Kathy Hutto Governmental Affairs Consultant Jackson Walker L.L.P November 8, 2013

 Governor Rick Perry –assumed office December 21, 2000 when Governor Bush resigned to become President.  Longest serving governor in Texas history  July 28, 2013 – announced he would not seek a 4 th term

The dominos start with Perry’s decision not to run. PERRY ABBOTT DEWHURST STAPLES PATTERSON COMBS

 Twelve years of pent-up ambition suddenly unleashed.  Attorney General Greg Abbott announces he is running for Governor. ◦ Also in the Republican Primary:  Tom Pauken  Miriam Martinez  Larry “Secede” Kilgore  Lisa Fritsch

 June 25, 2013 filibuster created enormous visibility for Senator Davis and many began encouraging he to run for Governor.  October 3, 2013 – she announced she would run for Governor.  No primary opponents anticipated.

 General Abbott running for higher office creates an opening for AG for the 1 st time since 2002  Three Republicans and one Democrat are vying for the office:  Representative Dan Branch (R)  Senator Ken Paxton (R)  Railroad Commissioner Barry Smitherman (R)  Sam Houston (D)

 With Railroad Commissioner Smitherman deciding to run for AG, the line began to form for his seat: ◦ Becky Berger ◦ Malachi Boyuls ◦ Wayne Christian ◦ Ray Keller ◦ Joe Pool, Jr. ◦ Ryan Sitton

 Lt. Governor David Dewhurst is facing 3 Republican challengers: ◦ Commissioner of Agriculture Todd Staples ◦ Land Commissioner Jerry Patterson ◦ Senator Dan Patrick Will Senator Leticia Van de Putte run on the Democratic ticket?

 Nolan Ryan  Eric Opiela  Sid Miller  Tommy Merritt  J Carnes  Kinky Friedman (D)

 George P. Bush (R)  David Watts (R)  John Cook (D)

 Senator Glenn Hegar (R)  Rep. Harvey Hilderbran (R)  Debra Medina (R)  Raul Torres (R)  Mike Collier (D) Susan Combs was elected Comptroller in 2006, but is not Running for re-election.

 31 Senators  15 up for re-election. So far 4 have opponents.  4 running for higher office: ◦ Wendy Davis for Governor ◦ Dan Patrick for Lt. Governor ◦ Ken Paxton for AG ◦ Glenn Hegar for Comptroller (has 4 year term)  Senator Tommy Williams resigned, so Special Election on 5/4/14 to fill his seat.  2 maybe 3 Chairmen gone-Williams, Patrick & Hegar

 150 Representatives – all up for re-election  15 contested races  Rep. Mark Strama resigned. Special Election was Tuesday. Now a run-off.  11 not running or running for higher office  8 of these are Chairs, including ◦ Appropriations ◦ Ways and Means ◦ Higher Education ◦ Natural Resources

 ◦ On bottom right side, find the box that says “Who Represents Me? ◦ Enter your address & hit submit. ◦ Find contact information for your:  U.S. Representative (i.e. Congressman/woman)  Texas State Senator  Texas State Representative  Texas State Board of Education Member

 Senator John Cornyn ◦ Offices in Washington, DC, Austin, Dallas, Harlingen, Houston, Lubbock, San Antonio and Tyler ◦  Senator Ted Cruz ◦ Offices in Washington, DC, Austin, Dallas, Houston, San Antonio and Tyler ◦

TypeFiledSignedVetoedFiled Without Signature HB3, SB1, HJR SJR 65 4 TOTALS6,0901,

 RIDER 51, Medicaid Funding Reduction and Cost Containment. a. Included in appropriations above in Goal B, Medicaid, Strategy B.1.5, Children, is a reduction of $200,000,000 in General Revenue Funds and $284,730,974 in Federal Funds in fiscal year 2014 and $200,000,000 in General Revenue Funds and $276,871,722 in Federal Funds in fiscal year 2015, a biennial total of $400,000,000 in General Revenue Funds and $561,602,696 in Federal Funds. The Health and Human Services Commission (HHSC) is authorized to transfer these reductions between fiscal years and to allocate these reductions among health and human services agencies as listed in Chapter 531, Government Code, pursuant to the notification requirements included in Subsection (c) of this rider. b. This reduction shall be achieved through the implementation of the plan described under subsection (c) which may include any or all of the following initiatives:

1. Implement payment reform and quality based payment adjustments in fee-for-service and in managed care premiums,… 10. Phase down Medicaid rates which are above Medicare rates, with separate consideration for an accurate and appropriate evaluation of the service delivery model when developing the rate for Medicaid rates for pediatric therapy services that have no equivalent Medicare service,

11. Develop a more appropriate fee schedule for therapy services, requiring providers to submit the National Provider Identification (NPI) on each claim, 12. Strengthen prior authorization requirements, 13. Strengthen and expand utilization and prior authorization reviews,… 17. Expand initiatives to pay more appropriately for outlier payments,…

CODEDESCRIPTIONCORF/ ORF ITHHA2012 MEDICARE 97003Eval OT$ Re-eval OT Therapeutic procedure, exercise Therapeutic activity

(o) The executive commissioner of the Health and Human Services Commission, in adopting reasonable rules and standards governing the determination of rates paid for physical, occupational, or speech therapy services under the medical assistance program, shall ensure that providers holding the same professional license and located in the same geographical region are reimbursed for the provision of a particular service at an equal rate, regardless of: (1) the setting in which the service is provided; or (2) whether the provider practices as a sole practitioner or is associated with or employed by another provider.

 S.B seeks to streamline the prior authorization process and improve access to medical services and procedures through the creation of a single, standard form for requesting prior authorization of health care services.  “Health care services" includes medical or health care treatments, consultations, procedures, drugs, supplies, imaging and diagnostic services, inpatient and outpatient care, medical devices, and durable medical equipment. The term does not include prescription drugs as defined by Section , Occupations Code.

 Get to know your State Senator and State Representative and their staff.  Invite them to visit your practice.  Volunteer in their campaigns. ◦ Put up yard signs ◦ Make phone calls ◦ Stuff envelopes ◦ Take people to the polls  Keep statistics that show how OT practice benefits your patients and the health care delivery system. Cost-benefit analysis is key.