By: Harris S.B. No. 955
Line and page numbers may not match official copy.
Bill not drafted by TLC or Senate E&E.
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the delegation of certain functions by health
1-3 maintenance organizations.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 2, Texas Health Maintenance Organization Act
1-6 (Article 20A.02, Vernon's Texas Insurance Code), is amended by
1-7 amending Subsection (ee) and adding Subsections (ff) to read as
1-8 follows:
1-9 (ee) "Delegated entity [network]" means an entity, other than
1-10 a health maintenance organization authorized to do business under
1-11 this Act [or an insurer authorized to do business under Chapter 3,
1-12 Insurance Code], which:
1-13 (1) by itself, or through subcontracts with one or
1-14 more entities including delegated third party, undertakes to
1-15 arrange for or to provide medical care or health care to an
1-16 enrollee in exchange for a predetermined payment on a prospective
1-17 basis; and
1-18 (2) accepts responsibility to perform, on behalf of
1-19 the health maintenance organization, any function regulated by this
1-20 Act as defined by subsection (d). [The term does not include an
1-21 individual physician or a group of employed physicians practicing
1-22 medicine under one federal tax identification number and whose
1-23 total claims paid to providers not employed by the group is less
2-1 than 20 percent of the total collected revenue of the group
2-2 calculated on a calendar year basis.]
2-3 (ff) "delegated network" means an entity, other than a
2-4 health maintenance organization authorized to do business under
2-5 this Act but does not meet the requirements of subsection (ee),
2-6 which:
2-7 (1) by itself, or through subcontracts with one or
2-8 more entities delegated third party, undertakes to arrange for or
2-9 to provide medical care or health care to an enrollee in exchange
2-10 for a predetermined payment on a prospective basis; and
2-11 (2) accepts responsibility to perform, on behalf of
2-12 the health maintenance organization, any function regulated by this
2-13 Act. The term does not include contracts between a delegated
2-14 entity and an individual physician or a group of employed
2-15 physicians practicing medicine under one federal tax identification
2-16 number and whose total claims paid to providers not employed by the
2-17 group is less than 20 percent of the total collected revenue of the
2-18 group calculated on a calendar year basis.
2-19 (gg) "delegated third party" means a third party that
2-20 contracts with a delegated entity, either directly or through
2-21 another third party, in which the third party:
2-22 (i) accepts responsibility to perform any
2-23 function regulated by this Act; or
2-24 (ii) receives or handles funds, if the receipt
2-25 or handling of such funds is directly or indirectly related to a
2-26 function regulated by this Act. The term includes a third party
3-1 that administers such funds.
3-2 SECTION 2. The Texas Health Maintenance Organization Act (Article
3-3 20A.18C, Vernon's Texas Insurance Code) is amended as follows:
3-4 Sec. 18C. REQUIREMENTS FOR DELEGATED ENTITIES AND NETWORKS
3-5 ]LDELEGATION OF CERTAIN FUNCTIONS TO DELEGATED NETWORKS . (a) A
3-6 health maintenance organization that [enters into a delegation
3-7 agreement with a delegated network] delegates any function required
3-8 by this Act shall execute a written agreement with each delegated
3-9 network and entity. The health maintenance organization shall file
3-10 these ]Lthe written agreements with the department not later than the
3-11 30th day after the date the agreement is executed. It shall be the
3-12 responsibility of the parties to each agreement to determine the
3-13 party that bears the expense of any provision required by this
3-14 subsection including the cost of any examinations conducted by the
3-15 department pursuant to Article 1.15 if applicable. The written
3-16 agreement must contain:
3-17 (1) a monitoring plan which allows the health
3-18 maintenance organization to track the minimum solvency requirements
3-19 ]Lto be established in this section, if applicable, which includes:
3-20 (A) a description of financial practices that
3-21 will ensure that the delegated network tracks and reports
3-22 liabilities that have been incurred but not reported;
3-23 (B) a summary of the total amount paid by the
3-24 delegated network to physicians and providers on a monthly basis;
3-25 and
3-26 (C) a summary of complaints from physicians,
4-1 enrollees, and providers regarding delays in payments of claims or
4-2 nonpayment of claims, including the status of each complaint, on a
4-3 monthly basis;
4-4 (2) a provision that the agreement cannot be
4-5 terminated without cause by the delegated network or the health
4-6 maintenance organization without written notice provided before the
4-7 90th day preceding the termination date;
4-8 (3) a provision that prohibits the delegated entity
4-9 and the physicians and providers with whom it has contracted from
4-10 billing or attempting to collect from an enrollee under any
4-11 circumstance, including the insolvency of the health maintenance
4-12 organization or other delegated entities, payments for covered
4-13 services other than authorized copayments and deductibles;
4-14 (4) a provision that the delegation agreement may not
4-15 be construed to limit in any way the health maintenance
4-16 organization's authority or responsibility, including financial
4-17 responsibility, to comply with all statutory and regulatory
4-18 requirements;
4-19 (5) a provision that requires the delegated entity to
4-20 deposit funds as described in the section, at a location in Texas
4-21 with a financial institution chartered by the United States or this
4-22 state. The funds accepted through the agreement by the delegated
4-23 entity are held by the delegated entity in a fiduciary capacity
4-24 (6) a provisions that requires the delegated entity
4-25 and network to comply with all statutory and regulatory
4-26 requirements relating to any function, duty, responsibility, or
5-1 delegation assumed by or carried out by the delegated entity or
5-2 network;
5-3 (7)(6) a provision that requires the [a] delegated
5-4 entity or network to permit the commissioner to examine at any time
5-5 any and all information that the commissioner reasonably believes
5-6 would be relevant to:
5-7 (A) the financial solvency of the delegated
5-8 entity;
5-9 (B) the financial solvency of the delegated
5-10 third party; or
5-11 (B) the ability of the delegated entity to meet
5-12 its responsibilities in connection with any function delegated to
5-13 the enity by the health maintenance organization;
5-14 (8) [(6)] a provision that requires the [a] delegated
5-15 entity or network [or a third party] to provide the [a] license number
5-16 [and to certify that the network] of any third party performing any
5-17 function for which a license as a [or third party is licensed as a]
5-18 third party administrator under Article 21.07-6, Insurance Code, or
5-19 as a utilization review agent under Article 21.58A or for which any
5-20 other license is required under this code, and that: [if the health
5-21 maintenance organization delegates its claims payment function to
5-22 the delegated network or a third party];
5-23 (A) enrollees will receive notification at the
5-24 time of enrollment which entity has responsibility for performing
5-25 utilization review; and
5-26 (B) the delegated entity or network or third
6-1 party performing utilization review shall do so in accordance with
6-2 Art. 21.58A, Insurance Code; and
6-3 (C) utilization review decisions made by the
6-4 delegated entity or network or a third party shall be forwarded to
6-5 the health maintenance organization on a monthly basis;
6-6 (8) [(7)] for delegated entities that handle funds
6-7 meant, at least in part, for the benefit of, or to provide services
6-8 to, enrollees of a health maintenance organization, a provision
6-9 that requires a delegated entity to establish and maintain reserves
6-10 which are:
6-11 (A) adequate for the liabilities and risks assumed by
6-12 the delegated entity as calculated in accordance with accepted
6-13 standards, practices and procedures in regard for the liabilities
6-14 and risks being reserved for, including known and unknown
6-15 components and anticipated expenses to provide such benefits or
6-16 services; and
6-17 (B) in the amount defined in section (d):
6-18 (i) must be secured by and only consist of
6-19 lawful money of the United States or bonds of the United States or
6-20 of this State or of any government insured mortgage loans; and
6-21 [(9)]]L(7) [ a provision that requires a delegated network
6-22 or a third party to provide a license number and to certify that
6-23 the network or third party is licensed as a utilization review
6-24 agent under Article 21.58A, Insurance Code, if the health
6-25 maintenance organization delegates its utilization review function
6-26 to the delegated network or a third party, and that:]
7-1 [(A) enrollees will receive notification at the time of enrollment
7-2 which entity has responsibility for performing utilization review;
7-3 and]
7-4 [(B) the delegated network or third party performing utilization
7-5 review shall do so in accordance with Art. 21.58A, Insurance Code;
7-6 and]
7-7 [(C) utilization review decisions made by the delegated network or
7-8 a third party shall be forwarded to the health maintenance
7-9 organization on a monthly basis];
7-10 (9) a provision that requires that any agreement in
7-11 which the delegated entity or delegated network delegates either
7-12 directly or indirectly any function required by this Act, including
7-13 the handling of funds, if applicable, as defined in Article
7-14 20A.02(ee), to a delegated third party shall be in writing;
7-15 (10) [(8)] a provision that requires the delegated
7-16 entity or network, in contracting either directly or through
7-17 another third party with any delegated third party to require the
7-18 delegated third party to comply with the all requirements that are
7-19 mandated by state law for an entity of its type.
7-20 (11) ([12]) an acknowledgment and agreement by the
7-21 delegated network that:
7-22 (A) the health maintenance organization is:
7-23 (i) required to establish, operate, and
7-24 maintain a health care delivery system, quality assurance system,
7-25 provider credentialing system, and other systems and programs that
7-26 meet statutory and regulatory standards;
8-1 (ii) directly accountable for compliance
8-2 with those standards; and
8-3 (iii) not precluded from contractually
8-4 requesting that the delegated network or entity provide proof of
8-5 financial viability;
8-6 (B) the role of the delegated network and [any]
8-7 entity with which it subcontracts through a delegated third party
8-8 [in contracting with the health maintenance organization] is limited
8-9 to performing certain delegated functions of the health maintenance
8-10 organization, using standards approved by the health maintenance
8-11 organization and which are in compliance with applicable statutes
8-12 and rules and subject to the health maintenance organization's
8-13 oversight and monitoring of the delegated network's performance;
8-14 and
8-15 (C) if the delegated network or entity fails to
8-16 meet monitoring standards established to ensure that functions
8-17 delegated or assigned to the network under the delegation contract
8-18 are in full compliance with all statutory and regulatory
8-19 requirements, the health maintenance organization may cancel
8-20 delegation of any or all delegated functions; and
8-21 (11) [(9)] a provision that requires the delegated
8-22 network or entity to make available to the health maintenance
8-23 organization samples of contracts with physicians and providers to
8-24 ensure compliance with the contractual requirements described by
8-25 Subdivisions (2) and (3) of this subsection, except that the
8-26 agreement may not require that the delegated network or entity make
9-1 available to the health maintenance organization contractual
9-2 provisions relating to financial arrangements with the delegated
9-3 network's physicians and providers;
9-4 (12[0]) the delegated network or entity to provide the
9-5 health maintenance organization, in a usable format necessary for
9-6 audit purposes and at most quarterly unless otherwise specified in
9-7 the agreement, the data necessary for the health maintenance
9-8 organization to comply with the department's reporting requirements
9-9 with respect to any delegated functions performed under the
9-10 delegation agreement, including:
9-11 (A) a summary:
9-12 (i) describing the methods, including
9-13 capitation, fee-for-service, or other risk arrangements, that the
9-14 delegated network used to pay its physicians and providers; and
9-15 (ii) including the percentage of
9-16 physicians and providers paid for each payment category;
9-17 (B) the period that claims and debts for medical
9-18 services owed by the delegated network have been pending and the
9-19 aggregate dollar amount of those claims and debts;
9-20 (C) information that will enable the health
9-21 maintenance organization to file claims for reinsurance,
9-22 coordination of benefits, and subrogation, if required by the
9-23 health maintenance organization's contract with the delegated
9-24 network; and
9-25 (D) documentation, except for information,
9-26 documents, and deliberations related to peer review that are
10-1 confidential or privileged under Section 5.06, Medical Practice Act
10-2 Article 4495b, Vernon's Texas Civil Statutes), that relates to:
10-3 (i) a regulatory agency's inquiry or
10-4 investigation of the delegated network or entity or of an
10-5 individual physician or provider with whom the delegated network or
10-6 entity contracts that relates to an enrollee of the health
10-7 maintenance organization; and
10-8 (ii) the final resolution of a regulatory
10-9 agency's inquiry or investigation; and
10-10 (13[1]) a provision relating to enrollee complaints that
10-11 requires the delegated network or entity to ensure that upon
10-12 receipt of a complaint, as defined by this Act, the delegated
10-13 network or entity shall report the complaint to the health
10-14 maintenance organization within two business days, except in the
10-15 case of a complaint involving emergency care as defined in this
10-16 Act. In the case of a complaint involving emergency care, the
10-17 delegated network or entity shall forward the complaint immediately
10-18 to the health maintenance organization. Nothing herein shall
10-19 prohibit the delegated network or entity from attempting to resolve
10-20 a complaint.
10-21 (b) The commissioner shall determine the information that a
10-22 [A] health maintenance organization shall provide to each delegated
10-23 entity or network which shall include the following information
10-24 provided in standard electronic format, at least monthly unless
10-25 otherwise stated [provided] in the agreement:
10-26 (1) the names and dates of birth or social security
11-1 numbers of the enrollees of the health maintenance organization who
11-2 are eligible or assigned to receive services from the delegated
11-3 network or entity, including the enrollees added and terminated
11-4 since the previous reporting period;
11-5 (2) the age, sex, benefit plan and any riders to that
11-6 benefit plan, and employer for the enrollees of the health
11-7 maintenance organization who are eligible or assigned to receive
11-8 services from the delegated network or entity;
11-9 (3) if the health maintenance organization pays any
11-10 claims for the delegated network or entity, a summary of the number
11-11 and amount of claims paid by the health maintenance organization on
11-12 behalf of the delegated network or entity during the previous
11-13 reporting period. A delegated entity or network is not precluded
11-14 from receiving, upon request, additional nonproprietary information
11-15 regarding such claims;
11-16 (4) if the health maintenance organization pays any
11-17 claims for the delegated network or entity, a summary of the number
11-18 and amount of pharmacy prescriptions paid for each enrollee for
11-19 which the delegated entity or network has taken partial risk during
11-20 the previous reporting period. A delegated entity or network is
11-21 not precluded from receiving, upon request, additional
11-22 nonproprietary information regarding such claims;
11-23 (5) information that enables the delegated entity or
11-24 network to file claims for reinsurance, coordination of benefits,
11-25 and subrogation; and
11-26 (6) patient complaint data that relates to the
12-1 delegated network or entity.
12-2 (c) In addition to the information required by Subsection
12-3 (b) of this section, a health maintenance organization shall
12-4 provide to a delegated entity or network [with which it has a
12-5 delegation agreement]:
12-6 (1) detailed risk-pool data, reported quarterly and on
12-7 settlement; and
12-8 (2) the percent of premium attributable to hospital or
12-9 facility costs, if hospital or facility costs impact the delegated
12-10 entity's or network's costs, reported quarterly, and, if there are
12-11 changes in hospital or facility contracts with the health
12-12 maintenance organization, the projected impact of those changes on
12-13 the percent of premium attributable to hospital and facility costs
12-14 within 30 days of such changes.
12-15 (d) A delegated entity that accepts financial risk
12-16 from an health maintenance organization for health care services to
12-17 be provided to enrollees of the health maintenance organization
12-18 shall establish and maintain reserves which are adequate for the
12-19 liabilities and risks assumed by the delegated entity, as
12-20 calculated in accordance with accepted standards, practices and
12-21 procedures in regard for the liabilities and risks being reserved
12-22 for, including known and unknown components and anticipated
12-23 expenses to provide such benefits or services. If the delegated
12-24 entity accepts financial risk for;
12-25 (1) more than one category of service for medical care,
12-26 hospital or other institutional services or prescription drugs, as
13-1 defined by section 551.003 of the Occupations Code, the delegated
13-2 entity shall establish and maintain reserves as described in
13-3 subsection (2) (i),(ii) or (iii) and shall only establish and
13-4 maintain reserves for the portion of services that are not within
13-5 their respective scope of licensure for medical care or hospital or
13-6 other institutional services, or
13-7 (2) in the event the scope of licensure includes both
13-8 medical care and hospital or institutional services, the entity
13-9 shall establish and maintain reserves that are adequate to cover
13-10 the liabilities and risks associated with the services, either
13-11 medical care or hospital and other institutional services, which
13-12 has been allocated the largest portion of the premium by the health
13-13 maintenance organization and assumed by the delegated network. If
13-14 the delegated network accepts financial risk for either medical
13-15 care or hospital and other institutional services, and prescription
13-16 drugs, as defined by section 551.003 of the Occupations Code, the
13-17 entity also shall establish and maintain reserves that are adequate
13-18 to cover the liabilities and risks associated with these
13-19 pharmaceutical services. At a minimum, the delegated entity must
13-20 maintain financial reserves equal to the greater of:
13-21 (i) 80 percent of the risks and liabilities that
13-22 must be reserved pursuant to this Subsection and that have been
13-23 incurred but not paid by the delegated entity; or
13-24 (ii) two months of the premium amount assumed by
13-25 the delegated entity for services that must be reserved pursuant to
13-26 this Subsection.
14-1 (iii) in no event does subsection (d) apply to a
14-2 delegated entity that shares risk with a health maintenance
14-3 organization.
14-4 (e) The financial reserves required by Subsection (d) must
14-5 be secured by and only consist of legal tender of the United States
14-6 or bonds of the United States or the State of Texas and shall be
14-7 held at a location in Texas with a financial institution chartered
14-8 by the United States or the State of Texas, in trust for benefit
14-9 of, or to provide health care services to, enrollees of the health
14-10 maintenance organization pursuant to the agreement between the
14-11 health maintenance organization and the delegated network.
14-12 (f) ([d]) A health maintenance organization that becomes aware
14-13 of any information [receives information through the monitoring plan
14-14 required by Subsection (a)(1) of this section] that indicates the
14-15 delegated entity or network is not operating in accordance with its
14-16 written agreement or is operating in a condition that renders the
14-17 continuance of its business hazardous to the enrollees, shall, in
14-18 writing:
14-19 (1) notify the delegated entity or network of those
14-20 findings and
14-21 (2) request a written explanation, along with
14-22 documentation in support of its explanation of:
14-23 (A) the delegated entity's or the delegated
14-24 network's apparent [network's] noncompliance with the written
14-25 agreement; or
14-26 (B) the delegated entity's or the delegated
15-1 network's apparent [network's] business hazardous to the enrollees;
15-2 and
15-3 (3) provide the commissioner with copies of all
15-4 notices and requests submitted to the delegated entity as well as
15-5 the responses and other documentation it generates or receives in
15-6 response to the notices and requests.
15-7 (g) ([e]) A delegated entity or network shall respond to a
15-8 request from a health maintenance organization under Subsection (d)
15-9 of this section in writing not later than the 30th day after the
15-10 date the request is received.
15-11 (h) [(f)] The health maintenance organization shall cooperate
15-12 with the delegated entity or network to correct any failure by the
15-13 delegated entity or network to comply with the regulatory
15-14 requirements of the department relating to any matters:
15-15 (1) delegated to the delegated entity or network by
15-16 the health maintenance organization; or
15-17 (2) necessary for the health maintenance organization
15-18 to ensure compliance with statutory or regulatory requirements.
15-19 [(g);] [The health maintenance organization shall notify the
15-20 department and request intervention if:]
15-21 [(1) the health maintenance organization does not
15-22 receive a timely response from the delegated network as required by
15-23 Subsection (e) of this section; or]
15-24 [(2) the health maintenance organization receives a
15-25 timely response from the delegated network as required by
15-26 Subsection (e) of this section, but the health maintenance
16-1 organization and the delegated network are unable to reach an
16-2 agreement as to whether the delegated network:]
16-3 [(A) is complying with the written agreement; or]
16-4 [(B) has corrected any problem regarding a practice
16-5 that is hazardous to an enrollee of the health maintenance
16-6 organization.]
16-7 (i) [(h)] On receipt of a notice, a request [for intervention]
16-8 under Subsection (f[d]) of this section, or in the event of
16-9 complaints filed with the department, the department may[;] examine
16-10 the matters contained in the notice as well as any other matters
16-11 relating to the financial solvency of the delegated entity or
16-12 network or its ability to meet its responsibilities in connection
16-13 with any function delegated to the entity or network by the health
16-14 maintenance organization
16-15 [(1) request financial and operational documents from
16-16 the delegated network to further investigate deficiencies indicated
16-17 by the monitoring plan]
16-18 [(2) conduct an on site audit of the delegated network
16-19 if the department determines that the delegated network is not
16-20 complying with the monitoring standards required under
16-21 Subsection(a)(1) of this section; or]
16-22 [(3) notwithstanding any other provisions, upon
16-23 violation of a monitoring plan, suspend or revoke the third party
16-24 administrator license or utilization review agent license of:]
16-25 [(A) the delegated network; or]
16-26 [(B) A third party with which the delegated
17-1 network has contracted].
17-2 (j) [(i)] Upon completion of its examination [The] the
17-3 department shall report to the delegated entity or network and the
17-4 health maintenance organization the results of its examination
17-5 along with any actions that the department determines are necessary
17-6 to ensure that:
17-7 (1) the health maintenance organization meets its
17-8 responsibilities under the code and applicable rules adopted by the
17-9 department; and
17-10 (2) the delegated entity or network can meet its
17-11 responsibilities in connection with any function delegated to the
17-12 entity by the health maintenance organization [review not later than
17-13 the 60th day after the date of the department's initial request for
17-14 documentation; provided, h]However, the department shall not report
17-15 to the health maintenance organization any information regarding
17-16 fee schedules, prices, cost of care, or other information not
17-17 relevant to the monitoring plan.
17-18 (k) [(j)] The delegated entity or network and the health
17-19 maintenance organization [network] shall respond to the department's
17-20 report and submit a corrective plan to the department [and to the
17-21 health maintenance organization] not later than the 30th day after
17-22 the date of receipt of [the delegated network receives] the
17-23 department's report. The department shall not report to the health
17-24 maintenance organization [The delegated network may withhold]
17-25 information regarding fee schedules, prices, cost of care, or other
17-26 information not relevant to the monitoring plan.
18-1 (l) [(k). reports and corrective plans required under
18-2 Subsection (i) or (j) of this section shall be treated as public
18-3 documents, except that h] Health care provider fee schedules,
18-4 prices, costs of care, reports and corrective plans or other
18-5 information not relevant to the monitoring plan and any other
18-6 information that is considered confidential by law shall be
18-7 considered confidential. A listing of all delegated network
18-8 agreements, indicating the parties to the agreement, filed under
18-9 Subsection (a) shall be considered public information and subject
18-10 to disclosure under Chapter 552, Government Code.
18-11 (m) [(l)] At any time, the [The] department may request that a
18-12 delegated network or entity take corrective action to comply with
18-13 the department's statutory and regulatory requirements that:
18-14 (1) relate to any matters delegated by the health
18-15 maintenance organization to the delegated entity or network; or
18-16 (2) are necessary to ensure the health maintenance
18-17 organization's compliance with statutory and regulatory
18-18 requirements.
18-19 (n) [(m)] Regardless of whether [If] a delegated entity or
18-20 network [does not comply] complies with the department's request for
18-21 corrective action, the department may order the health maintenance
18-22 organization to take any steps the commissioner deems necessary to
18-23 ensure that the health maintenance organization is in compliance
18-24 with this Act including but not limited to:
18-25 (1) reassumption of the functions delegated to the
18-26 delegated entity or network including claims payments for services
19-1 previously rendered to enrollees of the health maintenance
19-2 organization.
19-3 (2) [(1)] temporarily or permanently ceasing [cease]
19-4 assignment of new enrollees to the delegated network or entity;
19-5 (3) [(2)] the temporary or permanent [temporarily or
19-6 permanently] transfer of enrollees to alternative delivery systems
19-7 to receive services; [or]
19-8 (4) [(3)] immediate termination of [modify or terminate]
19-9 its contract with the delegated entity or network[.]; or
19-10 (o)[(n)] The commissioner shall maintain enrollee and provider
19-11 complaints in a manner that identifies complaints made about
19-12 delegated network or entities.
19-13 (p) notwithstanding any other provisions of this code, the
19-14 commissioner may suspend or revoke the license of any third party
19-15 administrator or utilization review agent that fails to comply with
19-16 this section.
19-17 (q) Section 18C of this Act does not apply to a group model
19-18 health maintenance organization as defined in section 6A of this
19-19 Act.
19-20 (r) [(o)] The commissioner shall adopt such rules [as] necessary
19-21 to [interpret,] implement, [and enforce] this section.
19-22 SECTION 3. This Act takes effect September 1, 2001. This
19-23 Act applies to contracts entered into by health maintenance
19-24 organizations that are entered into or renewed on or after January
19-25 1, 2002.
19-26 SECTION 4. The importance of this legislation and the
20-1 crowded condition of the calendars in both houses create an
20-2 emergency and an imperative public necessity that the
20-3 constitutional rule requiring bills to be read on three several
20-4 days in each house be suspended, and this rule is hereby suspended,
20-5 and that this Act take effect and be in force from and after its
20-6 passage, and it is so enacted.