By: Craddick H.B. No. 1592
73R6032 KLL-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the regulation of hospices; providing civil penalties.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Subtitle G, Title 2, Health and Safety Code, is
1-5 amended by adding Chapter 146 to read as follows:
1-6 CHAPTER 146. HOSPICE PROGRAM OF CARE
1-7 SUBCHAPTER A. GENERAL PROVISIONS
1-8 Sec. 146.001. SHORT TITLE. This chapter may be cited as the
1-9 Texas Hospice Act.
1-10 Sec. 146.002. DEFINITIONS. In this chapter:
1-11 (1) "Alternate delivery site" means a location or site
1-12 from which a hospice agency provides services within a portion of
1-13 the total geographical area served by that hospice.
1-14 (2) "Bereavement" means the process by which survivors
1-15 mourn and experience their grief.
1-16 (3) "Bereavement services" means support services
1-17 offered to the family during the period of bereavement.
1-18 (4) "Certified hospice provider" means a provider who
1-19 offers a hospice program of care and is certified by an official of
1-20 the United States Department of Health and Human Services as being
1-21 in compliance with conditions of participation adopted under Title
1-22 XVIII, Social Security Act (42 U.S.C. Section 1395 et seq.).
1-23 (5) "Council" means the Hospice Advisory Council.
1-24 (6) "Counselor" means a person qualified under
2-1 Medicare standards to provide counseling services to both the
2-2 patient and the family, including bereavement, dietary, spiritual,
2-3 and other counseling services.
2-4 (7) "Director" means the executive head of the Texas
2-5 Department of Health.
2-6 (8) "Family" means those persons sharing housing,
2-7 common ancestry, or a common personal commitment with the patient.
2-8 (9) "Home" means the patient's place of residence.
2-9 (10) "Hospice program of care" means a coordinated
2-10 program consistent with the standards and rules adopted under this
2-11 chapter that provides palliative care to terminally ill patients
2-12 and provides supportive services to patients and their families,
2-13 and that:
2-14 (A) is available 24 hours a day, seven days a
2-15 week, during the last stages of illness, during death, and during
2-16 bereavement;
2-17 (B) is provided by a medically directed
2-18 interdisciplinary team; and
2-19 (C) may be provided in a home, nursing home,
2-20 residential unit, or inpatient unit according to need.
2-21 (11) "Hospice services" means those services provided
2-22 to a patient or the patient's family as part of a hospice program
2-23 of care.
2-24 (12) "Inpatient unit" means a facility owned or
2-25 operated by a licensed hospice and located within the geographical
2-26 area served by the hospice that provides a continuum of medical or
2-27 nursing care or services to hospice patients admitted into the unit
3-1 and that is in compliance with the conditions of participation for
3-2 inpatient units adopted under Title XVIII, Social Security Act (42
3-3 U.S.C. Section 1395 et seq.), and standards adopted under this
3-4 chapter.
3-5 (13) "Interdisciplinary team" means a group of
3-6 individuals that work together in a coordinated manner to provide a
3-7 hospice program of care and that includes a physician, registered
3-8 nurse, social worker, and counselor.
3-9 (14) "Investigation" means an inspection or survey
3-10 conducted by a representative of the department to determine
3-11 whether a licensee is in compliance with this chapter and rules
3-12 adopted under this chapter or with Title XVIII, Social Security Act
3-13 (42 U.S.C. Section 1395 et seq.), and regulations adopted under
3-14 that Act.
3-15 (15) "Nurse" means a person licensed by the Board of
3-16 Nurse Examiners or the Board of Vocational Nurse Examiners.
3-17 (16) "Palliative care" means those services of
3-18 intervention that focus primarily on the reduction or abatement of
3-19 physical, psychosocial, and spiritual symptoms of terminal illness.
3-20 (17) "Physician" means a person licensed by the Texas
3-21 State Board of Medical Examiners.
3-22 (18) "Residential unit" means a facility owned or
3-23 operated by a licensed hospice and located within the geographical
3-24 area served by the hospice that provides living quarters and
3-25 hospice services to patients admitted into the unit and that is in
3-26 compliance with standards adopted under this chapter.
3-27 (19) "Social worker" means a person certified as a
4-1 social worker under Chapter 50, Human Resources Code.
4-2 (20) "Supportive services" means social, spiritual,
4-3 and emotional care provided to the patient and the patient's
4-4 family.
4-5 (21) "Terminal illness" means an illness for which
4-6 there is a limited prognosis if the illness runs its usual course.
4-7 (22) "Volunteer" means a person who provides
4-8 assistance to a hospice program of care without compensation other
4-9 than actual expenses incurred.
4-10 (Sections 146.003-146.010 reserved for expansion
4-11 SUBCHAPTER B. LICENSES
4-12 Sec. 146.011. LICENSE REQUIRED. (a) Except as provided by
4-13 Section 146.012, a person, including a health care facility
4-14 licensed under this code, may not establish, conduct, or operate a
4-15 hospice program of care or hold the person out to the public as a
4-16 provider of hospice services unless the person holds a hospice
4-17 license issued under this chapter.
4-18 (b) A person who is not licensed under this chapter may not
4-19 use the word "hospice," use any title or description of a facility,
4-20 organization, program, service provider, or services incorporating
4-21 the word "hospice," or use any other words, letters, abbreviations,
4-22 or insignia indicating or implying that the person holds a hospice
4-23 license.
4-24 (c) A license issued under this chapter includes authority
4-25 granted to the licensee to own or operate a residential unit or
4-26 inpatient unit in compliance with standards and rules adopted under
4-27 this chapter.
5-1 Sec. 146.012. EXEMPTION. A health care facility licensed
5-2 under this code that provides hospice services under a contract
5-3 with a person holding a hospice license issued under this chapter
5-4 is not required to obtain a license under this chapter.
5-5 Sec. 146.013. NONTRANSFERABILITY. (a) A license issued
5-6 under this chapter may not be transferred to another person but may
5-7 be transferred from one location to another location.
5-8 (b) A change of ownership or location shall be reported to
5-9 the department.
5-10 Sec. 146.014. TEMPORARY LICENSE. The department may issue a
5-11 nonrenewable temporary hospice license to a person who is in the
5-12 process of becoming licensed by the department as a hospice. A
5-13 temporary license is valid for six months from the date of its
5-14 issuance and is effective as provided by board rules.
5-15 Sec. 146.015. LICENSE APPLICATION. (a) An applicant for a
5-16 hospice license must:
5-17 (1) file a written application on a form prescribed by
5-18 the department;
5-19 (2) file with the application:
5-20 (A) the name of the owner of the hospice or a
5-21 list of the names of persons, if any, who own at least a 10 percent
5-22 interest in the hospice; and
5-23 (B) a list of any businesses with which the
5-24 hospice subcontracts and in which the owner or owners of the
5-25 hospice hold at least five percent of the ownership;
5-26 (3) cooperate with any inspections required by the
5-27 department for a license; and
6-1 (4) pay the license fee prescribed by this chapter.
6-2 (b) The board by rule shall require that, at a minimum,
6-3 before the department may approve a license application other than
6-4 an application for a renewal or alternate delivery site license,
6-5 the applicant must provide to the department:
6-6 (1) documentation establishing that, at a minimum, the
6-7 applicant has sufficient financial resources to provide the
6-8 services required by this chapter and by the department during the
6-9 term of the license;
6-10 (2) a list of the management personnel for the
6-11 proposed hospice, a description of personnel qualifications, and a
6-12 plan for providing continuing training and education for personnel
6-13 during the term of the license;
6-14 (3) documentation establishing that the applicant is
6-15 capable of meeting the minimum standards established by the board
6-16 relating to the quality of care; and
6-17 (4) a plan that provides for the orderly transfer of
6-18 care of the applicant's patients if the applicant cannot maintain
6-19 or deliver hospice services under the license.
6-20 (c) Information received by the department relating to the
6-21 competence and financial resources of the applicant is confidential
6-22 and may not be disclosed to the public.
6-23 Sec. 146.016. LICENSE ISSUANCE. The department shall issue
6-24 a hospice license to each applicant who:
6-25 (1) qualifies for the type of license requested;
6-26 (2) submits an application and license fee as required
6-27 by this chapter; and
7-1 (3) complies with all licensing standards adopted by
7-2 the board or required under this chapter.
7-3 Sec. 146.017. TERM OF LICENSE. (a) Except as provided by
7-4 Subsection (b), a hospice license expires on the first anniversary
7-5 of the date of issuance.
7-6 (b) The department may issue an initial license for a term
7-7 of less than one year to conform with the expiration dates of other
7-8 licenses held by the licensee under this chapter.
7-9 (c) The department, in accordance with board rules, may
7-10 issue a temporary license to an applicant for an initial license.
7-11 Sec. 146.018. DISPLAY OF LICENSE. A hospice license shall
7-12 contain the following information and shall be displayed in a
7-13 conspicuous place in the hospice office:
7-14 (1) the name and address of the hospice;
7-15 (2) the name of the owner or owners, if different from
7-16 the information provided under Subdivision (1); and
7-17 (3) the license expiration date.
7-18 Sec. 146.019. ALTERNATE DELIVERY SITE LICENSE. (a) The
7-19 board by rule shall establish standards required for the issuance
7-20 of an alternate delivery site license.
7-21 (b) The department shall issue an alternate delivery site
7-22 license to a qualified person who holds a hospice license.
7-23 (c) An alternate delivery site license expires on the same
7-24 date as the hospice license held by that person.
7-25 Sec. 146.020. FEES. (a) The board shall adopt hospice
7-26 license fees in amounts that are reasonable to meet the cost of
7-27 administering this chapter, except that the fees may not be:
8-1 (1) less than $600 or more than $1,000 for a temporary
8-2 or initial hospice license or an initial alternate delivery site
8-3 license; or
8-4 (2) less than $300 or more than $600 for renewal of a
8-5 hospice license or an alternate delivery site license.
8-6 (b) A fee charged under this section is nonrefundable.
8-7 Sec. 146.021. RULES. The board shall adopt rules necessary
8-8 to implement this chapter.
8-9 Sec. 146.022. MINIMUM STANDARDS. (a) The board, on the
8-10 recommendation of the council, shall adopt minimum standards for
8-11 hospices licensed under this chapter that are at least as stringent
8-12 as those required for certification as a certified hospice provider
8-13 under federal law.
8-14 (b) Standards adopted under Subsection (a) may relate to:
8-15 (1) qualifications for professional and
8-16 nonprofessional personnel, including volunteers;
8-17 (2) supervision of professional and nonprofessional
8-18 personnel, including volunteers;
8-19 (3) the provision and coordination of treatment and
8-20 services, including supportive and bereavement services;
8-21 (4) the organizational structure, including the lines
8-22 of authority, the delegation of responsibility, and the composition
8-23 of the interdisciplinary team;
8-24 (5) clinical and business records;
8-25 (6) financial ability to carry out the functions as
8-26 proposed;
8-27 (7) safety, fire prevention, and sanitary standards
9-1 for residential units and inpatient units; and
9-2 (8) any other aspect of hospice services necessary for
9-3 a hospice to perform its duties.
9-4 Sec. 146.023. FORMS. The department shall prescribe forms
9-5 necessary to perform its duties under this chapter.
9-6 Sec. 146.024. ENFORCEMENT OF OTHER LAW. The department
9-7 shall require a hospice to implement and enforce the applicable
9-8 provisions of Chapter 102, Human Resources Code.
9-9 (Sections 146.025-146.030 reserved for expansion
9-10 SUBCHAPTER C. ENFORCEMENT
9-11 Sec. 146.031. INSPECTIONS. The department or its authorized
9-12 representative may enter the premises of a license applicant or
9-13 licensee at reasonable times to conduct an inspection incidental to
9-14 the issuance of a license and at other times as the department
9-15 considers necessary to ensure compliance with this chapter and
9-16 rules adopted under this chapter.
9-17 Sec. 146.032. COMPLAINTS. A hospice shall provide each
9-18 person who receives hospice services with a written statement that
9-19 contains the name, address, and telephone number of the department
9-20 and a statement that informs recipients that a complaint against a
9-21 hospice may be directed to the department.
9-22 Sec. 146.033. INVESTIGATION OF COMPLAINT. (a) The
9-23 department or its authorized representative shall investigate each
9-24 complaint received regarding the provision of hospice services and
9-25 may as a part of the investigation:
9-26 (1) conduct an unannounced inspection of a place of
9-27 business, including an inspection of medical and personnel records,
10-1 if the department has reasonable cause to believe that the place of
10-2 business is in violation of this chapter or a rule adopted under
10-3 this chapter;
10-4 (2) conduct an interview with a recipient of hospice
10-5 services, which may be conducted in the recipient's home;
10-6 (3) if the recipient of hospice services is deceased,
10-7 conduct an interview with a family member or other person who would
10-8 have knowledge of the care received from the hospice; and
10-9 (4) interview a health care practitioner or any
10-10 hospice personnel who care for a recipient of hospice services.
10-11 (b) The reports, records, and working papers used or
10-12 developed in an investigation under this section are confidential
10-13 and may be disclosed only in accordance with rules adopted by the
10-14 board.
10-15 Sec. 146.034. CONFERENCE CONCERNING SURVEY. (a) The
10-16 department's authorized representative shall hold a conference with
10-17 the individual in charge of a hospice to explain the nature and
10-18 scope of the survey before beginning an on-site survey.
10-19 (b) When the survey is complete, the representative shall
10-20 hold a conference with the individual in charge of the hospice.
10-21 (c) The individual in charge of the hospice shall be fully
10-22 informed of the preliminary findings of the survey and shall be
10-23 given a reasonable opportunity to submit additional facts or other
10-24 information to the department's representative in response to those
10-25 findings. The response shall be made a part of the record of the
10-26 survey for all purposes.
10-27 (d) During the conference concluding a survey, the
11-1 department's representative shall identify any records that were
11-2 duplicated during the survey. Original hospice records may be
11-3 removed from a hospice only with the hospice's consent.
11-4 Sec. 146.035. RESULTS OF SURVEY. After a survey of a
11-5 licensee by the department, the department shall provide to the
11-6 chief executive officer of the hospice:
11-7 (1) specific and timely written notice of the
11-8 preliminary findings of the survey, including the specific nature
11-9 of the survey, the specific statute or rule allegedly violated, if
11-10 any, the specific nature of any finding regarding the alleged
11-11 violation or deficiency and, if a deficiency is alleged, the
11-12 severity of the deficiency alleged;
11-13 (2) information on the identity, including the
11-14 signature, of each department representative conducting, reviewing,
11-15 or approving the results of the survey and the date on which the
11-16 department representative acted on the matter; and
11-17 (3) on the request of the licensee, copies of all
11-18 documents relating to the survey maintained by the department or
11-19 provided by the department to any other state or federal agency not
11-20 made confidential by state law.
11-21 Sec. 146.036. DENIAL, SUSPENSION, OR REVOCATION OF LICENSE.
11-22 (a) The department may deny a license application or suspend or
11-23 revoke or probate the revocation of the license of a person who
11-24 fails to comply with this chapter or rules adopted under this
11-25 chapter.
11-26 (b) The department may immediately suspend or revoke a
11-27 license when the health and safety of persons are threatened. On
12-1 the issuance of an order of immediate suspension or revocation, the
12-2 department shall immediately provide to the chief executive officer
12-3 of the hospice adequate notice of the action taken, the legal basis
12-4 for the action, and the procedure governing appeal of the action.
12-5 A person whose license is suspended or revoked under this
12-6 subsection is entitled to a hearing not later than the seventh day
12-7 after the effective date of the suspension or revocation.
12-8 (c) A person whose application is denied or whose license is
12-9 suspended or revoked is entitled to a hearing before the department
12-10 if the person submits a written request to the department. The
12-11 Administrative Procedure and Texas Register Act (Article 6252-13a,
12-12 Vernon's Texas Civil Statutes) and the department's rules for
12-13 contested case hearings apply to hearings conducted under this
12-14 section and to appeals from department decisions.
12-15 Sec. 146.037. INJUNCTION. (a) A district court, on
12-16 petition of the department and on a finding by the court that a
12-17 person is violating this chapter, may by injunction:
12-18 (1) prohibit the person from continuing the violation;
12-19 or
12-20 (2) grant any other injunctive relief warranted by the
12-21 facts.
12-22 (b) The attorney general shall institute and conduct a suit
12-23 authorized by this section at the request of the department and in
12-24 the name of the state.
12-25 (c) A suit for injunctive relief must be brought in Travis
12-26 County.
12-27 Sec. 146.038. CIVIL PENALTY. (a) A person who establishes,
13-1 conducts, or operates a hospice program of care or holds the person
13-2 out to the public as a provider of hospice services without a
13-3 license issued under this chapter is liable for a civil penalty of
13-4 not less than $1,000 or more than $2,500 for each day of violation.
13-5 (b) The attorney general shall bring suit on behalf of the
13-6 state to collect the civil penalty. An action to recover a civil
13-7 penalty is in addition to an action brought for injunctive relief
13-8 under Section 146.037 or any other remedy provided by law.
13-9 (Sections 146.039-146.050 reserved for expansion
13-10 SUBCHAPTER D. HOSPICE ADVISORY COUNCIL
13-11 Sec. 146.051. DUTIES. The Hospice Advisory Council shall
13-12 consider the needs for hospice services in this state and shall
13-13 recommend for the board's consideration rules to implement
13-14 standards adopted under this chapter and other appropriate rules,
13-15 procedures, and actions regarding all matters relating to hospice
13-16 services.
13-17 Sec. 146.052. COMPOSITION. The council is composed of nine
13-18 members appointed by the director as follows:
13-19 (1) one member to represent the department;
13-20 (2) two members to represent consumers of hospice
13-21 services;
13-22 (3) one member to represent the Texas Department of
13-23 Human Services;
13-24 (4) two members to represent a statewide organization
13-25 the membership of which is primarily composed of providers of
13-26 hospice services;
13-27 (5) one member to represent private, nonprofit
14-1 providers of hospice services;
14-2 (6) one member to represent proprietary providers of
14-3 hospice services; and
14-4 (7) one member to represent a hospital-based provider
14-5 of hospice services.
14-6 Sec. 146.053. TERMS. Members of the council serve staggered
14-7 three-year terms, with the terms of three members expiring January
14-8 31 of each year.
14-9 Sec. 146.054. PRESIDING OFFICER. (a) The council shall
14-10 elect a presiding officer from among its members to preside at
14-11 meetings and to notify members of meetings.
14-12 (b) The presiding officer shall serve for one year and may
14-13 not serve in that capacity for more than two years.
14-14 Sec. 146.055. MEETINGS. The council shall meet at least
14-15 twice a year and at other times at the call of the presiding
14-16 officer, any three members of the council, or the director.
14-17 Sec. 146.056. COMPENSATION. Members of the council serve
14-18 without compensation but are entitled to reimbursement for expenses
14-19 incurred as provided by the General Appropriations Act for members
14-20 of boards of state agencies.
14-21 SECTION 2. Sections 142.001(4) and (5), Health and Safety
14-22 Code, are amended to read as follows:
14-23 (4) "Home health agency" means a place of business<,
14-24 including a hospice,> that provides a home health service. The
14-25 term does not include a person licensed under Chapter 146.
14-26 (5) "Home health service" means the provision, for pay
14-27 or other consideration, of a health service in a patient's
15-1 residence. The term does not include the provision of care under
15-2 an attendant care program administered by the Texas Department of
15-3 Human Services or the provision of hospice services by a person
15-4 licensed under Chapter 146.
15-5 SECTION 3. Sections 142.015(a) and (d), Health and Safety
15-6 Code, are amended to read as follows:
15-7 (a) The Home Health Services Advisory Council is composed of
15-8 the following nine <11> members, appointed by the governor:
15-9 (1) one representative of the department;
15-10 (2) two representatives of consumers of home health
15-11 agency <and hospice> services;
15-12 (3) one representative of the Texas Department of
15-13 Human Services;
15-14 (4) one representative of the Texas Association of
15-15 Home Health Agencies, Incorporated;
15-16 (5) one representative of private nonprofit home
15-17 health agencies;
15-18 (6) one representative of voluntary nonprofit home
15-19 health agencies;
15-20 (7) one representative of proprietary home health
15-21 agencies; and
15-22 (8) one representative of an official department home
15-23 health agency<;>
15-24 <(9) one member to represent Medicare-certified Class
15-25 A hospice providers affiliated with a home health agency, hospital,
15-26 or other health service provider; and>
15-27 <(10) one member to represent Medicare-certified Class
16-1 A hospice providers not affiliated with a home health agency,
16-2 hospital, or other health service provider>.
16-3 (d) Members of the council serve staggered two-year terms,
16-4 with the terms of five <six> members expiring on January 31 of
16-5 each even-numbered year and the terms of four <five> members
16-6 expiring on January 31 of each odd-numbered year.
16-7 SECTION 4. Section 142.021, Health and Safety Code, is
16-8 amended to read as follows:
16-9 Sec. 142.021. PERMITS TO ADMINISTER MEDICATION. A person
16-10 may not administer medication to a patient of a home health agency
16-11 or hospice unless the person:
16-12 (1) holds a license under state law that authorizes
16-13 the person to administer medication;
16-14 (2) holds a permit issued under Section 142.025 and
16-15 acts under the delegated authority of a person who holds a license
16-16 under state law that authorizes the person to administer
16-17 medication; or
16-18 (3) performs duties as a qualified dialysis technician
16-19 within the scope authorized by board rules.
16-20 SECTION 5. Section 142.023, Health and Safety Code, is
16-21 amended to read as follows:
16-22 Sec. 142.023. RULES FOR ADMINISTRATION OF MEDICATION. The
16-23 board by rule shall establish:
16-24 (1) minimum requirements for the issuance, denial,
16-25 renewal, suspension, emergency suspension, and revocation of a
16-26 permit to administer medication to a patient of a home health
16-27 agency or hospice;
17-1 (2) curricula to train persons to administer
17-2 medication to a patient of a home health agency or hospice;
17-3 (3) minimum standards for the approval of programs to
17-4 train persons to administer medication to patients of home health
17-5 agencies or hospices and for rescinding approval;
17-6 (4) the acts and practices that are allowed or
17-7 prohibited to a permit holder; and
17-8 (5) minimum standards for on-site supervision of a
17-9 permit holder by a registered nurse.
17-10 SECTION 6. Section 142.029(a), Health and Safety Code, is
17-11 amended to read as follows:
17-12 (a) A person commits an offense if the person knowingly
17-13 administers medication to a patient of a home health agency or
17-14 hospice and the person:
17-15 (1) does not hold a license under state law that
17-16 authorizes the person to administer medication; or
17-17 (2) does not hold a permit issued by the department
17-18 under Section 142.025.
17-19 SECTION 7. Section 142.030(a), Health and Safety Code, is
17-20 amended to read as follows:
17-21 (a) A person authorized by this subchapter to administer
17-22 medication to a patient of a home health agency or hospice may not
17-23 dispense dangerous drugs or controlled substances without complying
17-24 with the Texas Pharmacy Act (Article 4542a-1, Vernon's Texas Civil
17-25 Statutes).
17-26 SECTION 8. In making initial appointments to the Hospice
17-27 Advisory Council established under Chapter 146, Health and Safety
18-1 Code, as added by this Act, the director of the Texas Department of
18-2 Health shall designate three members to serve terms expiring
18-3 January 31, 1995, three members to serve terms expiring January 31,
18-4 1996, and three members to serve terms expiring January 31, 1997.
18-5 SECTION 9. A certified hospice provider holding a license on
18-6 January 1, 1994, as a hospice issued under Chapter 142, Health and
18-7 Safety Code, shall be licensed as a hospice under Chapter 146,
18-8 Health and Safety Code, as added by this Act, without payment of
18-9 any additional fee. The license expires on the same date as the
18-10 license granted under Chapter 142, Health and Safety Code. The
18-11 hospice shall provide a hospice program of care in accordance with
18-12 Chapter 146, Health and Safety Code, as added by this Act.
18-13 SECTION 10. Section 142.007, Health and Safety Code, is
18-14 repealed.
18-15 SECTION 11. The terms of the members of the Home Health
18-16 Services Advisory Council whose positions are eliminated by this
18-17 Act expire on the effective date of this Act. In making
18-18 appointments to the council for terms beginning February 1, 1994,
18-19 and February 1, 1995, the governor shall appoint the appropriate
18-20 number of members to one-year terms to satisfy the staggered-term
18-21 requirements of Section 142.015(d), Health and Safety Code, as
18-22 amended by this Act. Thereafter, members serve two-year terms.
18-23 SECTION 12. This Act takes effect January 1, 1994.
18-24 SECTION 13. The importance of this legislation and the
18-25 crowded condition of the calendars in both houses create an
18-26 emergency and an imperative public necessity that the
18-27 constitutional rule requiring bills to be read on three several
19-1 days in each house be suspended, and this rule is hereby suspended.