8B • Handguns

8. BILLS FILED #1 Education - 938 filed #2 Taxation – 560 filed #3 Special Districts & Authorities – 485 filed #4 Occupational Regulation – 366 filed #5 Vehicles & Traffic – 361 filed #6 County Govt. – 349 filed #7 Crimes – 339 filed #8 City Govt. – 339 filed #9 Courts – 337 filed #10 Property Interests – 334 filed

9. LeadingAge Texas IssuesBILLS FILED #1 Human Services – 242 filed #2 HHSC – 237 filed #3 Health Care Providers – 181 filed #4 Medicaid – 110 filed #5 Managed Care – 45 filed #6 Aging – 39 filed #7 DADS – 32 filed #8 Assisted Living Facilities – 19 files #9 Nursing Facilities – 16 filed #10 Long-Term Care – 11 filed

10. Priorities for the 83rd Legislature • Fully Fund the Medicaid base rate for nursing homes (17% or $372.1M in general revenue) • Preserve and fund the direct-care staff enhancement program. • Guarantee NF’s are protected under any STAR+PLUS expansions. • Increase funding for PACE ($30M in general revenue) • Maintain health care tort reform revisions. • Avoid the granny tax.

11. Medicaid Reimbursement Rates What do we know? • HHSC reported reimbursement rates where under-funded by 17%. $142.00 vs. $121.00 • HB 10 – Emergency Supplemental Appropriations $4.8B approved to fund Medicaid through 2013. • 2014-2015 Budget Rider • 2% increase in 2014. • 2% increase in 2015. • Possible 1% increase in 2015.

12. BUDGET RIDERS • Promote Innovative Nursing Home Care Models (Rider 72) • Encourage culture change, green house project homes and similar models as an alternative to traditional SNF’s. • Client Assessment for Acute Nursing Services in Medicaid (Rider 52) • Development of an objective assessment procress to assess acute care needs. • Quality-Based Payment and Delivery Reforms in Medicaid (Rider 53) • Develop quality-based outcome and process measures that can be used to implement quality-based payment systems. • Expansion of Community-Based Services (Rider 37) • Prevent institutionalizations. • Implementing A Person-Centered Care Pilot Project for Nursing Facilities (Rider 31) • Inspection process to improve NF staff knowledge, person-centered care practices and culture change models.

13. STAR+PLUS ExpansionSenate Bill 7 • STAR+PLUS Medicaid Managed Care will be expanded to long-term care and nursing homes. • The state will contract with managed care organizations to manage care and payment in nursing homes. • HHSC will be responsible for setting the reimbursement rate. • A 15 person Advisory Committee will oversee a two-part implementation (3 non-profit providers). • Quality-based payment system and incentives. • Implementation set for 2015.

14. The Future of PACE Program of All-Inclusive Care for The Elderly • Three PACE sites in TX • Amarillo • Lubbock • El Paso • PACE Expansion • Senate Budget Rider – Two new sites, 150 slots each. • House Budget Rider – Three new sites, 100 slots each. • 96 additional slots in Amarillo, Lubbock and El Paso.

15. KILL BILL • SB 7 • STAR+PLUS Expansion in Nursing Homes • SB 303 • Advanced directives and treatment decisions • SB 1842 • Restraint and seclusion procedures • HB 1829 • Patient handling in nursing homes

16. MOVING BILLS • HB 424 • sex offender status of residents in certain facilities. • HB 1971 • A pilot program conducted by DADS to authorize certain surveys of ALF’s • HB 2383 • Payment of LTC services and medical assistance eligibility. • HB 3196 • Licensing and performance bond. • HB 3729 • Licensing requirements for newsly constructed ALF’s. • SB 8 • Medicaid Fraud Prevention • SCR 28 • First Tuesday in March Texas AL Awareness Day.

18. FEDERAL ISSUES • Due to sequestration, SNF’s saw a 2% reduction in Medicare payments for services provided on or after April 1. But, SNF Medicare rates will increase 1.43% on Oct. 1 according to CMS. • Obama’s Budget Proposal • Reduce Medicare by $79B over the next 10 yrs. • Reduce Medicare payments for SNF’s with high re-hospitalizations up to 3%. • Survey and certification user fees to be paid by NF’s. LeadingAge strongly opposed. • No call to reduce funding to the states unlike previous years. • Older Americans Act funded at 2012 levels. • $400M for Section 202 Housing • House Budget Proposal • Medicaid block grants • Medicare Redesign • LeadingAge is opposing across-the-board cuts to Medicare reimbursement and Medicaid funding to the states.

19. FEDERAL ISSUESLeadingAge Priorities • Preservation of tax benefits for charitable deductions at the top of the agenda. • LeadingAge working for measures to demonstrate housing with supportive services and new construction funding for Section 202 senior housing. • Supporting legislation to correct the Medicare observation days problem. H.R. 1179 and S.569 to require any time a beneficiary spends in the hospital toward their three day stay requirement. • Working with the Long-Term Care Commission to develop a healthy, ethical, and affordable system of long-term services and supports.

20. THE INTERIM What Can You Do? • Identify the issues • What is important to you and your residents? • Know your audience • Legislators, the media, key stakeholders, and the public • Identify your allies • Individuals, local biz and civic groups, “community assets”, and churches • Become a leader • Don’t be afraid to lead the charge! • Spread the message • Increase your visibility, partner with allies, and make the connection. • Stay connected! • Become a credible resource for information.

21. QUESTIONS?