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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision and reimbursement of, or benefits for, |
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home telemonitoring services, telemedicine medical services, and |
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telehealth services under Medicaid and certain health benefit plans |
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provided to certain retired public employees. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Sections 531.02164(a) and (c), Government Code, |
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as amended by S.B. No. 219, Acts of the 84th Legislature, Regular |
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Session, 2015, are amended to read as follows: |
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(a) In this section: |
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(1) "Elderly individual" means an individual 60 years |
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of age or older. |
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(2) "Home and community support services agency" means |
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a person licensed under Chapter 142, Health and Safety Code, to |
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provide home health, hospice, or personal assistance services as |
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defined by Section 142.001, Health and Safety Code. |
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(3) [(2)] "Hospital" means a hospital licensed under |
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Chapter 241, Health and Safety Code. |
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(4) "Individual with special health care needs" means |
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an individual who has: |
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(A) a chronic physical or developmental |
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condition; or |
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(B) a terminal illness. |
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(c) The program required under this section must: |
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(1) provide that home telemonitoring services are |
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available [only] to a person [persons] who is: |
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(A) an elderly individual; |
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(B) an individual with special health care needs; |
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or |
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(C) an individual who: |
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(i) is [are] diagnosed with one or more of |
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the following conditions: |
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(a) [(i)] pregnancy; |
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(b) [(ii)] diabetes; |
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(c) [(iii)] heart disease; |
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(d) [(iv)] cancer; |
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(e) [(v)] chronic obstructive |
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pulmonary disease; |
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(f) [(vi)] hypertension; |
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(g) [(vii)] congestive heart failure; |
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(h) [(viii)] mental illness or |
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serious emotional disturbance; |
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(i) [(ix)] asthma; |
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(j) [(x)] myocardial infarction; or |
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(k) [(xi)] stroke; and |
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(ii) exhibits [(B) exhibit] two or more of |
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the following risk factors: |
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(a) [(i)] two or more |
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hospitalizations in the prior 12-month period; |
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(b) [(ii)] frequent or recurrent |
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emergency room admissions; |
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(c) [(iii)] a documented history of |
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poor adherence to ordered medication regimens; |
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(d) [(iv)] a documented history of |
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falls in the prior six-month period; |
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(e) [(v)] limited or absent informal |
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support systems; |
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(f) [(vi)] living alone or being home |
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alone for extended periods of time; and |
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(g) [(vii)] a documented history of |
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care access challenges; |
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(2) ensure that clinical information gathered by a |
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home and community support services agency or hospital while |
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providing home telemonitoring services is shared with the patient's |
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physician; and |
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(3) ensure that the program does not duplicate disease |
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management program services provided under Section 32.057, Human |
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Resources Code. |
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SECTION 2. Subchapter B, Chapter 531, Government Code, is |
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amended by adding Section 531.02165 to read as follows: |
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Sec. 531.02165. PROVISION OF TELEMEDICINE MEDICAL SERVICES |
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AND TELEHEALTH SERVICES TO RECIPIENTS AT RESIDENCE. (a) In this |
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section, "residence" means a place where a person resides and |
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includes a home, a nursing home, a convalescent home, or a |
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residential unit. |
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(b) Not later than June 1, 2016, the executive commissioner |
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shall develop and implement a pilot project under Medicaid that |
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provides for the reimbursement of telemedicine medical services and |
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telehealth services provided to a recipient while the recipient is |
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at the recipient's residence. |
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(c) Not later than December 1, 2018, the executive |
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commissioner shall submit a report to the legislature on the |
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results of the pilot project established under Subsection (b). The |
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report must include: |
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(1) an evaluation of the pilot project's success in |
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increasing health care access for Medicaid recipients; |
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(2) an evaluation of the cost savings to the state and |
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Medicaid recipients attributable to the pilot project; and |
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(3) a recommendation regarding the continuation, |
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expansion, or termination of the pilot project. |
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(d) The report required by Subsection (c) may be made in |
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conjunction with any other report the commission is required to |
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submit to the legislature if the executive commissioner determines |
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it appropriate. |
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(e) Subsections (c) and (d) and this subsection expire |
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September 1, 2019. |
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SECTION 3. Section 531.0217, Government Code, is amended by |
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adding Subsection (d-1) to read as follows: |
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(d-1) A request to the commission for reimbursement for a |
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telemedicine medical service that is medically necessary may not be |
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denied solely because of the delivery method of the service. |
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SECTION 4. Subchapter E, Chapter 1551, Insurance Code, is |
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amended by adding Section 1551.227 to read as follows: |
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Sec. 1551.227. PILOT PROJECT: TELEMEDICINE MEDICAL |
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SERVICES AND TELEHEALTH SERVICES TO ANNUITANTS AT RESIDENCE. (a) |
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In this section: |
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(1) "Telehealth service" and "telemedicine medical |
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service" have the meanings assigned by Section 531.001, Government |
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Code. |
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(2) "Residence" means a place where a person resides |
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and includes a home, a nursing home, a convalescent home, or a |
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residential unit. |
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(b) The board of trustees shall establish a pilot project |
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under which a group health benefit plan offered under the group |
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benefits program provides benefits for telemedicine medical |
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services and telehealth services provided to an annuitant at the |
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annuitant's residence. |
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(c) Not later than June 1, 2016, the board of trustees shall |
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enter into any agreements necessary to provide benefits for |
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telemedicine medical services and telehealth services to |
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annuitants who participate in the pilot project. The pilot project |
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must: |
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(1) provide services in a manner that allows at least |
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one percent of annuitants to participate in the pilot project; |
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(2) aim to provide quality and cost-effective care to |
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annuitants; and |
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(3) ensure that the pilot project is able to provide |
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services to annuitants. |
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(d) Not later than December 1, 2018, the board of trustees |
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shall submit a report to the legislature on the results of the pilot |
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project established under Subsection (b). The report must include: |
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(1) an evaluation of the pilot project's success; |
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(2) an evaluation of the cost savings to the state; and |
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(3) a recommendation regarding the continuation, |
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expansion, or termination of the pilot project. |
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(e) The board of trustees may adopt rules necessary to |
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implement this section. |
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(f) This section expires on September 1, 2019. |
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SECTION 5. Subchapter D, Chapter 1575, Insurance Code, is |
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amended by adding Section 1575.166 to read as follows: |
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Sec. 1575.166. PILOT PROJECT: TELEMEDICINE MEDICAL |
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SERVICES AND TELEHEALTH SERVICES TO RETIREES AT RESIDENCE. (a) In |
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this section: |
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(1) "Telehealth service" and "telemedicine medical |
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service" have the meanings assigned by Section 531.001, Government |
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Code. |
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(2) "Residence" means a place where a person resides |
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and includes a home, a nursing home, a convalescent home, or a |
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residential unit. |
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(b) The trustee shall establish a pilot project under which |
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a health benefit plan provided under this chapter provides benefits |
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for telemedicine medical services and telehealth services provided |
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to a retiree at the retiree's residence. |
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(c) Not later than June 1, 2016, the trustee shall enter |
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into any agreements necessary to provide benefits for telemedicine |
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medical services and telehealth services to retirees who |
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participate in the pilot project. The pilot project must: |
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(1) provide services in a manner that allows at least |
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one percent of retirees to participate in the pilot project; |
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(2) aim to provide quality and cost-effective care to |
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retirees; and |
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(3) ensure that the pilot project is able to provide |
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services to retirees. |
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(d) Not later than December 1, 2018, the trustee shall |
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submit a report to the legislature on the results of the pilot |
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project established under Subsection (b). The report must include: |
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(1) an evaluation of the pilot project's success; |
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(2) an evaluation of the cost savings to the state; and |
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(3) a recommendation regarding the continuation, |
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expansion, or termination of the pilot project. |
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(e) The trustee may adopt rules necessary to implement this |
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section. |
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(f) This section expires on September 1, 2019. |
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SECTION 6. Section 531.02176, Government Code, as amended |
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by S.B. No. 219, Acts of the 84th Legislature, Regular Session, |
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2015, is repealed. |
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SECTION 7. Section 531.02164, Government Code, as amended |
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by this Act, applies only to an insurance claim filed, an insurance |
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policy entered into, or a legal cause arising on or after the |
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effective date of this Act. An insurance claim filed, an insurance |
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policy entered into, or a legal cause that arose before the |
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effective date of this Act is governed by the law as it existed |
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immediately before the effective date of this Act, and that law is |
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continued in effect for that purpose. |
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SECTION 8. (a) Not later than March 1, 2016, the executive |
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commissioner of the Health and Human Services Commission shall |
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adopt the rules necessary to implement Section 531.02164, |
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Government Code, as amended by this Act. |
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(b) Not later than May 1, 2016, the executive commissioner of |
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the Health and Human Services Commission shall adopt the rules |
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necessary to implement Section 531.02165, Government Code, as added |
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by this Act, and Section 531.0217, Government Code, as amended by |
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this Act. |
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SECTION 9. Not later than May 1, 2016, the Employees |
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Retirement System of Texas shall adopt rules necessary to implement |
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Section 1551.227, Insurance Code, as added by this Act. |
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SECTION 10. Not later than May 1, 2016, the Teacher |
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Retirement System of Texas shall adopt rules necessary to implement |
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Section 1575.166, Insurance Code, as added by this Act. |
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SECTION 11. If before implementing any provision of this |
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Act a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 12. This Act takes effect September 1, 2015. |