1-1                                   AN ACT
 1-2     relating to the administration and operation of the state Medicaid
 1-3     program.
 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-5           SECTION 1.  Subchapter B, Chapter 12, Health and Safety Code,
 1-6     is amended by adding Section 12.0123 to read as follows:
 1-7           Sec. 12.0123.  EXTERNAL AUDITS OF CERTAIN MEDICAID
 1-8     CONTRACTORS.  (a)  In this section, "Medicaid contractor" means an
 1-9     entity that:
1-10                 (1)  is not a health and human services agency as
1-11     defined by Section 531.001, Government Code; and
1-12                 (2)  under contract with or otherwise on behalf of the
1-13     department, performs one or more administrative services in
1-14     relation to the department's operation of a part of the state
1-15     Medicaid program, such as claims processing, utilization review,
1-16     client enrollment, provider enrollment, quality monitoring, or
1-17     payment of claims.
1-18           (b)  The department shall contract with an independent
1-19     auditor to perform annual independent external financial and
1-20     performance audits of any Medicaid contractor used by the
1-21     department in the department's operation of a part of the state
1-22     Medicaid program.
1-23           (c)  The department shall ensure that audit procedures
1-24     related to financial audits and performance audits are used
 2-1     consistently in audits under this section.
 2-2           (d)  An audit required by this section must be completed
 2-3     before the end of the fiscal year immediately following the fiscal
 2-4     year for which the audit is performed.
 2-5           SECTION 2.  Section 533.003, Government Code, is amended to
 2-6     read as follows:
 2-7           Sec. 533.003.  CONSIDERATIONS IN AWARDING CONTRACTS.  In
 2-8     awarding contracts to managed care organizations, the commission
 2-9     shall:
2-10                 (1)  give preference to organizations that have
2-11     significant participation in the organization's provider network
2-12     from each health care provider in the region who has traditionally
2-13     provided care to Medicaid and charity care patients;
2-14                 (2)  give extra consideration to organizations that
2-15     agree to assure continuity of care for at least three months beyond
2-16     the period of Medicaid eligibility for recipients; [and]
2-17                 (3)  consider the need to use different managed care
2-18     plans to meet the needs of different populations; and
2-19                 (4)  consider the ability of organizations to process
2-20     Medicaid claims electronically.
2-21           SECTION 3.  Section 533.004, Government Code, is amended by
2-22     amending Subsection (a) and adding Subsection (e) to read as
2-23     follows:
2-24           (a)  In providing health care services through Medicaid
2-25     managed care to recipients in a health care service region, the
2-26     commission shall contract with a [at least one] managed care
2-27     organization in that region that is licensed under the Texas Health
 3-1     Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
 3-2     Code) to provide health care in that region and that is:
 3-3                 (1)  wholly owned and operated by a hospital district
 3-4     in that region;
 3-5                 (2)  created by a nonprofit corporation that:
 3-6                       (A)  has a contract, agreement, or other
 3-7     arrangement with a hospital district in that region or with a
 3-8     municipality in that region that owns a hospital licensed under
 3-9     Chapter 241, Health and Safety Code, and has an obligation to
3-10     provide health care to indigent patients; and
3-11                       (B)  under the contract, agreement, or other
3-12     arrangement, assumes the obligation to provide health care to
3-13     indigent patients and leases, manages, or operates a hospital
3-14     facility owned by the hospital district or municipality; or
3-15                 (3)  created by a nonprofit corporation that has a
3-16     contract, agreement, or other arrangement with a hospital district
3-17     in that region under which the nonprofit corporation acts as an
3-18     agent of the district and assumes the district's obligation to
3-19     arrange for services under the Medicaid expansion for children as
3-20     authorized by Chapter 444, Acts of the 74th Legislature, Regular
3-21     Session, 1995.
3-22           (e)  In providing health care services through Medicaid
3-23     managed care to recipients in a health care service region, with
3-24     the exception of the Harris service area for the STAR Medicaid
3-25     managed care program, as defined by the commission as of September
3-26     1, 1999, the commission shall also contract with a managed care
3-27     organization in that region that holds a certificate of authority
 4-1     as a health maintenance organization under Section 5, Texas Health
 4-2     Maintenance Organization Act (Article 20A.05, Vernon's Texas
 4-3     Insurance Code), and that:
 4-4                 (1)  is certified under Section 5.01(a), Medical
 4-5     Practice Act (Article 4495b, Vernon's Texas Civil Statutes);
 4-6                 (2)  is created by The University of Texas Medical
 4-7     Branch at Galveston; and
 4-8                 (3)  has obtained a certificate of authority as a
 4-9     health maintenance organization to serve one or more counties in
4-10     that region from the Texas Department of Insurance before September
4-11     2, 1999.
4-12           SECTION 4.  Section 533.005, Government Code, is amended to
4-13     read as follows:
4-14           Sec. 533.005.  REQUIRED CONTRACT PROVISIONS.  A contract
4-15     between a managed care organization and the commission for the
4-16     organization to provide health care services to recipients must
4-17     contain:
4-18                 (1)  procedures to ensure accountability to the state
4-19     for the provision of health care services, including procedures for
4-20     financial reporting, quality assurance, utilization review, and
4-21     assurance of contract and subcontract compliance;
4-22                 (2)  capitation and provider payment rates that ensure
4-23     the cost-effective provision of quality health care;
4-24                 (3)  a requirement that the managed care organization
4-25     provide ready access to a person who assists recipients in
4-26     resolving issues relating to enrollment, plan administration,
4-27     education and training, access to services, and grievance
 5-1     procedures;
 5-2                 (4)  a requirement that the managed care organization
 5-3     provide ready access to a person who assists providers in resolving
 5-4     issues relating to payment, plan administration, education and
 5-5     training, and grievance procedures;
 5-6                 (5)  a requirement that the managed care organization
 5-7     provide information and referral about the availability of
 5-8     educational, social, and other community services that could
 5-9     benefit a recipient;
5-10                 (6)  procedures for recipient outreach and education;
5-11                 (7)  a requirement that the managed care organization
5-12     make payment to a physician or provider for health care services
5-13     rendered to a recipient under a managed care plan not later than
5-14     the 45th day after the date a claim for payment is received with
5-15     documentation reasonably necessary for the managed care
5-16     organization to process the claim, or within a period, not to
5-17     exceed 60 days, specified by a written agreement between the
5-18     physician or provider and the managed care organization;
5-19                 (8)  a requirement that the commission, on the date of
5-20     a recipient's enrollment in a managed care plan issued by the
5-21     managed care organization, inform the organization of the
5-22     recipient's Medicaid certification [recertification] date; and
5-23                 (9)  a requirement that the managed care organization
5-24     comply with Section 533.006 as a condition of contract retention
5-25     and renewal.
5-26           SECTION 5.  Section 533.006(a), Government Code, is amended
5-27     to read as follows:
 6-1           (a)  The commission shall require that each managed care
 6-2     organization that contracts with the commission to provide health
 6-3     care services to recipients in a region:
 6-4                 (1)  seek participation in the organization's provider
 6-5     network from:
 6-6                       (A)  each health care provider in the region who
 6-7     has traditionally provided care to Medicaid recipients; [and]
 6-8                       (B)  each hospital in the region that has been
 6-9     designated as a disproportionate share hospital under the state
6-10     Medicaid program; and
6-11                       (C)  each specialized pediatric laboratory in the
6-12     region, including those laboratories located in children's
6-13     hospitals; and
6-14                 (2)  include in its provider network for not less than
6-15     three years:
6-16                       (A)  each health care provider in the region who:
6-17                             (i)  previously provided care to Medicaid
6-18     and charity care recipients at a significant level as prescribed by
6-19     the commission;
6-20                             (ii)  agrees to accept the prevailing
6-21     provider contract rate of the managed care organization; and
6-22                             (iii)  has the credentials required by the
6-23     managed care organization, provided that lack of board
6-24     certification or accreditation by the Joint Commission on
6-25     Accreditation of Healthcare Organizations may not be the sole
6-26     ground for exclusion from the provider network;
6-27                       (B)  each accredited primary care residency
 7-1     program in the region; and
 7-2                       (C)  each disproportionate share hospital
 7-3     designated by the commission as a statewide significant traditional
 7-4     provider.
 7-5           SECTION 6.  Section 533.007(e), Government Code, is amended
 7-6     to read as follows:
 7-7           (e)  The commission shall conduct a compliance and readiness
 7-8     review of each managed care organization that contracts with the
 7-9     commission not later than the 15th day before the date on which the
7-10     commission plans to begin the enrollment process in a region and
7-11     again not later than the 15th day before the date on which the
7-12     commission plans to begin to provide health care services to
7-13     recipients in that region through managed care.  The review must
7-14     include an on-site inspection and tests of service authorization
7-15     and claims payment systems, including the ability of the managed
7-16     care organization to process claims electronically, complaint
7-17     processing systems, and any other process or system required by the
7-18     contract.
7-19           SECTION 7.  Section 533.0075, Government Code, is amended to
7-20     read as follows:
7-21           Sec. 533.0075.  RECIPIENT ENROLLMENT.  The commission shall:
7-22                 (1)  encourage recipients to choose appropriate managed
7-23     care plans and primary health care providers by:
7-24                       (A)  providing initial information to recipients
7-25     and providers in a region about the need for recipients to choose
7-26     plans and providers not later than the 90th day before the date on
7-27     which the commission plans to begin to provide health care services
 8-1     to recipients in that region through managed care;
 8-2                       (B)  providing follow-up information before
 8-3     assignment of plans and providers and after assignment, if
 8-4     necessary, to recipients who delay in choosing plans and providers;
 8-5     and
 8-6                       (C)  allowing plans and providers to provide
 8-7     information to recipients or engage in marketing activities under
 8-8     marketing guidelines established by the commission under Section
 8-9     533.008 after the commission approves the information or
8-10     activities;
8-11                 (2)  consider the following factors in assigning
8-12     managed care plans and primary health care providers to recipients
8-13     who fail to choose plans and providers:
8-14                       (A)  the importance of maintaining existing
8-15     provider-patient and physician-patient relationships, including
8-16     relationships with specialists, public health clinics, and
8-17     community health centers;
8-18                       (B)  to the extent possible, the need to assign
8-19     family members to the same providers and plans; and
8-20                       (C)  geographic convenience of plans and
8-21     providers for recipients; [and]
8-22                 (3)  retain responsibility for enrollment and
8-23     disenrollment of recipients in managed care plans, except that the
8-24     commission may delegate the responsibility to an independent
8-25     contractor who receives no form of payment from, and has no
8-26     financial ties to, any managed care organization;
8-27                 (4)  develop and implement an expedited process for
 9-1     determining eligibility for and enrolling pregnant women and
 9-2     newborn infants in managed care plans;
 9-3                 (5)  ensure immediate access to prenatal services and
 9-4     newborn care for pregnant women and newborn infants enrolled in
 9-5     managed care plans, including ensuring that a pregnant woman may
 9-6     obtain an appointment with an obstetrical care provider for an
 9-7     initial maternity evaluation not later than the 30th day after the
 9-8     date the woman applies for Medicaid; and
 9-9                 (6)  temporarily assign Medicaid-eligible newborn
9-10     infants to the traditional fee-for-service component of the state
9-11     Medicaid program for a period not to exceed the earlier of:
9-12                       (A)  60 days; or
9-13                       (B)  the date on which the Texas Department of
9-14     Human Services has completed the newborn's Medicaid eligibility
9-15     determination, including assignment of the newborn's Medicaid
9-16     eligibility number.
9-17           SECTION 8.  Subchapter A, Chapter 533, Government Code, is
9-18     amended by adding Sections 533.012-533.015 to read as follows:
9-19           Sec. 533.012.  MORATORIUM ON IMPLEMENTATION OF CERTAIN PILOT
9-20     PROGRAMS; REVIEW; REPORT.  (a)   Notwithstanding any other law, the
9-21     commission may not implement Medicaid managed care pilot programs,
9-22     Medicaid behavioral health pilot programs, or Medicaid Star + Plus
9-23     pilot programs in a region for which the commission has not:
9-24                 (1)  received a bid from a managed care organization to
9-25     provide health care services to recipients in the region through a
9-26     managed care plan; or
9-27                 (2)  entered into a contract with a managed care
 10-1    organization to provide health care services to recipients in the
 10-2    region through a managed care plan.
 10-3          (b)  The commission shall:
 10-4                (1)  review any outstanding administrative and
 10-5    financial issues with respect to Medicaid managed care pilot
 10-6    programs, Medicaid behavioral health pilot programs, and Medicaid
 10-7    Star + Plus pilot programs implemented in health care service
 10-8    regions;
 10-9                (2)  review the impact of the Medicaid managed care
10-10    delivery system, including managed care organizations, prepaid
10-11    health plans, and primary care case management, on:
10-12                      (A)  physical access and program-related access
10-13    to appropriate services by recipients, including recipients who
10-14    have special health care needs;
10-15                      (B)  quality of health care delivery and patient
10-16    outcomes;
10-17                      (C)  utilization patterns of recipients;
10-18                      (D)  statewide Medicaid costs;
10-19                      (E)  coordination of care and care coordination
10-20    in Medicaid Star + Plus pilot programs;
10-21                      (F)  the level of administrative complexity for
10-22    providers, recipients, and managed care organizations;
10-23                      (G)  public hospitals, medical schools, and other
10-24    traditional providers of indigent health care; and
10-25                      (H)  competition in the marketplace and network
10-26    retention; and
10-27                (3)  evaluate the feasibility of developing a separate
 11-1    reimbursement methodology for public hospitals under a Medicaid
 11-2    managed care delivery system.
 11-3          (c)  In performing its duties and functions under Subsection
 11-4    (b), the commission shall seek input from the state Medicaid
 11-5    managed care advisory committee created under Subchapter C.  The
 11-6    commission may coordinate the review required under Subsection (b)
 11-7    with any other study or review the commission is required to
 11-8    complete.
 11-9          (d)  Notwithstanding Subsection (a), the commission may
11-10    implement Medicaid managed care pilot programs, Medicaid behavioral
11-11    health pilot programs, and Medicaid Star + Plus pilot programs in a
11-12    region described by that subsection if the commission finds that:
11-13                (1)  outstanding administrative and financial issues
11-14    with respect to the implementation of those programs in health care
11-15    service regions have been resolved; and
11-16                (2)  implementation of those programs in a region
11-17    described by Subsection (a) would benefit both recipients and
11-18    providers.
11-19          (e)  Not later than November 1, 2000, the commission shall
11-20    submit a report to the governor and the legislature that:
11-21                (1)  states whether the outstanding administrative and
11-22    financial issues with respect to the pilot programs described by
11-23    Subsection (b)(1) have been sufficiently resolved;
11-24                (2)  summarizes the findings of the review conducted
11-25    under Subsection (b);
11-26                (3)  recommends which elements of the Medicaid managed
11-27    care delivery system should be applied to the traditional
 12-1    fee-for-service component of the state Medicaid program to achieve
 12-2    the goals specified in Section 533.002(1); and
 12-3                (4)  recommends whether Medicaid managed care pilot
 12-4    programs, Medicaid behavioral health pilot programs, or Medicaid
 12-5    Star + Plus pilot programs should be implemented in health care
 12-6    service regions described by Subsection (a).
 12-7          (f)  To the extent practicable, this section may not be
 12-8    construed to affect the duty of the commission to plan the
 12-9    continued expansion of Medicaid managed care pilot programs,
12-10    Medicaid behavioral health pilot programs, and Medicaid Star + Plus
12-11    pilot programs in health care service regions described by
12-12    Subsection (a)  after July 1, 2001.
12-13          (g)  Notwithstanding any other law, the commission may not
12-14    use federal medical assistance funds to implement any long-term
12-15    care integrated network pilot studies.
12-16          (h)  This section expires July 1, 2001.
12-17          Sec. 533.013.  PREMIUM PAYMENT RATE DETERMINATION; REVIEW AND
12-18    COMMENT.  (a)  In determining premium payment rates paid to a
12-19    managed care organization under a managed care plan, the commission
12-20    shall consider:
12-21                (1)  the regional variation in costs of health care
12-22    services;
12-23                (2)  the range and type of health care services to be
12-24    covered by premium payment rates;
12-25                (3)  the number of managed care plans in a region;
12-26                (4)  the current and projected number of recipients in
12-27    each region, including the current and projected number for each
 13-1    category of recipient;
 13-2                (5)  the ability of the managed care plan to meet costs
 13-3    of operation under the proposed premium payment rates;
 13-4                (6)  the applicable requirements of the federal
 13-5    Balanced Budget Act of 1997 and implementing regulations that
 13-6    require adequacy of premium payments to managed care organizations
 13-7    participating in the state Medicaid program;
 13-8                (7)  the adequacy of the management fee paid for
 13-9    assisting enrollees of Supplemental Security Income (SSI) (42
13-10    U.S.C. Section 1381 et seq.) who are voluntarily enrolled in the
13-11    managed care plan;
13-12                (8)  the impact of reducing premium payment rates for
13-13    the category of recipients who are pregnant; and
13-14                (9)  the ability of the managed care plan to pay under
13-15    the proposed premium payment rates inpatient and outpatient
13-16    hospital provider payment rates that are comparable to the
13-17    inpatient and outpatient hospital provider payment rates paid by
13-18    the commission under a primary care case management model or a
13-19    partially capitated model.
13-20          (b)  In determining the maximum premium payment rates paid to
13-21    a managed care organization that is licensed under the Texas Health
13-22    Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
13-23    Code), the commission shall consider and adjust for the regional
13-24    variation in costs of services under the traditional
13-25    fee-for-service component of the state Medicaid program,
13-26    utilization patterns, and other factors that influence the
13-27    potential for cost savings.  For a service area with a service area
 14-1    factor of .93 or less, or another appropriate service area factor,
 14-2    as determined by the commission, the commission may not discount
 14-3    premium payment rates in an amount that is more than the amount
 14-4    necessary to meet federal budget neutrality requirements for
 14-5    projected fee-for-service costs unless:
 14-6                (1)  a historical review of managed care financial
 14-7    results among managed care organizations in the service area served
 14-8    by the organization demonstrates that additional savings are
 14-9    warranted;
14-10                (2)  a review of Medicaid fee-for-service delivery in
14-11    the service area served by the organization has historically shown
14-12    a significant overutilization by recipients of certain services
14-13    covered by the premium payment rates in comparison to utilization
14-14    patterns throughout the rest of the state; or
14-15                (3)  a review of Medicaid fee-for-service delivery in
14-16    the service area served by the organization has historically shown
14-17    an above-market cost for services for which there is substantial
14-18    evidence that Medicaid managed care delivery will reduce the cost
14-19    of those services.
14-20          (c)  The premium payment rates paid to a managed care
14-21    organization that is licensed under the Texas Health Maintenance
14-22    Organization Act (Chapter 20A, Vernon's Texas Insurance Code) shall
14-23    be established by a competitive bid process but may not exceed the
14-24    maximum premium payment rates established by the commission under
14-25    Subsection (b).
14-26          (d)  Subsection (b) applies only to a managed care
14-27    organization with respect to Medicaid managed care pilot programs,
 15-1    Medicaid behavioral health pilot programs, and Medicaid Star + Plus
 15-2    pilot programs implemented in a health care service region after
 15-3    June 1, 1999.
 15-4          Sec. 533.014.  PROFIT SHARING.  (a)  The commission shall
 15-5    adopt rules regarding the sharing of profits earned by a managed
 15-6    care organization through a managed care plan providing health care
 15-7    services under a contract with the commission under this chapter.
 15-8          (b)  Any amount received by the state under this section
 15-9    shall be deposited in the general revenue fund for the purpose of
15-10    funding the state Medicaid program.
15-11          Sec. 533.015.  COORDINATION OF EXTERNAL OVERSIGHT ACTIVITIES.
15-12    To the extent possible, the commission shall coordinate all
15-13    external oversight activities to minimize duplication of oversight
15-14    of managed care plans under the state Medicaid program and
15-15    disruption of operations under those plans.
15-16          SECTION 9.  Chapter 533, Government Code, is amended by
15-17    adding Subchapter C to read as follows:
15-18                SUBCHAPTER C.  STATEWIDE ADVISORY COMMITTEE
15-19          Sec. 533.041.  APPOINTMENT AND COMPOSITION.  (a)  The
15-20    commission shall appoint a state Medicaid managed care advisory
15-21    committee.  The advisory committee consists of representatives of:
15-22                (1)  hospitals;
15-23                (2)  managed care organizations;
15-24                (3)  primary care providers;
15-25                (4)  state agencies;
15-26                (5)  consumer advocates representing low-income
15-27    recipients;
 16-1                (6)  consumer advocates representing recipients with a
 16-2    disability;
 16-3                (7)  parents of children who are recipients;
 16-4                (8)  rural providers;
 16-5                (9)  advocates for children with special health care
 16-6    needs;
 16-7                (10)  pediatric health care providers, including
 16-8    specialty providers;
 16-9                (11)  long-term care providers, including nursing home
16-10    providers;
16-11                (12)  obstetrical care providers;
16-12                (13)  community-based organizations serving low-income
16-13    children and their families; and
16-14                (14)  community-based organizations engaged in
16-15    perinatal services and outreach.
16-16          (b)  The advisory committee must include a member of each
16-17    regional Medicaid managed care advisory committee appointed by the
16-18    commission under Subchapter B.
16-19          Sec. 533.042.  MEETINGS.  The advisory committee shall meet
16-20    at least quarterly, shall develop procedures that provide the
16-21    public with reasonable opportunity to appear before the committtee
16-22    and speak on any issue under the jurisdiction of the committee, and
16-23    is subject to Chapter 551.
16-24          Sec. 533.043.  POWERS AND DUTIES.  The advisory committee
16-25    shall:
16-26                (1)  provide recommendations to the commission on the
16-27    statewide implementation and operation of Medicaid managed care;
 17-1                (2)  assist the commission with issues relevant to
 17-2    Medicaid managed care to improve the policies established for and
 17-3    programs operating under  Medicaid managed care, including the
 17-4    early and periodic screening, diagnosis, and treatment program,
 17-5    provider and patient education issues, and patient eligibility
 17-6    issues; and
 17-7                (3)  disseminate or make available to each regional
 17-8    advisory committee appointed under Subchapter B information on best
 17-9    practices with respect to Medicaid managed care that is obtained
17-10    from a regional advisory committee.
17-11          Sec. 533.044.  OTHER LAW.  Except as provided by this
17-12    subchapter, the advisory committee is subject to Chapter 2110.
17-13          SECTION 10.  Section 2.07(c), Chapter 1153, Acts of the 75th
17-14    Legislature, Regular Session, 1997, is amended to read as follows:
17-15          (c)  As soon as possible after development of the new
17-16    provider contract, the commission and each agency operating part of
17-17    the state Medicaid program by rule shall require each provider who
17-18    enrolled in the program before completion of the new contract to
17-19    reenroll in the program under the new contract or modify the
17-20    provider's existing contract in accordance with commission or
17-21    agency procedures as necessary to comply with the requirements of
17-22    the new contract.  The commission shall study the feasibility of
17-23    authorizing providers to reenroll in the program online or through
17-24    other electronic means.  On completion of the study, if the
17-25    commission determines that an online or other electronic method for
17-26    reenrollment of providers is feasible, the commission shall develop
17-27    and implement the electronic method of reenrollment for providers
 18-1    not later than September 1, 2000.  A provider must reenroll in the
 18-2    state Medicaid program or make the necessary contract modifications
 18-3    not later than March 31, 2000 [September 1, 1999], to retain
 18-4    eligibility to participate in the program, unless the commission
 18-5    implements under this subsection an electronic method of
 18-6    reenrollment for providers, in which event a provider must reenroll
 18-7    or make the contractual modifications not later than September 1,
 18-8    2000.  The commission by rule may extend a reenrollment deadline
 18-9    prescribed by this subsection if a significant number of providers,
18-10    as determined by the commission, have not met the reenrollment
18-11    requirements by the applicable deadline.
18-12          SECTION 11.  (a)  Not later than January 1, 2000, the Health
18-13    and Human Services Commission shall implement the expedited process
18-14    for determining eligibility for and enrollment of certain
18-15    recipients in Medicaid managed care plans required by Section
18-16    533.0075(4), Government Code, as added by this Act.
18-17          (b)  The Health and Human Services Commission shall report
18-18    quarterly to the standing committees of the senate and house of
18-19    representatives with primary jurisdiction over Medicaid managed
18-20    care regarding the status of the expedited process described by
18-21    Subsection (a) of this section.  The commission shall submit
18-22    quarterly reports under this subsection until the commission
18-23    determines the process is fully implemented and functioning
18-24    successfully.
18-25          SECTION 12.  If before implementing any provision of this Act
18-26    a state agency determines that a waiver or other authorization from
18-27    a federal agency is necessary for implementation, the Health and
 19-1    Human Services Commission shall request the waiver or authorization
 19-2    and may delay implementing that provision until the waiver or
 19-3    authorization is granted.
 19-4          SECTION 13.  The importance of this legislation and the
 19-5    crowded condition of the calendars in both houses create an
 19-6    emergency and an imperative public necessity that the
 19-7    constitutional rule requiring bills to be read on three several
 19-8    days in each house be suspended, and this rule is hereby suspended,
 19-9    and that this Act take effect and be in force from and after its
19-10    passage, and it is so enacted.
         _______________________________     _______________________________
             President of the Senate              Speaker of the House
               I certify that H.B. No. 2896 was passed by the House on May
         8, 1999, by the following vote:  Yeas 142, Nays 0, 1 present, not
         voting; that the House refused to concur in Senate amendments to
         H.B. No. 2896 on May 27, 1999, and requested the appointment of a
         conference committee to consider the differences between the two
         houses; and that the House adopted the conference committee report
         on H.B. No. 2896 on May 30, 1999, by the following vote:  Yeas 144,
         Nays 0, 1 present, not voting.
                                             _______________________________
                                                 Chief Clerk of the House
               I certify that H.B. No. 2896 was passed by the Senate, with
         amendments, on May 24, 1999, by the following vote:  Yeas 30, Nays
         0; at the request of the House, the Senate appointed a conference
         committee to consider the differences between the two houses; and
         that the Senate adopted the conference committee report on H.B. No.
         2896 on May 30, 1999, by the following vote:  Yeas 30, Nays 0.
                                             _______________________________
                                                 Secretary of the Senate
         APPROVED:  _____________________
                            Date
                    _____________________
                          Governor