77R10970 MCK-D
By Maxey, Gray, Chavez H.B. No. 1615
Substitute the following for H.B. No. 1615:
By Maxey C.S.H.B. No. 1615
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the regulation and reimbursement of telemedicine
1-3 medical services.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 531.0216, Government Code, is amended to
1-6 read as follows:
1-7 Sec. 531.0216. PARTICIPATION AND REIMBURSEMENT OF
1-8 TELEMEDICINE MEDICAL SERVICE PROVIDERS UNDER MEDICAID. (a) The
1-9 commission by rule shall develop and implement a system to
1-10 reimburse providers of services under the state Medicaid program
1-11 for services performed using telemedicine medical services.
1-12 (b) In developing the system, the commission by rule shall:
1-13 (1) review programs and pilot projects in other states
1-14 to determine the most effective method for reimbursement;
1-15 (2) establish billing codes and a fee schedule for
1-16 services; [and]
1-17 (3) provide for an approval process before a provider
1-18 can receive reimbursement for services;
1-19 (4) consult with the Texas Department of Health and
1-20 the telemedicine advisory committee to develop a procedure to deny
1-21 reimbursement for a medical service that, based on credible
1-22 clinical evidence, is shown to be medically inappropriate;
1-23 (5) establish pilot programs in designated areas of
1-24 this state under which the commission, in administering
2-1 government-funded health programs, may reimburse a health
2-2 professional participating in the pilot program for telehealth
2-3 services authorized under the licensing law applicable to the
2-4 health professional; and
2-5 (6) establish a separate provider identifier for
2-6 telemedicine medical services providers.
2-7 (c) The commission shall encourage physicians, teaching
2-8 hospitals, small rural hospitals, federally qualified health
2-9 centers, and state-owned health care facilities to participate as
2-10 telemedicine medical service providers in the health care delivery
2-11 system. The commission may not require that a service be provided
2-12 to a patient through telemedicine medical services when the service
2-13 can reasonably be provided by a physician through a face-to-face
2-14 consultation with the patient in the community in which the patient
2-15 resides or works. This subsection does not prohibit the
2-16 authorization of the provision of any service to a patient through
2-17 telemedicine medical services at the patient's request.
2-18 (d) Subject to Section 153.004, Occupations Code [5.11,
2-19 Medical Practice Act (Article 4495b, Vernon's Texas Civil
2-20 Statutes)], the commission may adopt rules as necessary to
2-21 implement this section.
2-22 (e) The commission may not reimburse a health care facility
2-23 for telemedicine medical services provided to a Medicaid recipient
2-24 unless the facility complies with the minimum standards adopted
2-25 under Section 531.02161.
2-26 (f) Not later than December 1 of each even-numbered year,
2-27 the commission shall report to the speaker of the house of
3-1 representatives and the lieutenant governor on the effects of
3-2 telemedicine medical services on the Medicaid program in the state,
3-3 including the number of physicians and health professionals using
3-4 telemedicine medical services, the geographic and demographic
3-5 disposition of the physicians and health professionals, the number
3-6 of patients receiving telemedicine medical services, the types of
3-7 services being provided, and the cost of utilization of
3-8 telemedicine medical services to the program.
3-9 (g) In this section:
3-10 (1) "Telehealth service" has the meaning assigned by
3-11 Section 57.042, Utilities Code.
3-12 (2) "Telemedicine medical service"[, "telemedicine"]
3-13 has the meaning assigned by Section 57.042, Utilities Code.
3-14 SECTION 2. Subchapter B, Chapter 531, Government Code, is
3-15 amended by adding Section 531.02161 to read as follows:
3-16 Sec. 531.02161. TELEMEDICINE TECHNOLOGY STANDARDS. (a) In
3-17 this section, "telemedicine medical service" has the meaning
3-18 assigned by Section 57.042, Utilities Code.
3-19 (b) The commission and the Telecommunications Infrastructure
3-20 Fund Board by joint rule shall establish and adopt minimum
3-21 standards for an operating system used in the provision of
3-22 telemedicine medical services by a health care facility
3-23 participating in the state Medicaid program, including standards
3-24 for electronic transmission, software, and hardware.
3-25 (c) In developing standards under this section, the
3-26 commission and the Telecommunications Infrastructure Fund Board
3-27 shall address:
4-1 (1) authentication and authorization of users;
4-2 (2) authentication of the origin of information;
4-3 (3) the prevention of unauthorized access to the
4-4 system or information;
4-5 (4) system security, including the integrity of
4-6 information that is collected, program integrity, and system
4-7 integrity;
4-8 (5) maintenance of documentation about system and
4-9 information usage; and
4-10 (6) information storage, maintenance, and
4-11 transmission.
4-12 SECTION 3. Section 531.0217, Government Code, is amended to
4-13 read as follows:
4-14 Sec. 531.0217. REIMBURSEMENT FOR CERTAIN MEDICAL
4-15 CONSULTATIONS. (a) In this section:
4-16 (1) "Health professional" means:
4-17 (A) a physician; or
4-18 (B) an individual who is:
4-19 (i) licensed or certified in this state to
4-20 perform health care services; and
4-21 (ii) authorized to assist a physician in
4-22 providing telemedicine medical services that are delegated and
4-23 supervised by the physician [an advanced nurse practitioner, an
4-24 allied health professional, a mental health professional, a
4-25 physician, or a physician assistant who is licensed in this state].
4-26 (2) "Physician" means a person licensed to practice
4-27 medicine in this state under Subtitle B, Title 3, Occupations Code.
5-1 ["Rural county" means a county that:]
5-2 [(A) has a population of 50,000 or less; or]
5-3 [(B) contains an area that was not designated as
5-4 an urban area by the United States Bureau of the Census according
5-5 to the 1990 federal census and does not have within the boundaries
5-6 of the county a hospital that:]
5-7 [(i) is licensed under Chapter 241, Health
5-8 and Safety Code; and]
5-9 [(ii) has more than 100 beds.]
5-10 (3) "Telehealth service" has the meaning assigned by
5-11 Section 57.042, Utilities Code.
5-12 (4) "Telemedicine medical service" has the meaning
5-13 assigned by Section 57.042, Utilities Code. ["Rural health
5-14 facility" means a health facility that is located in a rural county
5-15 and at least 30 miles from any accredited medical school or any
5-16 teaching hospital affiliated with an accredited medical school and
5-17 that is:]
5-18 [(A) a licensed, nonprofit hospital;]
5-19 [(B) a health clinic that is affiliated with:]
5-20 [(i) an accredited medical school;]
5-21 [(ii) a teaching hospital that is
5-22 affiliated with an accredited medical school;]
5-23 [(iii) a hospital described by Paragraph
5-24 (C); or]
5-25 [(iv) a federally qualified health center,
5-26 as defined by 42 U.S.C. Section 1396d(l)(2)(B), as amended; or]
5-27 [(C) a hospital that:]
6-1 [(i) is licensed under Chapter 241, Health
6-2 and Safety Code;]
6-3 [(ii) is owned or operated by a
6-4 municipality, county, hospital district, or hospital authority; and]
6-5 [(iii) provides inpatient or outpatient
6-6 services.]
6-7 [(4) "Telemedical consultation" means a medical
6-8 consultation for purposes of patient diagnosis or treatment that
6-9 requires the use of advanced telecommunications technology,
6-10 including:]
6-11 [(A) compressed digital interactive video,
6-12 audio, or data transmission;]
6-13 [(B) clinical data transmission via computer
6-14 imaging for teleradiology or telepathology; and]
6-15 [(C) other technology that facilitates access in
6-16 rural counties to health care services or medical specialty
6-17 expertise.]
6-18 (b) The commission by rule shall require each health and
6-19 human services agency that administers a part of the Medicaid
6-20 program to provide Medicaid reimbursement for a telemedicine
6-21 medical service initiated or [telemedical consultation] provided by
6-22 a physician [licensed in this state who practices in:]
6-23 [(1) a rural health facility;]
6-24 [(2) an accredited medical school; or]
6-25 [(3) a teaching hospital that is affiliated with an
6-26 accredited medical school].
6-27 (c) The commission shall ensure that reimbursement is
7-1 provided only for a telemedicine medical service initiated or
7-2 [consultation] provided by a physician [described in Subsection (b)
7-3 to a health professional who practices in a rural county].
7-4 (d) The commission shall require reimbursement for a
7-5 telemedicine medical service [telemedical consultation] at the same
7-6 rate as the Medicaid program reimburses for a comparable in-person
7-7 medical service [consultation]. A request for reimbursement may
7-8 not be denied solely because an in-person medical service
7-9 [consultation] between a physician and a patient did not occur.
7-10 (e) A health care facility that receives reimbursement under
7-11 this section for a telemedicine medical service [consultations]
7-12 provided by a physician [physicians] who practices [practice] in
7-13 that facility or [and] a health professional who participates in a
7-14 telemedicine medical service [obtains consultations] under this
7-15 section shall establish quality of care protocols and patient
7-16 confidentiality guidelines to ensure that the telemedicine medical
7-17 service meets [telemedical consultations meet] legal requirements
7-18 and acceptable patient care standards.
7-19 (f) The commission may not require a telemedicine medical
7-20 service [telemedical consultation] if an in-person consultation
7-21 with a physician is reasonably available where the patient resides
7-22 or works. The commission shall require facilities and providers of
7-23 telemedicine medical services to make a good faith effort to
7-24 identify and coordinate with existing providers to preserve and
7-25 protect existing health care systems and medical relationships in
7-26 an area.
7-27 (g) If a patient receiving a telemedicine medical service
8-1 has a primary care physician and consents to the notification, the
8-2 commission shall require that the primary care physician be
8-3 notified of the telemedicine medical service for the purpose of
8-4 sharing medical information.
8-5 (h) The commission in consultation with the Texas State
8-6 Board of Medical Examiners shall monitor and regulate the use of
8-7 telemedicine medical services to ensure compliance with this
8-8 section. In addition to any other method of enforcement, the
8-9 commission may use a corrective action plan to ensure compliance
8-10 with this section.
8-11 (i) [(g)] The Texas State Board of Medical Examiners, in
8-12 consultation with the commission, as appropriate, may adopt rules
8-13 as necessary to:
8-14 (1) ensure that appropriate care, including quality of
8-15 care, is provided to patients who receive telemedicine medical
8-16 services [that are provided through a telemedical consultation];
8-17 [and]
8-18 (2) prevent abuse and fraud through the use of
8-19 telemedicine medical services [telemedical consultations],
8-20 including rules relating to filing of claims and records required
8-21 to be maintained in connection with telemedicine;
8-22 (3) ensure adequate supervision of health
8-23 professionals who are not physicians and who provide telemedicine
8-24 medical services;
8-25 (4) establish the maximum number of health
8-26 professionals who are not physicians that a physician may supervise
8-27 through a telemedicine medical service; and
9-1 (5) require a face-to-face consultation between a
9-2 patient and a physician providing a telemedicine medical service
9-3 within a certain number of days following an initial telemedicine
9-4 medical service only if the physician has never seen the patient.
9-5 (j) [(h)] The commissioner shall establish an advisory
9-6 committee to coordinate state telemedicine efforts and assist the
9-7 commission in:
9-8 (1) evaluating [developing] policies for telemedicine
9-9 medical services under Section 531.0216 and this section;
9-10 (2) monitoring the types of programs receiving
9-11 reimbursement under this section; and
9-12 (3) coordinating the activities of state agencies
9-13 interested in the use of telemedicine medical services [telemedical
9-14 consultations under this section].
9-15 (k) This section does not affect any requirement relating
9-16 to:
9-17 (1) a federally qualified health center;
9-18 (2) a rural health clinic; or
9-19 (3) physician delegation of the authority to carry out
9-20 or sign prescription drug orders to an advanced practice nurse or
9-21 physician assistant.
9-22 SECTION 4. Subchapter D, Chapter 62, Health and Safety Code,
9-23 is amended by adding Section 62.157 to read as follows:
9-24 Sec. 62.157. TELEMEDICINE MEDICAL SERVICES. (a) In
9-25 providing covered benefits to a child, a health plan provider must
9-26 permit benefits to be provided through telemedicine medical
9-27 services in accordance with policies developed by the commission.
10-1 (b) The policies must provide for:
10-2 (1) the availability of covered benefits appropriately
10-3 provided through telemedicine medical services that are comparable
10-4 to the same types of covered benefits provided without the use of
10-5 telemedicine medical services; and
10-6 (2) the availability of covered benefits for different
10-7 services performed by multiple health care providers during a
10-8 single session of telemedicine medical services, if the commission
10-9 determines that delivery of the covered benefits in that manner is
10-10 cost-effective in comparison to the costs that would be involved in
10-11 obtaining the services from providers without the use of
10-12 telemedicine medical services, including the costs of
10-13 transportation and lodging and other direct costs.
10-14 (c) In developing the policies required by Subsection (a),
10-15 the commission shall consult with the telemedicine advisory
10-16 committee.
10-17 (d) In this section, "telemedicine medical service" has the
10-18 meaning assigned by Section 57.042, Utilities Code.
10-19 SECTION 5. Section 1, Article 21.53F, Insurance Code, as
10-20 added by Section 1, Chapter 880, Acts of the 75th Legislature,
10-21 Regular Session, 1997, is amended to read as follows:
10-22 Sec. 1. DEFINITIONS. In this article:
10-23 (1) "Health benefit plan" means a plan described by
10-24 Section 2 of this article.
10-25 (2) "Health professional" means:
10-26 (A) a physician; or
10-27 (B) an individual who is:
11-1 (i) licensed or certified in this state to
11-2 perform health care services; and
11-3 (ii) authorized to assist a physician in
11-4 providing telemedicine medical services that are delegated and
11-5 supervised by the physician.
11-6 (3) "Physician" means a person licensed to practice
11-7 medicine in this state under Subtitle B, Title 3, Occupations Code.
11-8 (4) "Telemedicine medical service" has the meaning
11-9 assigned by Section 57.042, Utilities Code. ["Telemedicine" means
11-10 the use of interactive audio, video, or other electronic media to
11-11 deliver health care. The term includes the use of electronic media
11-12 for diagnosis, consultation, treatment, transfer of medical data,
11-13 and medical education. The term does not include services
11-14 performed using a telephone or facsimile machine.]
11-15 SECTION 6. Section 3, Article 21.53F, Insurance Code, as
11-16 added by Section 1, Chapter 880, Acts of the 75th Legislature,
11-17 Regular Session, 1997, is amended to read as follows:
11-18 Sec. 3. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES. (a) A
11-19 health benefit plan may not exclude a telemedicine medical service
11-20 from coverage under the plan solely because the service is
11-21 [provided through telemedicine and] not provided through a
11-22 face-to-face consultation.
11-23 (b) Benefits [for a service provided through telemedicine]
11-24 required under this article may be made subject to a deductible,
11-25 copayment, or coinsurance requirement. A deductible, copayment, or
11-26 coinsurance applicable to a particular service provided through
11-27 telemedicine medical services may not exceed the deductible,
12-1 copayment, or coinsurance required by the health benefit plan for a
12-2 comparable medical [the same] service provided through a
12-3 face-to-face consultation.
12-4 SECTION 7. Section 4, Article 21.53F, Insurance Code, as
12-5 added by Section 1, Chapter 880, Acts of the 75th Legislature,
12-6 Regular Session, 1997, is amended to read as follows:
12-7 Sec. 4. INFORMED CONSENT. A treating physician or [other]
12-8 health professional [care provider] who provides or facilitates the
12-9 use of telemedicine medical services shall ensure that the informed
12-10 consent of the patient, or another appropriate person with
12-11 authority to make health care treatment decisions for the patient,
12-12 is obtained before telemedicine medical services are provided
12-13 [through telemedicine].
12-14 SECTION 8. Section 5, Article 21.53F, Insurance Code, as
12-15 added by Section 1, Chapter 880, Acts of the 75th Legislature,
12-16 Regular Session, 1997, is amended to read as follows:
12-17 Sec. 5. CONFIDENTIALITY. A treating physician or [other]
12-18 health professional [care provider] who provides or facilitates the
12-19 use of telemedicine medical services shall ensure that the
12-20 confidentiality of the patient's medical information is maintained
12-21 as required by Chapter 159, Occupations Code [Section 5.08, Medical
12-22 Practice Act (Article 4495b, Vernon's Texas Civil Statutes)], or
12-23 other applicable law.
12-24 SECTION 9. Section 6(b), Article 21.53F, Insurance Code, as
12-25 added by Section 1, Chapter 880, Acts of the 75th Legislature,
12-26 Regular Session, 1997, is amended to read as follows:
12-27 (b) The Texas State Board of Medical Examiners, in
13-1 consultation with the commissioner, as appropriate, may adopt rules
13-2 as necessary to:
13-3 (1) ensure that appropriate care, including quality of
13-4 care, is provided to patients who receive telemedicine medical
13-5 services [that are provided through telemedicine]; [and]
13-6 (2) prevent abuse and fraud through use of
13-7 telemedicine medical services, including rules relating to filing
13-8 of claims and records required to be maintained in connection with
13-9 telemedicine medical services;
13-10 (3) ensure adequate supervision of health
13-11 professionals who are not physicians and who provide telemedicine
13-12 medical services;
13-13 (4) establish the maximum number of health
13-14 professionals who are not physicians that a physician may supervise
13-15 through a telemedicine medical service; and
13-16 (5) require a face-to-face consultation between a
13-17 patient and a physician providing a telemedicine medical service
13-18 within a certain number of days following an initial telemedicine
13-19 medical service only if the physician has never seen the patient.
13-20 SECTION 10. Section 153.004, Occupations Code, is amended to
13-21 read as follows:
13-22 Sec. 153.004. RULES REGARDING TELEMEDICINE MEDICAL SERVICES.
13-23 (a) In consultation with the Health and Human Services Commission
13-24 and the commissioner of insurance, the board may adopt rules as
13-25 necessary to:
13-26 (1) ensure that appropriate care is provided to
13-27 Medicaid and Medicare patients who receive telemedicine medical
14-1 services [that are provided through telemedicine]; and
14-2 (2) prevent abuse and fraud in the use of telemedicine
14-3 medical services for Medicaid and Medicare patients.
14-4 (b) The rules adopted under Subsection [Section] (a)(2) may
14-5 include rules relating to filing of claims and records required to
14-6 be maintained in relation to telemedicine medical services.
14-7 SECTION 11. Section 57.042, Utilities Code, is amended by
14-8 amending Subdivision (11) and adding Subdivision (12) to read as
14-9 follows:
14-10 (11) "Telehealth service" means a health service,
14-11 other than a telemedicine medical service, delivered by a licensed
14-12 or certified health professional acting within the scope of the
14-13 health professional's license or certification who does not perform
14-14 a telemedicine medical service.
14-15 (12) "Telemedicine medical service" means a health
14-16 care service initiated by a physician or provided by a health
14-17 professional acting under physician delegation and supervision for
14-18 purposes of patient assessment by a health professional, diagnosis
14-19 or consultation by a physician, treatment, or the transfer of
14-20 medical data, that requires the use of advanced telecommunications
14-21 technology, other than by telephone or facsimile, including:
14-22 (A) compressed digital interactive video, audio,
14-23 or data transmission;
14-24 (B) clinical data transmission using computer
14-25 imaging by way of still image capture; and
14-26 (C) other technology that facilitates access to
14-27 health care services or medical specialty expertise[:]
15-1 [(A) means medical services delivered by
15-2 telecommunications technologies to rural or underserved public
15-3 not-for-profit health care facilities or primary health care
15-4 facilities in collaboration with an academic health center and an
15-5 associated teaching hospital or tertiary center or with another
15-6 public not-for-profit health care facility; and]
15-7 [(B) includes consultive services, diagnostic
15-8 services, interactive video consultation, teleradiology,
15-9 telepathology, and distance education for working health care
15-10 professionals].
15-11 SECTION 12. Section 57.046(b), Utilities Code, is amended to
15-12 read as follows:
15-13 (b) The board shall use money in the qualifying entities
15-14 account for any purpose authorized by this subchapter, including:
15-15 (1) equipment;
15-16 (2) wiring;
15-17 (3) material;
15-18 (4) program development;
15-19 (5) training;
15-20 (6) installation costs; [and]
15-21 (7) a statewide telecommunications network; and
15-22 (8) funding an automated system to integrate client
15-23 services and eligibility requirements for health and human services
15-24 across agencies.
15-25 SECTION 13. Sections 57.047(a) and (b), Utilities Code, are
15-26 amended to read as follows:
15-27 (a) The board may award a grant to a project or proposal
16-1 that:
16-2 (1) provides equipment and infrastructure necessary
16-3 for:
16-4 (A) distance learning;
16-5 (B) an information sharing program of a library;
16-6 [or]
16-7 (C) telemedicine medical services; or
16-8 (D) telehealth services;
16-9 (2) develops and implements the initial or
16-10 prototypical delivery of a course or other distance learning
16-11 material;
16-12 (3) trains teachers, faculty, librarians, or
16-13 technicians in the use of distance learning or information sharing
16-14 materials and equipment;
16-15 (4) develops a curriculum or instructional material
16-16 specially suited for telecommunications delivery;
16-17 (5) provides electronic information; or
16-18 (6) establishes or carries out an information sharing
16-19 program.
16-20 (b) The board may award a loan to a project or proposal to
16-21 acquire equipment needed for distance learning and telemedicine
16-22 medical service projects.
16-23 SECTION 14. Subchapter C, Chapter 57, Utilities Code, is
16-24 amended by adding Section 57.0475 to read as follows:
16-25 Sec. 57.0475. ELIGIBILITY FOR GRANTS TO HEALTH CARE
16-26 FACILITIES. (a) The board may award a grant under Section
16-27 57.047(a)(1)(C) only to a health care facility that:
17-1 (1) is a hospital or other entity, including a health
17-2 clinic, that:
17-3 (A) is supported by local or regional tax
17-4 revenue;
17-5 (B) is a certified nonprofit health corporation
17-6 under federal law; or
17-7 (C) is an ambulatory health care center; or
17-8 (2) meets the criteria adopted by the board and the
17-9 Health and Human Services Commission under Subsection (b).
17-10 (b) The board and the Health and Human Services Commission
17-11 shall jointly adopt rules prescribing the criteria a health care
17-12 facility not described by Subsection (a)(1) must meet to be
17-13 eligible to receive a grant under Section 57.047(a)(1)(C). In
17-14 determining the criteria, the board and commission shall prioritize
17-15 health care facilities based on:
17-16 (1) the amount of charity care provided by each
17-17 facility during the year preceding the year in which the facility
17-18 applies for a grant; and
17-19 (2) the number of Medicaid patients and patients
17-20 enrolled in the state child health plan treated by each facility
17-21 during the year preceding the year in which the facility applies
17-22 for a grant.
17-23 (c) The criteria adopted under Subsection (b) must provide
17-24 that a health care facility is not eligible to receive a grant
17-25 under Section 57.047(a)(1)(C) if the health care facility did not
17-26 provide any charity care or treat any patients described by
17-27 Subsection (b)(2) during the year preceding the year in which the
18-1 facility applies for a grant.
18-2 SECTION 15. Section 58.253(a), Utilities Code, is amended to
18-3 read as follows:
18-4 (a) On customer request, an electing company shall provide
18-5 private network services to:
18-6 (1) an educational institution;
18-7 (2) a library;
18-8 (3) a nonprofit telemedicine center;
18-9 (4) a public or not-for-profit hospital;
18-10 (5) a project funded by the telecommunications
18-11 infrastructure fund under Subchapter C, Chapter 57, except to the
18-12 extent the project benefits a health care facility that:
18-13 (A) is not supported by local or regional tax
18-14 revenue;
18-15 (B) is not a certified nonprofit health
18-16 corporation under federal law; or
18-17 (C) is not an ambulatory health care center; or
18-18 (6) a legally constituted consortium or group of
18-19 entities listed in this subsection.
18-20 SECTION 16. Not later than October 1, 2001, the Health and
18-21 Human Services Commission and the Telecommunications Infrastructure
18-22 Fund Board shall adopt minimum standards for an operating system
18-23 used by a health care facility in providing telemedicine medical
18-24 services to a Medicaid recipient as required by Section 531.02161,
18-25 Government Code, as added by this Act.
18-26 SECTION 17. Not later than January 1, 2002, the Health and
18-27 Human Services Commission shall adopt rules required by Section
19-1 531.0217, Government Code, as amended by this Act.
19-2 SECTION 18. Section 57.046(b)(8), Utilities Code, as added
19-3 by this Act, expires September 1, 2003.
19-4 SECTION 19. If before implementing any provision of this Act
19-5 a state agency determines that a waiver or authorization from a
19-6 federal agency is necessary for implementation of that provision,
19-7 the agency affected by the provision shall request the waiver or
19-8 authorization and may delay implementing that provision until the
19-9 waiver or authorization is granted.
19-10 SECTION 20. This Act takes effect immediately if it receives
19-11 a vote of two-thirds of all the members elected to each house, as
19-12 provided by Section 39, Article III, Texas Constitution. If this
19-13 Act does not receive the vote necessary for immediate effect, this
19-14 Act takes effect September 1, 2001.