1. 2011-2012 Texas Allianceof Groundwater Districts

2. TML IEBP Mission StatementTo provide excellent service and administrativeservices to eligible municipalities in Texas by utilizing innovative, affordable alternativeswhile maintaining financial integrity. Exclusive to Public SectorPublic &Not-for- Member Private Profit Equity Sector 3. Alliance RelationshipTML IEBP IS THE VALUE ADDED SOLUTION 4. 4 Political Subdivisions010-2011CategoryGroupsLivesCategoryGroups Lives Assistance League 150Municipal Water Authority 212 Association of Governments16 Municipal Water District110 City454 20,316 Navigation District 1 8 Conservation District 611Police Department 117 Council of Governments 10 902Port Authority114 County (or Central) Appraisal District 73 837Public Utility Board268 County Irrigation District18 Public Utility District 1 1 Drainage District 427Regional Planning Commission5247 Emergency Communication District 1264Risk Pool 3388 Emergency Medical Services District 8 105River Authority 5350 Emergency Service District876Special Utility District 15115 Fresh Water Supply District 531Transit District279 Health District 2 313Underground Water Conservation District1152 Hospital District 7 169Voluntary Fire Department 121 Housing Authority99 610Water Authority 213 Improvement District214Water Conservation & Improvement District 20 186 Irrigation District 131Water Improvement District433 Library District512Water Supply District 531 Municipal Utility Authority 121Water/Wastewater District 597 Municipal Utility District 18 116Grand 805 25,461 5. Cost Management in the New World 5Per Employer Per Year (PEPY) Cost of Healthcare: Medical w/Rx Pool Industry Standard10,4759,8219,0288,4497,9707,5167,1406,616 6,3706,059 5,837 6,070 6,0005,4215,126 5,026 5,0484,843200420052006200720082009201020112012 6. 6 Healthcare FactsPatient Protection Affordable Care Act (PPACA) Affordable Care Act (ACA) Is Healthcare a Privilege or a Right? Resources: http://www.healthcare.gov http://www.dol.gov/ebsa/healthreform http://www.healthytexasonline.com http://cciio.ems.gov 1,14,12http://www.urac.org - Issue Brief/Utilization Review Accreditation Commission (URAC) 7. 7Healthcare TourismProcedureUSIndiaThailand SingaporeHeart Bypass $130,000 $10,000 $11,000$18,500Heart Valve Replacement $160,000 $9,000 $10,000$12,500Angioplasty$57,000 $11,000 $13,000 $13,000Hip Replacement$43,000 $9,000 $10,000$12,500Hysterectomy $20,000 $3,000 $4,500 $6,000Knee Replacement $40,000 $8,500 $10,000$13,000Spinal Fusion$62,000 $5,500 $7,000 $9,000 8. 8Healthcare Facts Patient Protection Affordable Care Act March 23, 2010 - Signed by the President March 30, 2010 - Amended by Health Care and Education Affordability Reconciliation Act Healthcare Reform Estimated Funding Required: $829B - $900B Healthcare Costs are in excess of 15% of Gross NationalProduct. Starbucks spends more on healthcare than coffeebeans. General Motors spends more on healthcare than onsteel. 9. 9 Healthcare Facts Medicare Expansion- The U.S. could face a shortage ofPrimary Care Physicians by 2025. Uninsured Population continues to grow Implementing healthcare for dependents to the attained age 26 increased insured population by $2.5M Texas is identified Medicaid expansion as a cost of $24B over the next 10 years Uncompensated Care Uninsured population Ineligible Care 10. 10Healthcare Facts Healthcare Reform Washington Debate February 15-17, 2012 Doc Fix Extension/Sustainable Growth Rate (SGR) Physicians will not incur Medicare payment cuts of 27.4% and their current Medicare rates will be frozen at about a 2% increase until 12.31.12. (10 month extension-Republicans were pushing for 24 months) Projected 1.1.13, 30% decrease in rates Payroll Tax Extension Unemployment Insurance Extension Prohibition of physician owned hospitals (Delayed) Medicare is currently estimated to be unfunded by 2017. $300B in cuts from Medicare over 10 years means 27.4% decrease in pay (attend to doc fix amendment) 10% of Medicare patients responsible for 2/3 of the cost) 11. 11 Health Information Technology Health Information Technology (HITECH)Advancement/Upgrades Conversion from ICD-9 to ICD-10 October 2013 Delayed until October 2014 (2 Year discussion); Expansion of Diagnosis Codes: 14,000 to more than 67,000 and procedure codes from 13,000 to 85,000 CMS announced its intention to review ICD-10 implementation timeline using a rule based process. Possibly two year extension; 2015 ICD-11 is available 12. 12 Current Regulatory Mandates: Post PPACA2010 Benefits All Plans Prohibition of Lifetime Maximum Dependent Coverage to Attained age 26 Pre-Existing Coverage Prohibition 250 W-2 Forms, 2012 19 prohibition of pre-existing limitation Expansion of Medicare and Medicaid, Offering subsidiesto lower-income Americans, without coverage Full Time/Part Time benefit coverage: definition of parttime employee: 30/25/20 hours a week, seasonal labor>120 days/year Healthcare Reform Employer Compliance PenaltyAssessment 2014 Exchange Notice to employees establishing statehealth insurance exchanges Exchanges will be certified for operations Jan 1, 2013. States may allow employers with more than 50/100 employees to purchase coverage in Exchange, 2014 Large Employers, 2017 22. Status of State Legislation to Establish22WAExchanges MEMT ND VT ORMNNHID SDNY WIMAMI WY CT RIIA PA CANV NENJOHMDIL IN DEUT WVCOKS MO VA KY NCTN AZOK NMAR SCMS ALGATXLAAKFL Legislation signed to establish exchange since PPACA Legislation failed Health exchanges established before PPACAGovernor vetoed legislation Legislation signed intending to establish or study exchangeNo legislation HI Legislation passed by one or both houses Governor pursued nonlegislative options Legislation pending in one or both houses [includes District of Columbia]Source: Commonwealth Fund Analysis of National Conference of State Legislatures Data as of July 2011 23. 23 Evolving Healthcare ReformRepeal or Revise: 2014 Reform Laws Non tax deductible penalties Pay or PlayMandate: $2,000 per full-time worker with 50 or moreemployees Inadequate Coverage Free Voucher Program: 100%-400% of Federal Poverty level and premium is more than 8.4%-9% of household income. Inadequate Coverage: Penalty $3,000 (# of employees receiving a premium tax credit or cost subsidy) Offering Small Employer Tax Credits that providecoverage; Premium Tax Credit: Small Business Health Options Program (SHOP); 50 or fewer employees with $50,000/$40,000 maximum average wage: Tax Credit for tax exempt employers maximum of 35% 24. 24Have a Great Day! Thank Youfor your Time and Attention