By: Phelan, Paddie, Springer, H.B. No. 1576
      González of El Paso, Rose, et al.
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
 
  relating to the delivery of certain medical transportation
  services, including under Medicaid and certain other health and
  human services programs; imposing a mandatory payment; authorizing
  an administrative penalty.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 531.02414(a), Government Code, is
  amended by amending Subdivision (1) and adding Subdivisions (1-a)
  and (3) to read as follows:
               (1)  "Medical transportation program" means the
  program that provides nonemergency transportation services [to and
  from covered health care services, based on medical necessity,] to
  recipients under Medicaid, the children with special health care
  needs program, and the transportation for indigent cancer patients
  program, who have no other means of transportation.
               (1-a)  "Nonemergency transportation service" means a
  service provided to transport a person to or from medically
  necessary services covered under a health care program in which the
  person is enrolled. The term does not include a nonmedical
  transportation service as defined by Section 531.024142.
               (3)  "Transportation network company" has the meaning
  assigned by Section 2402.001, Occupations Code.
         SECTION 2.  Section 531.02414, Government Code, is amended
  by amending Subsection (f) and adding Subsections (i), (j), (k),
  (l), and (m) to read as follows:
         (f)  Except as provided by Subsection (j), the [The]
  commission shall require compliance with the rules adopted under
  Subsection (e) in any contract entered into with a regional
  contracted broker to provide nonemergency transportation services
  under the medical transportation program.
         (i)  Emergency medical services personnel and emergency
  medical services vehicles, as those terms are defined by Section
  773.003, Health and Safety Code, may not provide nonemergency
  transportation services under the medical transportation program.
         (j)  A regional contracted broker may subcontract with a
  transportation network company to provide services under this
  section.  A rule or other requirement adopted by the executive
  commissioner under Subsection (e) does not apply to the
  subcontracted transportation network company or a motor vehicle
  operator who is part of the company's network.  The commission or
  the regional contracted broker may not require a motor vehicle
  operator who is part of the subcontracted transportation network
  company's network to enroll as a Medicaid provider to provide
  services under this section.
         (k)  The commission or a regional contracted broker that
  subcontracts with a transportation network company under
  Subsection (j) may require the transportation network company or a
  motor vehicle operator who provides services under this section to
  be periodically screened against the list of excluded individuals
  and entities maintained by the Office of Inspector General of the
  United States Department of Health and Human Services.
         (l)  Notwithstanding any other law, a motor vehicle operator
  who is part of the network of a transportation network company that
  subcontracts with a regional contracted broker under Subsection (j)
  and who satisfies the driver requirements in Section 2402.107,
  Occupations Code, is qualified to provide services under this
  section. The commission and the regional contracted broker may not
  impose any additional requirements on a motor vehicle operator who
  satisfies the driver requirements in Section 2402.107, Occupations
  Code, to provide services under this section.
         (m)  For purposes of this section and notwithstanding
  Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
  operator who provides services under this section may use a
  wheelchair-accessible vehicle equipped with a lift or ramp that is
  capable of transporting passengers using a fixed-frame wheelchair
  in the cabin of the vehicle if the vehicle otherwise meets the
  requirements of Section 2402.111, Occupations Code.
         SECTION 3.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.024142 to read as follows:
         Sec. 531.024142.  NONMEDICAL TRANSPORTATION SERVICES UNDER
  MEDICAID. (a) In this section:
               (1)  "Managed care organization" means a managed care
  organization that contracts with the commission to provide health
  care services to Medicaid recipients under Chapter 533.
               (2)  "Nonmedical transportation service" means:
                     (A)  curb-to-curb transportation in a standard
  passenger vehicle to and from a medically necessary, nonemergency
  covered health care service of a Medicaid recipient enrolled in a
  managed care plan that the managed care organization that provides
  health care services to the recipient determines meets the level of
  care that is medically appropriate for the recipient and that is
  scheduled not more than 48 hours before the transportation occurs,
  including transportation related to:
                           (i)  discharge of a recipient from a health
  care facility;
                           (ii)  receipt of urgent care; and
                           (iii)  obtaining pharmacy services and
  prescription drugs; and
                     (B)  any other transportation to or from a
  medically necessary, nonemergency covered health care service the
  commission considers appropriate to be provided by a transportation
  vendor, as determined by commission rule or policy.
               (3)  "Transportation network company" has the meaning
  assigned by Section 2402.001, Occupations Code.
               (4)  "Transportation vendor" means an entity,
  including a transportation network company, that contracts with a
  managed care organization to provide nonmedical transportation
  services.
         (b)  The executive commissioner shall adopt rules regarding
  the manner in which nonmedical transportation services may be
  arranged and provided.
         (c)  The rules must require a managed care organization to
  create a process to:
               (1)  verify that a passenger is eligible to receive
  nonmedical transportation services;
               (2)  ensure that nonmedical transportation services
  are provided only to and from covered health care services in areas
  in which a transportation network company operates;
               (3)  refer a Medicaid recipient enrolled in a managed
  care plan offered by the managed care organization to the medical
  transportation program described by Section 531.02414 if:
                     (A)  by rule the managed care organization is not
  responsible for providing transportation services; or
                     (B)  the recipient requires an accessible or
  specialized vehicle that is not available through a transportation
  vendor; and
               (4)  ensure the timely delivery of nonmedical
  transportation services to a Medicaid recipient, including by
  setting reasonable service response goals.
         (d)  A rule adopted in accordance with Subsection (c)(4) may
  not penalize a managed care organization that contracts with a
  transportation vendor under this section if the vendor is unable to
  provide nonmedical transportation services to a Medicaid recipient
  after the managed care organization has made a specific request for
  those services.
         (e)  The rules must require a transportation vendor to,
  before permitting a motor vehicle operator to provide nonmedical
  transportation services:
               (1)  confirm that the operator:
                     (A)  is at least 18 years of age;
                     (B)  maintains a valid driver's license issued by
  this state, another state, or the District of Columbia; and
                     (C)  possesses proof of registration and
  automobile financial responsibility for each motor vehicle to be
  used to provide nonmedical transportation services;
               (2)  conduct, or cause to be conducted, a local, state,
  and national criminal background check for the operator that
  includes the use of:
                     (A)  a commercial multistate and
  multijurisdiction criminal records locator or other similar
  commercial nationwide database; and
                     (B)  the national sex offender public website
  maintained by the United States Department of Justice or a
  successor agency;
               (3)  confirm that any vehicle to be used to provide
  nonmedical transportation services:
                     (A)  meets the applicable requirements of Chapter
  548, Transportation Code; and
                     (B)  except as provided by Subsection (j), has at
  least four doors; and
               (4)  obtain and review the operator's driving record.
         (f)  The rules may not permit a motor vehicle operator to
  provide nonmedical transportation services if the operator:
               (1)  has been convicted in the three-year period
  preceding the issue date of the driving record obtained under
  Subsection (e)(4) of:
                     (A)  more than three offenses classified by the
  Department of Public Safety as moving violations; or
                     (B)  one or more of the following offenses:
                           (i)  fleeing or attempting to elude a police
  officer under Section 545.421, Transportation Code;
                           (ii)  reckless driving under Section
  545.401, Transportation Code;
                           (iii)  driving without a valid driver's
  license under Section 521.025, Transportation Code; or
                           (iv)  driving with an invalid driver's
  license under Section 521.457, Transportation Code;
               (2)  has been convicted in the preceding seven-year
  period of any of the following:
                     (A)  driving while intoxicated under Section
  49.04 or 49.045, Penal Code;
                     (B)  use of a motor vehicle to commit a felony;
                     (C)  a felony crime involving property damage;
                     (D)  fraud;
                     (E)  theft;
                     (F)  an act of violence; or
                     (G)  an act of terrorism; or
               (3)  is found to be registered in the national sex
  offender public website maintained by the United States Department
  of Justice or a successor agency.
         (g)  The commission may not require:
               (1)  a motor vehicle operator to enroll as a Medicaid
  provider to provide nonmedical transportation services; or
               (2)  a managed care organization to credential a motor
  vehicle operator to provide nonmedical transportation services.
         (h)  The commission or a managed care organization that
  contracts with a transportation vendor may require the
  transportation vendor or a motor vehicle operator who provides
  services under this section to be periodically screened against the
  list of excluded individuals and entities maintained by the Office
  of Inspector General of the United States Department of Health and
  Human Services.
         (i)  Notwithstanding any other law, a motor vehicle operator
  who is part of a transportation network company's network and who
  satisfies the driver requirements in Section 2402.107, Occupations
  Code, is qualified to provide nonmedical transportation services.
  The commission and a managed care organization may not impose any
  additional requirements on a motor vehicle operator who satisfies
  the driver requirements in Section 2402.107, Occupations Code, to
  provide nonmedical transportation services.
         (j)  For purposes of this section and notwithstanding
  Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
  operator who provides services under this section may use a
  wheelchair-accessible vehicle equipped with a lift or ramp that is
  capable of transporting passengers using a fixed-frame wheelchair
  in the cabin of the vehicle if the vehicle otherwise meets the
  requirements of Section 2402.111, Occupations Code.
         SECTION 4.  Section 533.00257(a), Government Code, is
  amended by adding Subdivision (2-a) to read as follows:
               (2-a)  "Transportation network company" has the
  meaning assigned by Section 2402.001, Occupations Code.
         SECTION 5.  Section 533.00257, Government Code, is amended
  by amending Subsections (d) and (g) and adding Subsections (k),
  (l), (m), and (n) to read as follows:
         (d)  Except as provided by Subsections (k) and (m), a [A]
  managed transportation organization that participates in the
  medical transportation program must attempt to contract with
  medical transportation providers that:
               (1)  are considered significant traditional providers,
  as defined by rule by the executive commissioner;
               (2)  meet the minimum quality and efficiency measures
  required under Subsection (g) and other requirements that may be
  imposed by the managed transportation organization; and
               (3)  agree to accept the prevailing contract rate of
  the managed transportation organization.
         (g)  Except as provided by Subsections (k) and (m), the [The]
  commission shall require that managed transportation organizations
  and providers participating in the medical transportation program
  meet minimum quality and efficiency measures as determined by the
  commission.
         (k)  A managed transportation organization may subcontract
  with a transportation network company to provide services under
  this section.  A rule or other requirement adopted by the executive
  commissioner under this section or Section 531.02414 does not apply
  to the subcontracted transportation network company or a motor
  vehicle operator who is part of the company's network.  The
  commission or the managed transportation organization may not
  require a motor vehicle operator who is part of the subcontracted
  transportation network company's network to enroll as a Medicaid
  provider to provide services under this section.
         (l)  The commission or a managed transportation organization
  that subcontracts with a transportation network company under
  Subsection (k) may require the transportation network company or a
  motor vehicle operator who provides services under this section to
  be periodically screened against the list of excluded individuals
  and entities maintained by the Office of Inspector General of the
  United States Department of Health and Human Services.
         (m)  Notwithstanding any other law, a motor vehicle operator
  who is part of the network of a transportation network company that
  subcontracts with a managed transportation organization under
  Subsection (k) and who satisfies the driver requirements in Section
  2402.107, Occupations Code, is qualified to provide services under
  this section. The commission and the managed transportation
  organization may not impose any additional requirements on a motor
  vehicle operator who satisfies the driver requirements in Section
  2402.107, Occupations Code, to provide services under this section.
         (n)  For purposes of this section and notwithstanding
  Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
  operator who provides services under this section may use a
  wheelchair-accessible vehicle equipped with a lift or ramp that is
  capable of transporting passengers using a fixed-frame wheelchair
  in the cabin of the vehicle if the vehicle otherwise meets the
  requirements of Section 2402.111, Occupations Code.
         SECTION 6.  Subchapter A, Chapter 533, Government Code, is
  amended by adding Section 533.00259 to read as follows:
         Sec. 533.00259.  DELIVERY OF NONMEDICAL TRANSPORTATION
  SERVICES. (a) In this section, "nonmedical transportation
  service" and "transportation vendor" have the meanings assigned by
  Section 531.024142.
         (b)  The commission shall:
               (1)  not later than January 1, 2020, designate at least
  four managed care service areas, two of which must be urban service
  areas, and require each managed care organization that contracts
  with the commission to provide health care services to recipients
  in those areas to arrange for the provision of nonmedical
  transportation services;
               (2)  not later than July 1, 2020, designate at least
  eight managed care service areas, four of which must be urban
  service areas, and require each managed care organization that
  contracts with the commission to provide health care services to
  recipients in those areas to arrange for the provision of
  nonmedical transportation services; and
               (3)  not later than January 1, 2021, require each
  managed care organization that contracts with the commission to
  provide health care services to recipients to arrange for the
  provision of nonmedical transportation services.
         (b-1)  A managed care organization may contract with a
  transportation vendor or other third party to arrange for the
  provision of nonmedical transportation services. If a managed care
  organization contracts with a third party that is not a
  transportation vendor to arrange for the provision of nonmedical
  transportation services, the third party shall contract with a
  transportation vendor to deliver the nonmedical transportation
  services.
         (c)  A managed care organization that contracts with a
  transportation vendor or other third party to arrange for the
  provision of nonmedical transportation services shall ensure the
  effective sharing and integration of service coordination, service
  authorization, and utilization management data between the managed
  care organization and the transportation vendor or third party.
         (d)  A managed care organization may not require:
               (1)  a motor vehicle operator to enroll as a Medicaid
  provider to provide nonmedical transportation services; or
               (2)  the credentialing of a motor vehicle operator to
  provide nonmedical transportation services.
         (e)  For purposes of this section and notwithstanding
  Section 2402.111(a)(2)(A), Occupations Code, a motor vehicle
  operator who provides services under this section may use a
  wheelchair-accessible vehicle equipped with a lift or ramp that is
  capable of transporting passengers using a fixed-frame wheelchair
  in the cabin of the vehicle if the vehicle otherwise meets the
  requirements of Section 2402.111, Occupations Code.
         SECTION 7.  Section 773.003, Health and Safety Code, is
  amended by adding Subdivision (5) to read as follows:
               (5)  "Commission" means the Health and Human Services
  Commission.
         SECTION 8.  Chapter 773, Health and Safety Code, is amended
  by adding Subchapter J to read as follows:
  SUBCHAPTER J. TEXAS AMBULANCE RESPONSE SAFETY NET PROGRAM
         Sec. 773.301.  PURPOSE. The purpose of this subchapter is to
  authorize the commission to establish and administer the Texas
  ambulance response safety net program as a self-funded ground
  ambulance service provider participation program for ground
  ambulance service providers in accordance with this subchapter.
         Sec. 773.302.  DEFINITIONS. In this subchapter:
               (1)  "Average commercial rate" means the average amount
  payable by commercial payors for the same service.  The rate is
  calculated by:
                     (A)  aligning the paid Medicaid claims with the
  Medicare fees for each Healthcare Common Procedure Coding System
  code or Current Procedural Terminology code for a ground ambulance
  service provider;
                     (B)  calculating the Medicare payment for the
  claims described in Paragraph (A);
                     (C)  calculating a commercial-to-Medicare
  conversion factor for each ground ambulance service provider by
  dividing the total amount of the average commercial payments for
  the claims by the total Medicare payments for the claims; and
                     (D)  recalculating at least once every three years
  the commercial-to-Medicare ratio for ground ambulance service
  providers.
               (2)  "Net patient revenue" means a ground ambulance
  service provider's estimated net realizable revenue from patients,
  third-party payors, and other entities for ground ambulance
  services rendered, including estimated retroactive adjustments
  required by reimbursement agreements with third-party payors.  The
  term does not include:
                     (A)  the amounts the provider reduces for payors
  who have a fee schedule established by federal or state statute or a
  contractual agreement;
                     (B)  Medicaid payments received by the provider,
  including any payments for individuals who are dually eligible for
  Medicaid and Medicare;
                     (C)  amounts the provider reduces to zero as an
  uncollectible payment from any payor that are not contractual
  allowances, provided that the provider attempted to collect the
  payment; or
                     (D)  amounts related to ground ambulance services
  that are waived or forgiven by a paying entity due to the financial
  hardship of the patient, provided that the waiver or forgiveness is
  implemented in accordance with a written policy of the entity that
  is consistent with national standards adopted by the Healthcare
  Financial Management Association or a similar organization.
         Sec. 773.303.  APPLICABILITY. (a)  This subchapter applies
  only to a ground ambulance service provider that is:
               (1)  an emergency medical services provider as defined
  by Section 773.003 and licensed under this chapter;
               (2)  a nonpublic, nonfederal provider of ground
  ambulance services; and
               (3)  a participant in the state Medicaid program.
         (b)  This subchapter does not apply to:
               (1)  an entity that provides only nonemergency ground
  ambulance services;
               (2)  a state or local governmental entity that provides
  ground ambulance services; or
               (3)  an entity that is required to hold a license under
  Section 773.045(b).
         (c)  The executive commissioner may not modify the
  applicability of this subchapter in an effort to comply with the
  requirements of 42 C.F.R. Section 433.68.
         Sec. 773.304.  MANDATORY PAYMENTS BASED ON NET PATIENT
  REVENUE. (a)  Except as otherwise provided by this subchapter, the
  commission shall require an annual mandatory payment to be assessed
  on each ground ambulance service provider's net patient revenue
  related to the provision of emergency ground ambulance services.  
  The mandatory payment is to be collected quarterly.  The commission
  shall update the amount of the mandatory payment at least annually.
         (b)  The commission shall uniformly and consistently impose
  the mandatory payment on each ground ambulance service provider and
  use the same formula for each provider in calculating the mandatory
  payment.
         (c)  The total amount of all mandatory payments for the state
  fiscal year in which the mandatory payments are imposed may not
  exceed:
               (1)  the state portion, excluding any federal financial
  participation, of the cost of reimbursement enhancements provided
  in this subchapter that are directly attributable to reimbursements
  to ground ambulance service providers; or
               (2)  an amount equal to six percent of the net operating
  revenue of all ground ambulance service providers for the provision
  of emergency ground ambulance services, or an amount otherwise
  permitted by federal law, provided that the maximum mandatory
  payment for a provider in any year may not exceed the provider's net
  patient revenue, as reported by the provider, subject to Section
  773.306(b).
         (d)  Subject to the maximum amount prescribed by Subsection
  (c), the commission shall set the mandatory payment in an amount
  that in the aggregate generates sufficient revenue to cover the
  administrative expenses of the commission for activities under this
  subchapter.
         (e)  Not later than the 30th day before the end of each
  quarter, the commission shall issue to each ground ambulance
  service provider a notice of the amount of the mandatory payment
  required to be paid by the provider in the next quarter.
         (f)  A ground ambulance service provider may not add a
  mandatory payment required under this subchapter as a surcharge to
  a patient or a third-party payor.
         (g)  A ground ambulance service provider shall make
  mandatory payments only in the manner provided by this subchapter.
         Sec. 773.305.  ASSESSMENT AND COLLECTION OF MANDATORY
  PAYMENTS. (a) Subject to Subsection (b), the commission shall
  collect a mandatory payment required under this subchapter.
         (b)  The commission may contract for the assessment and
  collection of mandatory payments under this subchapter.
         Sec. 773.306.  REPORT; INSPECTION OF RECORDS. (a) The
  commission shall require a ground ambulance service provider to
  submit a report at least annually, but not more than quarterly, that
  includes information necessary to assist the commission in making a
  determination on mandatory payments under this subchapter.
         (b)  The executive commissioner may audit or inspect the
  records of a ground ambulance service provider to the extent
  necessary to ensure the accuracy of any data submitted to the
  commission under this subchapter.
         Sec. 773.307.  FAILURE TO SUBMIT TIMELY OR ACCURATE REPORT
  OR PAYMENT; AUDIT; ADMINISTRATIVE PENALTY. (a) The commission may
  assess a reasonable penalty against a ground ambulance service
  provider, not to exceed 15 percent of the quarterly portion of the
  provider's mandatory payment, for failure to timely submit the
  quarterly portion of a mandatory payment or a report required under
  this subchapter.
         (b)  If a ground ambulance service provider submits an
  inaccurate report required under this subchapter, the commission
  may conduct an audit of the provider's records and may require the
  provider to pay the cost of any audit expenses and related hearings.
         (c)  A penalty assessed under this section is in addition to
  any other penalties and remedies applicable under state or federal
  law.
         (d)  If a ground ambulance service provider refuses to submit
  a quarterly portion of a mandatory payment, the commission may
  suspend all Medicaid payments to the provider until:
               (1)  the provider submits the quarterly portion of the
  mandatory payment and any associated penalties; or
               (2)  the provider and the commission reach a negotiated
  settlement.
         Sec. 773.308.  TEXAS AMBULANCE RESPONSE SAFETY NET TRUST
  FUND. (a) The Texas ambulance response safety net trust fund is
  established as a trust fund to be held by the comptroller outside
  the state treasury and administered by the commission as trustee.
         (b)  The trust fund consists of:
               (1)  all revenue from the mandatory payments required
  by this subchapter, including any administrative penalties and any
  interest attributable to delinquent payments; and
               (2)  the earnings of the fund.
         (c)  Money deposited to the trust fund may be used only to:
               (1)  provide reimbursements for ground ambulance
  services delivered to Medicaid recipients under a fee-for-service
  arrangement by a ground ambulance service provider to which this
  subchapter applies based on the provider's average commercial rate,
  including reimbursement enhancements to the statewide dollar
  amount rate used to reimburse ground ambulance service providers;
               (2)  pay the administrative expenses of the commission
  solely for activities under this subchapter; and
               (3)  refund a portion of a mandatory payment collected
  in error from a provider.
         (d)  All revenue from the mandatory payments required by this
  subchapter must be deposited in the trust fund.
         (e)  Money in the trust fund may not be used to expand
  Medicaid eligibility under the Patient Protection and Affordable
  Care Act (Pub. L. No. 111-148) as amended by the Health Care and
  Education Reconciliation Act of 2010 (Pub. L. No. 111-152).
         Sec. 773.309.  INVALIDITY; FEDERAL FUNDS. The commission
  shall stop collection of the mandatory payment and, not later than
  the 30th day after the date collection is stopped, return to each
  ground ambulance service provider, in proportion to the total
  amount paid by each provider compared to the total amount paid by
  all providers, any unspent money deposited to the credit of the
  trust fund, if:
               (1)  any provision of or procedure under this
  subchapter is held invalid by a final court order that is not
  subject to appeal;
               (2)  the commission determines that the imposition of
  the mandatory payment and the expenditure of amounts collected as
  prescribed by this subchapter will not entitle the state to receive
  federal matching funds under the Medicaid program or will be
  inconsistent with the objectives described by Section
  537.002(b)(7), Government Code; or
               (3)  the commission determines that the amount of the
  mandatory payments collected would exceed the amount paid in
  increased Medicaid fee-for-service reimbursement rates for
  services provided to individuals who are dually eligible for
  Medicaid and Medicare.
         Sec. 773.310.  RULES. The executive commissioner shall
  adopt rules necessary to implement this subchapter.
         SECTION 9.  Subchapter B, Chapter 32, Human Resources Code,
  is amended by adding Section 32.080 to read as follows:
         Sec. 32.080.  ENHANCED PAYMENT MODEL FOR CERTAIN AMBULANCE
  PROVIDERS. (a) The executive commissioner, in consultation with
  ambulance providers, by rule shall establish an enhanced payment
  model for reimbursing non-state operated public ambulance
  providers who provide ground emergency medical transportation
  services to recipients of medical assistance. The enhanced payment
  model must be implemented under the Medicaid fee-for-service
  delivery model through supplemental payments and the Medicaid
  managed care delivery model through an enhanced reimbursement or
  payment rate.
         (b)  The commission may not use general revenue to reimburse
  non-state operated public ambulance providers under or administer
  the enhanced payment model.
         (c)  Reimbursements made under the enhanced payment model
  must be:
               (1)  in addition to money appropriated to the
  commission for reimbursing non-state operated public ambulance
  providers; and
               (2)  provided in a manner that maximizes the
  availability of federal money.
         (d)  Under the enhanced payment model, the commission may:
               (1)  receive and spend money from an intergovernmental
  transfer on:
                     (A)  reimbursing non-state operated public
  ambulance providers; and
                     (B)  covering the cost of establishing and
  administering the enhanced payment model; and
               (2)  as necessary, certify that reimbursements made
  under the enhanced payment model are public funds eligible for
  federal financial participation in accordance with the
  requirements of 42 C.F.R. Section 433.51.
         SECTION 10.  As soon as practicable after the effective date
  of this Act, the executive commissioner of the Health and Human
  Services Commission shall establish the amount of the initial
  mandatory payment imposed under Subchapter J, Chapter 773, Health
  and Safety Code, as added by this Act, based on available net
  patient revenue information.
         SECTION 11.  If before implementing any provision of this
  Act a state agency determines that a waiver or authorization from a
  federal agency is necessary for implementation of that provision,
  the agency affected by the provision shall request the waiver or
  authorization and:
               (1)  for a provision of Subchapter J, Chapter 773,
  Health and Safety Code, as added by this Act, shall delay
  implementing that provision, including the collection of a
  mandatory payment, until the waiver or authorization is granted and
  begin implementing the provision on the date the waiver or
  authorization is granted; and
               (2)  for any other provision, may delay implementing
  the provision until the waiver or authorization is granted.
         SECTION 12.  As soon as practicable after the effective date
  of this Act, the executive commissioner of the Health and Human
  Services Commission shall adopt rules as necessary to implement the
  changes in law made by this Act.
         SECTION 13.  This Act takes effect immediately if it
  receives a vote of two-thirds of all the members elected to each
  house, as provided by Section 39, Article III, Texas Constitution.
  If this Act does not receive the vote necessary for immediate
  effect, this Act takes effect September 1, 2019.