1. KATHY HUTTO GOVERNMENTAL AFFAIRS CONSULTANT JACKSON WALKER L.L.P. PRESENTATION AT TOTA MOUNTAIN CENTRAL CONFERENCE 11/7/14 IT’S A NEW BALL GAME! WHAT TO EXPECT FROM THE TEXAS LEGISLATURE

2. NEW LEADERSHIP Republicans swept statewide offices for the 10th consecutive election Governor - Greg Abbott 1 st new Governor in 14 years Lt. Governor – Dan Patrick

3. THE ONLY RETURNING PLAYER Speaker of the House Joe Straus  1 st elected to the House in 2005  1 st elected Speaker in 2009, so this will be 4 th Session  Will be challenged, but should be easily re-elected  House viewed as the calm port in the upcoming storm.

4. CHANGE IN LINEUP HOUSE  23 new members  If Rep. Lois Kolkhorst wins Glenn Hegar’s old Senate seat, will have 24 new House members  98 Rs v. 53 Ds (gain of 3 by Rs)  10 Chairmen not returning including some on key committees to OTs : Appropriations Public Health Higher Education

5. LINEUP CHANGES GREATER IN SENATE 8 of 31 Senators will be Freshman. More conservative 13 of 31 will have 2 years or less experience 6 Chairman not returning plus threat to not appoint any “D” Chairs would knock out 6 more

6. LOOMING ISSUE School Finance Judge John Dietz, 250 th District Court, on 8/28/14 declared the Texas school finance system violates the Texas Constitution on the issues of equity, adequacy, and a state property tax, but does not violate the “taxpayer equity” provision of the Constitution. Judge Dietz’ ruling enjoins the state from distributing any funds under Chapters 41 and 42 and Section 12.106 (charter schools) after July 1, 2015 if the constitutional violations are not remedied by the Legislature. The case was appealed directly to the Texas Supreme Court by Attorney General Abbott— which automatically stays the injunction — and most likely we will not see a ruling from the Supreme Court until next summer, after the 84 th Legislature adjourns. If the Texas Supreme Court upholds the findings on equity and a state property tax, it will not necessarily require the state to spend additional money on public education, though the legislature has typically responded with higher funding. If the Supreme Court upholds the finding on adequacy, it would more than likely necessitate and increase in state funding.

7. OTHER BIG ISSUES Water Transportation Immigration/Border Security School Choice Gun Rights – campus carry/open carry Transparency in spending/end fund diversions Social issues

8. ONGOING CHALLENGE HHSC directed to achieve Medicaid savings of $400 million in General Revenue from 25 cost containment initiatives One initiative = phase down Medicaid rates which are above Medicare rates Also, develop a more appropriate fee schedule for therapy services, requiring providers to submit their NPI on each claim (at a minimum, name of provider)

9. Pediatric Study Forthcoming HHSC has commissioned A&M to perform an independent review comparing Texas Medicaid’s authorization policies, rates and utilizations patterns for pediatric acute therapy (OT, PT and Speech) to those in other state Medicaid programs and commercial insurance plans. Findings expected this Fall and will impact the budget as HHSC will be expected to come up with more cost savings.

10. SUNSET All Health and Human Services agencies under review o Health and Human Services Commission (HHSC) o Department on Aging & Disability Services o Department of State Health Services (DSHS) o Department of Assistive & Rehabilitative Services o Department of Family & Protective Services

11. DSHS SUNSET RECOMMENDATION To allow DSHS to focus on public health matters instead of occupational licensing, transfer 12 regulatory programs from DSHS to the Texas Department of Licensing and Regulation (TDLR), and require TDLR to create associated advisory committees for each profession in place of existing boards and committees. In absorbing these functions, TDLR should create a focused health section to ensure development of related expertise. Phase 1 (FY 2016–2017) a. Athletic Trainers b. Dietitians c. Hearing Fitters and Dispensers d. Midwifery e. Orthotics and Prosthetics f. Speech-language Pathologists and Audiologists Phase 2 (FY 2018–2019) g. Code Enforcement Officers h. Laser Hair Removal i. Massage Therapists j. Mold Assessors and Remediators k. Offender Education Providers l. Sanitarians

12. DSHS RECOMMENDATION (CON’T) Four boards are being transferred to the Texas Medical Board a. Medical Physicists b. Medical Radiologic Technologists c. Perfusionists d. Respiratory Care Practitioners Four will be retained at DSHS, but their placement will be considered during the Sunset review of the structure of the mental and behavioral health components of the health and human services system. a. Chemical Dependency Counselors b. Marriage and Family Therapists c. Professional Counselors d. Social Workers. Based on the lack of need for continued state intervention in certain activities and occupations, the Legislature should deregulate 11 programs, including: Dyslexia Therapists and Practitioners Opticians

13. IMPLICATION FOR OTs AND COTAs 1 st phase of move of health care licensing agencies to TDLR begins September 1, 2015. Sunset review of TBOTE, TBPTE, & ECPTOTE begins with self-evaluation report in summer of 2015. Sunset date for TBOTE, TBPTE and the Executive Council of PT & OT Examiners is September 1, 2017.

14. FOCUS FOR TOTA IN UPCOMING SESSION Role of OT as Mental Health Professional BIG CHALLENGE – NO ONE AT THE CAPITOL THINKS OF OTs AS HAVING A MH ROLE EDUCATING LEGISLATORS & THEIR STAFF AS TO WHAT THAT ROLE IS AND YOUR EDUCATIONAL PREPARATION WILL BE KEY TO OUR SUCCESS. IT TAKES A VILLAGE!

15. OT’S ROLE IN MENTAL HEALTH SERVICES Help individuals modify behaviors that interfere with effective emotional, social or intellectual functioning Increase individual’s ability to live as independently as possible while engaging in meaningful & productive life roles Work with clients to establish goals related to improving participation in one’s home, school, workplace, and community. Teach and facilitate skills in the areas of problem solving, medication management, home and community safety, social skills, activities of daily living, vocational and leisure interests, stress management, and more.

16. WHY IS OT IMPORTANT IN MH SERVICES? Improves symptom and medication management as well as increases social skills, social participation, and personal well-being Decreases negative psychological symptoms, hospital admissions and readmissions, poor treatment compliance, and social exclusion

17. LEGISLATION OUR CHAMPION – Representative Garnet Coleman (D- Houston) OUR BILL – Will add occupational therapists to the definition of non-physician mental health professional in the Texas Mental Health Code, Chapter 571.003(15), Health and Safety Code.