1. The “State” of CT Lisa A. Winkler Executive Director Connecticut Association of Ambulatory Surgery Centers October 15, 2015

2. Overview Formed the Association in 2005 Worked with a Core Group of Administrators Membership includes all of the state’s freestanding ASCs Formed one of the 3 state approved PSOs-All ASCs are Members

3. A History of Success Negotiated CON legislation to allow for addition of ORs, Service Lines, Ability to Move without CON oversight Defeated Previous provider Tax legislation Defeated and then Delayed Patient level data reporting Developed Positive Relationships with OHCA and DPH-Seen as a respected Organization Positioned the industry well from a regulatory perspective Defeated and then Mitigated WC Fee Schedule Legislation Through the PSO, provided patient education Federal Level-Congressional Delegation Leadership on ASC Legislation.

4. The 2015 Session 5 Days before the end of the session negotiated compromise legislation that greatly mitigated the effects of hospital conversion legislation ASCs-SB 811 – Improved ASC price transparency for patients – Eliminated costly, mandatory EMR requirements – Eliminated burdensome reporting requirements – Eliminated provisions that would have required a paper notice to be mailed to each patient within 2 days of scheduling

5. Finance Package-a new 6% tax on “gross receipts” of ASCs – 3 days before the end of session – Voted out of the Finance Committee without language – Presented as a means of capturing lost tax revenue when converting from a for-profit to a non-profit – No Public Hearing Budget Narrowly Passed – Extensive Discussion on the Floor – Good News-Budget Implementation Bills Not Voted before the end of the session The 2015 Session

6. “ All politics is local” Tip O’Neil, former House Speaker Mobilized a grassroots/grasstops campaign Legislative Meetings in the days after the session in preparation for the Special Session Big Issues Raised in our Discussions (Aside from the Fiscal Climate): – Other States with ASC Taxes (NJ, Wisconsin, etc.) – CT’s Health Care Taxes (Hospitals/Nursing Homes) – Corporate Revenue/Venture Capital Results (After 3-4 weeks of Lobbying) : – Thousands of Emails and Calls Logged – Meetings with Every Leader, OPM, Governor’s Office – Extensive Floor Debate, Commitments to “Help” Next Session – First $1m exempted and ability to “pass on” the tax

7. Connecticut’s Budget 2011 and 2015 Largest tax increases in state’s history On track for a $900 million deficit in 2018 3 months in to this fiscal year, Governor made $103 million in rescissions Hospitals bore the brunt of the October cuts – Approximately $190 million, including the loss of federal matching dollars. (This week restored $14 to small hospitals.) Next Revenue estimates November 10th

8. Multi-pronged Approach Coordinated Effort-Unified Message Grassroots Campaign – Facility Visits-Toolkit, Talking Points – Votervoice – Key Contacts – Allies-Physician Groups, Specialties, CSMS, Patients DRS Comptroller Economic Impact Study Media The Repeal Effort 2016 Session February-May

9. Take Aways Get Involved in your State Association/ASCA Contribute to PAC-National and State – Critical to Support Legislators Who Understand the Value-Proposition of ASCs Get to know you state legislators – Host a visit National Visit Your ASC Day – Become a Resource – Engage Patients/Local Businesses