KILL BILL: VOL.. 3.

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1 KILL BILL: VOL.. 3 The Texas 83 rd Legislature LeadingAge Texas Annual Meeting May 20, 2013 Alyse Migliaro, Public Policy Manager David Thomason, Consultant Norm Hood, Consultant

2 Today s Presentation 2012 General Election Pre-session Advocacy Pre-session Politics THE BIG ISSUES LeadingAge Texas Issues: Priorities for the 83 rd 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 Total Members Republicans Democrats Year

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 83 rd legislative session.

6 The Budget Pre-Session Politics 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 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 #1 Education filed #2 Taxation 560 filed BILLS 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 Issues BILLS 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 83 rd Legislature Fully Fund the Medicaid base rate for nursing homes (17% or $372.1M in general revenue) Preserve and fund the direct-care 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%. $ vs. $ HB 10 Emergency Supplemental Appropriations $4.8B approved to fund Medicaid through Budget Rider 2% increase in % increase in 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 Expansion Senate 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 SB 7 KILL BILL 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 HB 424 MOVING BILLS 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 ISSUES LeadingAge 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 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?

Medicaid Interpreter Services Pilot: Report on Program Effectiveness and Feasibility of Statewide Expansion

Medicaid Interpreter Services Pilot: Report on Program Effectiveness and Feasibility of Statewide Expansion Report on Program Effectiveness and Feasibility of Statewide Expansion Pursuant to S.B. 376, 79th Legislature, Regular Session, 2005 Submitted by the Health and Human Services Commission January 2007 Table