By Delco H.B. No. 2099 A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to the containment of health care costs and to ensuring 1-3 the quality of the delivery of health care services; creating the 1-4 Texas Health Care Cost Containment Council; making appropriations; 1-5 creating offenses and providing penalties. 1-6 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-7 ARTICLE 1 1-8 SECTION 1.01. PURPOSE. As a result of rising health care 1-9 costs and concerns expressed by consumers, businesses, health care 1-10 providers, and payors and as a result of the study completed by the 1-11 Texas Health Policy Task Force, there is an urgent need to abate 1-12 escalating costs and to address the quality of health care delivery 1-13 for all Texans. It is the purpose of this legislation to address 1-14 these concerns. 1-15 ARTICLE 2 1-16 SECTION 2.01. Subtitle E, Health and Safety Code, is amended 1-17 by adding Chapter 108 to read as follows: 1-18 CHAPTER 108. TEXAS HEALTH CARE COST 1-19 CONTAINMENT COUNCIL 1-20 Sec. 108.001. CREATION OF COUNCIL. The Texas Health Care 1-21 Cost Containment Council is created under the commission of health. 1-22 The council shall report directly to the governor, the legislature, 1-23 and the public. 2-1 Sec. 108.002. DEFINITIONS. In this chapter: 2-2 (1) "Ambulatory service facility" means a facility 2-3 licensed in Texas, not part of a hospital, which provides medical, 2-4 diagnostic, or surgical treatment to patients not requiring 2-5 hospitalization, including ambulatory surgical facilities, 2-6 ambulatory imaging or diagnostic centers, birthing centers, 2-7 freestanding emergency rooms, and any other facilities providing 2-8 ambulatory care which charge a separate facility charge. 2-9 (2) "Charge" or "rate" means the amount billed by a 2-10 provider for specific goods or services provided to a patient prior 2-11 to any adjustment for contractual allowances. 2-12 (3) "Council" means the Texas Health Care Cost 2-13 Containment Council. 2-14 (4) "Covered services" means any health care services 2-15 or procedures connected with episodes of illness that require 2-16 either inpatient hospital care or major ambulatory service such as 2-17 surgical, medical, or major radiological procedures, including any 2-18 initial and followup outpatient services associated with the 2-19 episode of illness before, during, or after inpatient hospital care 2-20 or major ambulatory service. 2-21 (5) "Data source" means a hospital, a health care 2-22 facility, an ambulatory service facility, a physician, a licensed 2-23 health care provider, or a health maintenance organization as 2-24 defined in Section 2, Texas Health Maintenance Organization Act 2-25 (Article 20A.02, Vernon's Texas Insurance Code); a hospital, 3-1 medical, retiree, or health service plan; third-party payors or 3-2 insurers providing health or accident insurance; self-insured 3-3 employers providing health or accident coverage or benefits; health 3-4 claims paid by homeowners, auto liability insurance, worker's 3-5 compensation plans, or other benefit plans; any health and benefit 3-6 plan that provides health or accident benefits or insurance 3-7 pertaining to covered service in this state; preferred provider 3-8 organizations; health and human services agencies for those covered 3-9 services they purchase or provide through the medical assistance 3-10 program under Chapter 32, Human Resources Code; and any other payor 3-11 for covered services in this state. 3-12 (6) "Health care facility" means: 3-13 (A) a general or special hospital, whether 3-14 public or private, profit or nonprofit, as defined in Chapter 241; 3-15 (B) an ambulatory surgical center as defined in 3-16 Chapter 243; 3-17 (C) a private mental hospital as defined in 3-18 Chapter 577; 3-19 (D) a chemical dependency treatment facility as 3-20 defined in Chapter 464; 3-21 (E) a rehabilitation outpatient and inpatient 3-22 center; and 3-23 (F) hemodialysis units and kidney disease 3-24 treatment centers and any other facility designated as a health 3-25 care facility under federal law. 4-1 (7) "Health care insurer" means any person, 4-2 corporation, or other entity that offers administrative, indemnity, 4-3 or payment services for health care in exchange for a premium, 4-4 fees, charge, or other consideration under a program of health care 4-5 benefits including but not limited to an insurance company, 4-6 association, stipulated premium insurance company, or exchange 4-7 issuing health insurance policies in this state; hospital and 4-8 medical services plan corporation; group hospital service 4-9 corporation; health maintenance organization; preferred provider 4-10 organization; fraternal benefit society; beneficial society; and 4-11 third-party administrator. 4-12 (8) "Health maintenance organization" means an 4-13 organization as defined in Section 2, Texas Health Maintenance 4-14 Organization Act (Article 20A.02, Vernon's Texas Insurance Code). 4-15 (9) "High technology diagnostic or treatment center" 4-16 means a health treatment center that utilizes high technology 4-17 equipment including but not limited to magnetic resonance imaging 4-18 devices, lithotriptors, kidney dialysis machines, and appropriate 4-19 equipment for providing chemotherapy or radiation treatment. 4-20 (10) "Hospital" means an institution licensed in this 4-21 state which is a general or special hospital, private mental, 4-22 chronic disease, or other type of hospital or a substance abuse, 4-23 rehabilitation, radiation, chemotheraphy, or kidney disease 4-24 treatment center, whether profit or nonprofit, and including those 4-25 operated by an agency of state or local government. 5-1 (11) "Indigent care" means the actual costs, as 5-2 determined by the council, for the provision of appropriate health 5-3 care, on an inpatient or outpatient basis, given to individuals who 5-4 cannot pay for their care because they are above the medical 5-5 assistance eligibility levels and have no health insurance or other 5-6 financial resources which can cover their health care. 5-7 (12) "Major ambulatory surgical center" means a 5-8 facility engaged in surgical or medical procedures, including 5-9 diagnostic and therapeutic radiological procedures, commonly 5-10 performed in hospitals or ambulatory service facilities, which are 5-11 not of a type commonly performed or which cannot be safely 5-12 performed in physicians' offices and which require special 5-13 facilities such as operating rooms or suites or special equipment 5-14 such as fluoroscopic equipment or computed tomographic scanners or 5-15 a postprocedure recovery room or short-term convalescent room. 5-16 (13) "Medically indigent" or "indigent" means the 5-17 status of a person as described in the definition of indigent care. 5-18 (14) "Patient identification number" means that number 5-19 composed of numeric, alpha, or alphanumeric characters which has 5-20 been assigned by a third-party payor to identify a policyholder, 5-21 member, or subscriber. 5-22 (15) "Payment" means the payments that providers 5-23 actually accept for their services, exclusive of charity care, 5-24 rather than the charges they bill. 5-25 (16) "Payor" means any person or entity including but 6-1 not limited to health care insurers and purchasers that make direct 6-2 payments to providers for covered services. 6-3 (17) "Physician" means an individual licensed under 6-4 the laws of this state to practice medicine and surgery within the 6-5 scope of the Medical Practice Act (Article 4495b, Vernon's Texas 6-6 Civil Statutes). 6-7 (18) "Preferred provider organization" means any 6-8 arrangement between a health care insurer and providers of health 6-9 care services which specifies rates of payment to such providers 6-10 which differ from their usual and customary charges to the general 6-11 public and which encourage enrollees to receive health services 6-12 from such providers. 6-13 (19) "Provider" means a hospital, a physician, or any 6-14 licensed or certified health care provider. 6-15 (20) "Provider quality" means the extent to which a 6-16 provider renders care that, within the capabilities of modern 6-17 medicine, obtains for patients medically acceptable health outcomes 6-18 and prognoses, adjusted for patient severity, and treats patients 6-19 compassionately and responsively. 6-20 (21) "Provider service effectiveness" means the 6-21 effectiveness of services rendered by a provider, determined by 6-22 measurement of the medical outcome of patients, grouped by 6-23 severity, receiving those services. 6-24 (22) "Purchaser" means a corporation, labor 6-25 organization, and any other entity that purchases benefits which 7-1 provide covered services for their employees or members. 7-2 (23) "Raw data" or "data" means data collected by the 7-3 council under Section 108.009 in the form initially received. 7-4 (24) "Severity" means in any patient, the measurable 7-5 degree of the potential for failure of one or more vital organs. 7-6 Sec. 108.003. COUNCIL COMPOSITION AND VOTING. (a) The 7-7 council is composed of three nonvoting ex officio state agency 7-8 members and nine voting members appointed by the governor and 7-9 confirmed by the senate as follows: 7-10 (1) the commissioner of health; 7-11 (2) the commissioner of health and human services; 7-12 (3) an insurance board member or the commissioner of 7-13 insurance; 7-14 (4) two representatives of the business community, 7-15 with at least one representing small business, who are purchasers 7-16 of health care but who are not involved in the provision of health 7-17 care or health insurance; 7-18 (5) one representative from labor who is not involved 7-19 in the provision of health care or health insurance; 7-20 (6) two consumer representatives who are not involved 7-21 in the provision of health care or health insurance; 7-22 (7) one representative of the commercial insurance 7-23 carriers; 7-24 (8) two representatives of the health care provider 7-25 community; and 8-1 (9) one expert in health cost data management who is 8-2 not primarily involved in the provision of health care. 8-3 (b) The chair shall be appointed by the governor and serves 8-4 at the pleasure of the governor. Members shall annually elect a 8-5 vice-chair of the council from among the business, labor, and 8-6 consumer representatives on the council. 8-7 (c) Six voting members constitute a quorum for the 8-8 transaction of any business, and an act by the majority of the 8-9 voting members present at any meeting in which there is a quorum 8-10 shall be deemed to be an act of the council. 8-11 (d) The council shall adopt bylaws not inconsistent with 8-12 this chapter and may appoint such committees or elect such officers 8-13 subordinate to those provided for in Subsection (b) as it deems 8-14 advisable. 8-15 (e) The members of the council shall not receive a salary or 8-16 per diem allowance for serving as members of the council but shall 8-17 be reimbursed for actual and necessary expenses incurred in the 8-18 performance of their duties. The expenses may include 8-19 reimbursement of travel and living expenses while engaged in 8-20 council business. 8-21 Sec. 108.004. MEETINGS. (a) The council is subject to the 8-22 opening meetings law, Chapter 271, Acts of the 60th Legislature, 8-23 Regular Session, 1967 (Article 6252-17, Vernon's Texas Civil 8-24 Statutes). 8-25 (b) The council shall meet as often as necessary to perform 9-1 its duties under this chapter. 9-2 (c) The council shall also publish a notice of its meetings 9-3 in at least four newspapers in general circulation in the state. 9-4 Sec. 108.005. TERMS. (a) The terms of the agency members 9-5 are concurrent with their terms of office. The nine appointed 9-6 council members serve six-year terms and continue to serve until 9-7 their successors are appointed and qualify, except that, of the 9-8 members first appointed: 9-9 (1) one representative of business, one consumer 9-10 representative, and one representative of the health provider 9-11 community serve terms to expire two years from the date of initial 9-12 appointment; 9-13 (2) the representative from labor, the representative 9-14 of the commercial insurance carriers, and the expert in health cost 9-15 data management serve terms to expire four years from the date of 9-16 initial appointment; and 9-17 (3) one representative of business, one consumer 9-18 representative, and one representative of the health provider 9-19 community serve terms to expire six years from the date of initial 9-20 appointment. 9-21 (b) No appointed member shall be eligible to serve more than 9-22 two full consecutive terms of six years. 9-23 (c) A member may be removed by the appointing authority for 9-24 absence from one-half or more of the scheduled meetings in a year. 9-25 A member may be removed for just cause by the appointing authority 10-1 after recommendation by a vote of at least two-thirds of the 10-2 members of the council. 10-3 Sec. 108.006. POWERS AND DUTIES OF THE COUNCIL. (a) The 10-4 council shall protect patient confidentiality and exercise all 10-5 powers necessary and appropriate to carry out its duties. 10-6 (b) The council shall employ an executive director, legal 10-7 counsel, investigators, and other staff necessary to comply with 10-8 the provisions of this chapter and regulations promulgated 10-9 hereunder and engage professional consultants as it deems necessary 10-10 to the performance of its duties. 10-11 (c) The council shall promulgate rules and regulations 10-12 necessary to carry out its duties under this chapter. 10-13 Sec. 108.007. REVIEW POWERS. The council or the council's 10-14 representative may make any inspection of all documents and 10-15 records, used by data sources, required for purposes of compiling 10-16 data and reports. The council may compel providers to produce 10-17 accurate documents and records. 10-18 Sec. 108.008. AUTHORIZATION TO PERFORM CERTAIN DUTIES AND 10-19 FUNCTIONS. (a) The council shall develop a computerized system 10-20 for the collection, analysis, and dissemination of data. 10-21 (b) The council shall prescribe a Texas Uniform Claims and 10-22 Billing Form for all data sources and all providers which shall be 10-23 utilized and maintained by all data sources and all providers for 10-24 all services covered under this chapter. 10-25 (c) The council shall adopt and implement a methodology and 11-1 collect and disseminate data reflecting provider quality and 11-2 provider service effectiveness. 11-3 (d) The council shall make reports to the legislature and 11-4 the governor on the rate of increase in the cost of health care in 11-5 the state and the effectiveness of the council in carrying out the 11-6 legislative intent of this chapter. In addition, the council may 11-7 make recommendations on the need for further health care cost 11-8 containment legislation. The council shall also make annual 11-9 reports on the quality and effectiveness of health care and access 11-10 to health care for all citizens of the state. 11-11 (e) The council shall adopt, within 180 days following 11-12 commencement of its operations as part of the Texas Uniform Claims 11-13 and Billing Form for covered services pursuant to Subsection (b) 11-14 and Section 108.009(b) a standard billing form for all providers, 11-15 which shall include, in addition to information required pursuant 11-16 to Section 108.009(c), such other information and explanations as 11-17 the council deems necessary and which itemizes all charges for 11-18 services, equipment, supplies, and medicine. Each provider shall 11-19 be required to utilize the standard billing form for covered 11-20 services within 90 days of adoption of the form by the council. 11-21 Such itemized billings shall be written in language that is 11-22 understandable to the average person and be presented to each 11-23 patient on discharge from a health care facility or provision of 11-24 physician services or within a reasonable time thereafter. 11-25 Sec. 108.009. DATA SUBMISSION AND COLLECTION. (a) The 12-1 council is authorized to collect and data sources are required to 12-2 submit on request of the council all data required in this section, 12-3 according to uniform submission formats, coding systems, and other 12-4 technical specifications necessary to render the incoming data 12-5 substantially valid, consistent, compatible, and manageable using 12-6 electronic data processing. 12-7 (b) The council shall furnish the uniform claims and billing 12-8 form format to all data sources, and the claims and billing form 12-9 shall be utilized and maintained by all data sources for all 12-10 services covered by this chapter. The Texas Uniform Claims and 12-11 Billing Form shall consist of the Uniform Hospital Billing Form 12-12 UB-82/HCFA-1450 and the HCFA-1500, or their successors, as 12-13 developed by the National Uniform Billing Committee, with 12-14 additional fields as necessary to provide all of the data set forth 12-15 in Subsections (c) and (d). 12-16 (c) For each covered service performed, the council shall be 12-17 required to collect a hospital, major ambulatory service, or health 12-18 care facility discharge data record which includes all the 12-19 following: 12-20 (1) uniform patient identifier, continuous across 12-21 multiple episodes and providers; 12-22 (2) patient's date of birth; 12-23 (3) patient's sex; 12-24 (4) patient's race and ethnicity; 12-25 (5) patient's marital status; 13-1 (6) ZIP Code number of patient's primary residence; 13-2 (7) date of admission; 13-3 (8) source of admission; 13-4 (9) type of admission; 13-5 (10) date of discharge; 13-6 (11) principal and up to four secondary diagnoses by 13-7 standard code; 13-8 (12) principal procedure by council-specified standard 13-9 code and date; 13-10 (13) up to three secondary procedures by 13-11 council-specified standard codes and dates; 13-12 (14) uniform health care facility identifier, 13-13 continuous across episodes, patients, and providers; 13-14 (15) uniform identifier of admitting physician, by 13-15 unique physician identification number established by the council, 13-16 continuous across episodes, patients, and providers; 13-17 (16) uniform identifier of consulting physicians, by 13-18 unique physician identification number established by the council, 13-19 continuous across episodes, patients, and providers; 13-20 (17) total charges of the health care facility, 13-21 segregated into major categories, including but not limited to room 13-22 and board, radiology, laboratory, operating room, drugs, medical 13-23 supplies, and other goods and services according to guidelines 13-24 specified by the council; 13-25 (18) actual payments to the health care facility, 14-1 segregated, if available, according to the categories specified in 14-2 Subdivision (17); 14-3 (19) charges of each physician or licensed provider 14-4 rendering service relating to an incident of hospitalization or 14-5 treatment in an ambulatory service facility; 14-6 (20) actual payments to each physician or licensed 14-7 provider rendering service pursuant to Subdivision (19); 14-8 (21) uniform identifier of primary payor; 14-9 (22) ZIP Code number of facility where health care 14-10 service is rendered; 14-11 (23) Medicaid provider number; 14-12 (24) indigent status; 14-13 (25) county of residence of patient; 14-14 (26) deductible; 14-15 (27) co-insurance amount; 14-16 (28) uniform identifier for payor group contract 14-17 number; 14-18 (29) patient discharge status; and 14-19 (30) data elements listed in Chapter 311. 14-20 (d) In carrying out its duty to collect data on provider 14-21 quality and provider service effectiveness under Section 14-22 108.008(c), the council shall define a methodology to measure 14-23 provider service effectiveness which may include additional data 14-24 elements to be specified by the council sufficient to carry out its 14-25 responsibilities under Section 108.008(c). The council may adopt a 15-1 nationally recognized methodology of quantifying and collecting 15-2 data on provider quality and provider service effectiveness. The 15-3 council shall include in the Texas Uniform Claims and Billing Form 15-4 a field consisting of the data elements required to provide 15-5 information on each provision of covered services sufficient to 15-6 permit analysis of provider quality and provider service 15-7 effectiveness within 180 days of commencement of its operations. 15-8 (e) Except as otherwise provided by law, all licensed and 15-9 certified providers are required to submit and the council is 15-10 authorized to collect, in accordance with submission dates and 15-11 schedules established by the council, the following additional 15-12 data, provided such data are not available to the council from 15-13 public records: 15-14 (1) audited annual financial reports of all hospitals 15-15 and health care facilities or entities providing covered services 15-16 as defined in Section 108.002; 15-17 (2) the Medicare cost report (OMB Form 2552 or 15-18 equivalent federal form) or the AG-12 form for Medical Assistance 15-19 or successor forms, whether completed or partially completed and 15-20 including the settled Medicare cost report and the certified AG-12 15-21 form; 15-22 (3) additional data, including but not limited to data 15-23 which can be used to provide the following information: 15-24 (A) the incidence of medical and surgical 15-25 procedures in the population for individual providers; 16-1 (B) status of licensure and accreditation of 16-2 hospitals and ambulatory service facilities; 16-3 (C) mortality rates for specified diagnoses and 16-4 treatments, grouped by severity, for individual providers; 16-5 (D) rates of infection for specified diagnoses 16-6 and treatments, grouped by severity, for individual providers; 16-7 (E) morbidity rates for specified diagnoses and 16-8 treatments, grouped by severity, for individual providers; 16-9 (F) readmission rates for specified diagnoses 16-10 and treatments, grouped by severity, for individual providers; and 16-11 (G) rate of incidence of postdischarge provider 16-12 care for selected diagnoses and procedures, grouped by severity, 16-13 for individual providers; and 16-14 (4) any other data the council requires to carry out 16-15 its responsibilities pursuant to Section 108.008(c). 16-16 Sec. 108.010. DATA DISSEMINATION AND PUBLICATION. 16-17 (a) Subject to the restrictions on access to council data 16-18 established under Section 108.012 and utilizing the data collected 16-19 under Section 108.009 as well as other data, records, and matters 16-20 of record available to it, the council shall prepare and issue 16-21 reports to the legislature and to the general public, according to 16-22 the provisions of this section. 16-23 (b) The council shall, for every provider within the state 16-24 and within appropriate regions and subregions within the state and 16-25 for those inpatient and outpatient services which, when ranked by 17-1 order of frequency, account for at least 75 percent of all covered 17-2 services and which, when ranked by order of total payments, account 17-3 for at least 75 percent of total payments, prepare and issue 17-4 quarterly reports that at least provide information on the 17-5 following: 17-6 (1) comparisons among all providers of payments 17-7 received, charges, population-based admission or incidence rates, 17-8 and provider service effectiveness, such comparisons to be grouped 17-9 according to diagnosis and severity and to identify each provider 17-10 by name and type or specialty; 17-11 (2) comparisons among all providers of inpatient and 17-12 outpatient charges and payments for room and board, ancillary 17-13 services, drugs, equipment and supplies, and total services, such 17-14 comparisons to be grouped according to provider quality and 17-15 provider service effectiveness and according to diagnosis and 17-16 severity and to identify each health care facility by name and 17-17 type; 17-18 (3) the incidence rate of selected medical or surgical 17-19 procedures, the provider service effectiveness, and the payments 17-20 received for those providers, identified by the name and type or 17-21 specialty, for which these elements vary significantly from the 17-22 norms for all providers; and 17-23 (4) until and unless a methodology to measure provider 17-24 quality and provider service effectiveness pursuant to Sections 17-25 108.008(c) and 108.009(c) and (d) is available to the council, 18-1 comparisons among all providers, grouped according to diagnosis, 18-2 procedure, and severity, which identify facilities by name and type 18-3 and physicians by name and specialty, of charges and payments 18-4 received, readmission rates, mortality rates, morbidity rates, and 18-5 infection rates. Following adoption of the methodology specified 18-6 in Sections 108.008(c) and 108.009(c) and (d), the council may, at 18-7 its discretion, discontinue publication of this component of the 18-8 report. 18-9 Sec. 108.011. RAW DATA REPORTS AND COMPUTER ACCESS TO 18-10 COUNCIL DATA. The council shall provide special reports derived 18-11 from raw data and a means for computer-to-computer access to its 18-12 raw data to any purchaser, pursuant to Section 108.013. The 18-13 council shall provide such reports and computer-to-computer access, 18-14 at its discretion, to other parties requesting it. The council may 18-15 charge fees to parties requesting data to offset the costs of 18-16 production of the data. 18-17 Sec. 108.012. GENERAL ACCESS TO COUNCIL DATA. (a) The 18-18 information and data received by the council shall be utilized by 18-19 the council for the benefit of the public. Subject to specific 18-20 limitations the council by rule establishes, the council shall make 18-21 determinations on requests for information in favor of access. 18-22 (b) Any person who knowingly releases council data violating 18-23 the patient confidentiality, actual payments, discount data, or 18-24 raw data safeguards established by the council to an unauthorized 18-25 person commits an offense. An unauthorized person who knowingly 19-1 receives or possesses such data commits an offense. An offense 19-2 under this subsection is punishable on conviction by a fine of 19-3 $10,000 or imprisonment for not more than five years, or both such 19-4 fine and imprisonment. 19-5 Sec. 108.013. ACCESS TO RAW COUNCIL DATA BY PURCHASERS. 19-6 (a) The council shall provide access to its raw data to 19-7 purchasers. 19-8 (b) A means to enable computer-to-computer access by any 19-9 purchaser to raw data of the council shall be developed, adopted, 19-10 and implemented by the council. 19-11 Sec. 108.014. ENFORCEMENT; PENALTY. (a) The attorney 19-12 general at the request of the council, shall administer and enforce 19-13 this chapter. 19-14 (b) Any person who fails to supply data pursuant to Section 19-15 108.009 commits an offense. An offense under this section is 19-16 punishable on conviction by a fine of $25,000 or imprisonment for 19-17 not more than five years, or both such fine and imprisonment. 19-18 (c) Failure to report on each prescribed deadline is a 19-19 separate offense and subject to penalty. 19-20 ARTICLE 3 19-21 SECTION 3.01. (a) The Texas Health Care Cost Containment 19-22 Council may accept gifts, grants, money, and contributions from any 19-23 public or private source to perform its duties under this Act. 19-24 (b) For the fiscal year ending August 31, 1994, the sum of 19-25 $2 million is appropriated from the designated account in the 20-1 general revenue fund to the Texas Health Care Cost Containment 20-2 Council to carry out its duties under this Act. Available funds 20-3 from the designated account or other gifts, grants, money, or 20-4 contributions over $2 million shall also be appropriated for the 20-5 purposes of the council. 20-6 (c) For the fiscal year ending August 31, 1995, the sum of 20-7 $2 million is appropriated from the designated account in the 20-8 general revenue fund to the Texas Health Care Cost Containment 20-9 Council to carry out its duties under this Act. Available funds 20-10 from the designated account or other gifts, grants, money, or 20-11 contributions over $2 million shall also be appropriated for the 20-12 purposes of the council. 20-13 SECTION 3.02. (a) Appointments to the Texas Health Care 20-14 Cost Containment Council shall be made by the governor as soon as 20-15 practicable after the effective date of this Act. 20-16 (b) The Texas Health Care Cost Containment Council shall 20-17 begin operations immediately following the making of the 20-18 appointments required by Subsection (a) of this section. 20-19 SECTION 3.03. This Act takes effect September 1, 1993. 20-20 SECTION 3.04. The importance of this legislation and the 20-21 crowded condition of the calendars in both houses create an 20-22 emergency and an imperative public necessity that the 20-23 constitutional rule requiring bills to be read on three several 20-24 days in each house be suspended, and this rule is hereby suspended.