87R11767 SRA-F
 
  By: Lucio, et al. S.B. No. 1944
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to end-of-life issues and hospice care.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter A, Chapter 166, Health and Safety
  Code, is amended by adding Section 166.012 to read as follows:
         Sec. 166.012.  PATIENT AND PROVIDER AUTONOMY. This chapter
  does not:
               (1)  authorize a surrogate or patient's proxy to
  supersede the patient's wishes or desires, if known by the patient's
  physician, family member, or surrogate;
               (2)  subject to Section 166.046, require a health care
  provider to continue treatment or care considered outside the
  appropriate scope of care or in violation of the provider's ethical
  duties; or
               (3)  prohibit a health care provider or facility from
  performing any test or diagnostic necessary to determine the
  patient's medical condition or related functions.
         SECTION 2.  Section 166.046, Health and Safety Code, is
  amended by adding Subsections (a-1), (a-2), and (b-1) and amending
  Subsections (b), (c), and (e) to read as follows:
         (a-1)  When an ethics or medical committee review is
  initiated under this chapter, the ethics or medical committee
  shall:
               (1)  inform the patient or surrogate that the patient
  or surrogate may discontinue the process under this section by
  providing written notice to the ethics or medical committee;
               (2)  appoint a patient liaison familiar with
  end-of-life issues and hospice care options to assist the patient
  or surrogate throughout the process described by this section; and
               (3)  advise the patient or surrogate that the patient's
  attending physician may present medical facts at the meeting of the
  ethics or medical committee.
         (a-2)  The patient's attending physician may attend and
  present facts at an ethics or medical committee review meeting
  initiated under this chapter but may not participate as a member of
  the committee in the review of that case.
         (b)  When a meeting of the ethics or medical committee is
  required under this section, not later than the seventh calendar
  day before the date scheduled for that meeting, unless this period
  is waived by mutual agreement, the committee shall provide to the
  patient or surrogate [The patient or the person responsible for the
  health care decisions of the individual who has made the decision
  regarding the directive or treatment decision]:
               (1)  [may be given] a written description of the ethics
  or medical committee review process and any other policies and
  procedures related to this section adopted by the health care
  facility;
               (2)  notice that the patient or surrogate is entitled
  to receive the continued assistance of a patient liaison to assist
  the patient or surrogate throughout the review process;
               (3)  notice that the patient or surrogate may:
                     (A)  seek a second opinion at the patient's or
  surrogate's expense from other medical professionals regarding the
  patient's medical status and treatment requirements; and
                     (B)  communicate the resulting information to the
  members of the committee for consideration before the meeting;
               (4)  [shall be informed of the committee review process
  not less than 48 hours before the meeting called to discuss the
  patient's directive, unless the time period is waived by mutual
  agreement;
               [(3)  at the time of being so informed, shall be
  provided:
                     [(A)]  a copy of the appropriate statement set
  forth in Section 166.052; and
               (5) [(B)]  a copy of the registry list of health care
  providers, health care facilities, and referral groups that, in
  compliance with any state laws prohibiting barratry, have
  volunteered their readiness to consider accepting transfer or to
  assist in locating a provider willing to accept transfer that is
  posted on the website maintained by the department under Section
  166.053.
         (b-1)  The patient or surrogate[; and
               [(4)]  is entitled to:
               (1)  an invitation to [(A)] attend and participate in
  the meeting of the ethics or medical committee, excluding the
  committee's deliberations, if the patient or surrogate elects to
  attend or participate;
               (2)  be accompanied at the meeting by as many as five
  persons, or more persons at the committee's discretion, for
  support, subject to the facility's reasonable written attendance
  policy as necessary to:
                     (A)  facilitate information sharing and
  discussion of the patient's medical status and treatment
  requirements; and
                     (B)  preserve the order and decorum of the
  meeting;
               (3)  receive a written explanation of the decision
  reached during the review process;
               (4) [(C)]  receive a copy of the portion of the
  patient's medical record related to the treatment received by the
  patient in the facility for the lesser of:
                     (A) [(i)]  the period of the patient's current
  admission to the facility; or
                     (B) [(ii)]  the preceding 30 calendar days; and
               (5) [(D)]  receive a copy of all of the patient's
  reasonably available diagnostic results and reports related to the
  medical record provided under Subdivision (4) [Paragraph (C)].
         (c)  The written explanation required by Subsection (b-1)(3)
  [(b)(4)(B)] must be included in the patient's medical record.
         (e)  If the patient or the person responsible for the health
  care decisions of the patient is requesting life-sustaining
  treatment that the attending physician has decided and the ethics
  or medical committee has affirmed is medically inappropriate
  treatment, the patient shall be given available life-sustaining
  treatment pending transfer under Subsection (d). This subsection
  does not authorize withholding or withdrawing pain management
  medication, medical procedures necessary to provide comfort, or any
  other health care provided to alleviate a patient's pain. The
  patient is responsible for any costs incurred in transferring the
  patient to another facility. The attending physician, any other
  physician responsible for the care of the patient, and the health
  care facility are not obligated to provide life-sustaining
  treatment after the 14th calendar [10th] day after both the written
  decision and the patient's medical record required under Subsection
  (b-1) [(b)] are provided to the patient or the person responsible
  for the health care decisions of the patient unless ordered to do so
  under Subsection (g), except that artificially administered
  nutrition and hydration must be provided unless, based on
  reasonable medical judgment, providing artificially administered
  nutrition and hydration would:
               (1)  hasten the patient's death;
               (2)  be medically contraindicated such that the
  provision of the treatment seriously exacerbates life-threatening
  medical problems not outweighed by the benefit of the provision of
  the treatment;
               (3)  result in substantial irremediable physical pain
  not outweighed by the benefit of the provision of the treatment;
               (4)  be medically ineffective in prolonging life; or
               (5)  be contrary to the patient's or surrogate's
  clearly documented desire not to receive artificially administered
  nutrition or hydration.
         SECTION 3.  Subchapter B, Chapter 166, Health and Safety
  Code, is amended by adding Section 166.0465 to read as follows:
         Sec. 166.0465.  ETHICS OR MEDICAL COMMITTEE POLICIES;
  CONFLICTS OF INTEREST AND DISCRIMINATION. Each health care
  facility that provides review by an ethics or medical committee
  under Section 166.046 shall adopt and implement a policy on:
               (1)  preventing financial and health care professional
  conflicts of interest that may arise during a review under that
  section;
               (2)  allowing participation on, and interaction with,
  the committee by telephone, videoconference, or other secure
  electronic means; and
               (3)  prohibiting consideration of a patient's permanent
  physical or mental disability during the review unless the
  disability is relevant in determining whether a medical or surgical
  intervention is medically appropriate.
         SECTION 4.  Sections 166.052(a) and (b), Health and Safety
  Code, are amended to read as follows:
         (a)  In cases in which the attending physician refuses to
  honor an advance directive or health care or treatment decision
  requesting the provision of life-sustaining treatment, the
  statement required by Section 166.046(b)(4) [166.046(b)(3)(A)]
  shall be in substantially the following form:
  When There Is A Disagreement About Medical Treatment:  The
  Physician Recommends Against Certain Life-Sustaining Treatment
  That You Wish To Continue
         You have been given this information because you have
  requested life-sustaining treatment* for yourself as the patient or
  on behalf of the patient, as applicable, which the attending
  physician believes is not medically appropriate. This information
  is being provided to help you understand state law, your rights, and
  the resources available to you in such circumstances. It outlines
  the process for resolving disagreements about treatment among
  patients, families, and physicians. It is based upon Section
  166.046 of the Texas Advance Directives Act, codified in Chapter
  166, Texas Health and Safety Code.
         When an attending physician refuses to comply with an advance
  directive or other request for life-sustaining treatment because of
  the physician's judgment that the treatment would be medically
  inappropriate, the case will be reviewed by an ethics or medical
  committee. Life-sustaining treatment will be provided through the
  review.
         You will receive notification of this review at least seven
  calendar days [48 hours] before a meeting of the committee related
  to your case. You are entitled to attend the meeting. With your
  agreement, the meeting may be held sooner than seven calendar days
  [48 hours], if possible.
         You are entitled to receive a written explanation of the
  decision reached during the review process.
         If after this review process both the attending physician and
  the ethics or medical committee conclude that life-sustaining
  treatment is medically inappropriate and yet you continue to
  request such treatment, then the following procedure will occur:
         1.  The physician, with the help of the health care facility,
  will assist you in trying to find a physician and facility willing
  to provide the requested treatment.
         2.  You are being given a list of health care providers,
  licensed physicians, health care facilities, and referral groups
  that have volunteered their readiness to consider accepting
  transfer, or to assist in locating a provider willing to accept
  transfer, maintained by the Department of State Health Services.
  You may wish to contact providers, facilities, or referral groups
  on the list or others of your choice to get help in arranging a
  transfer.
         3.  The patient will continue to be given life-sustaining
  treatment until the patient can be transferred to a willing
  provider for up to 14 calendar [10] days from the time you were
  given both the committee's written decision that life-sustaining
  treatment is not appropriate and the patient's medical record. The
  patient will continue to be given after the 14-calendar-day
  [10-day] period treatment to enhance pain management and reduce
  suffering, including artificially administered nutrition and
  hydration, unless, based on reasonable medical judgment, providing
  artificially administered nutrition and hydration would hasten the
  patient's death, be medically contraindicated such that the
  provision of the treatment seriously exacerbates life-threatening
  medical problems not outweighed by the benefit of the provision of
  the treatment, result in substantial irremediable physical pain not
  outweighed by the benefit of the provision of the treatment, be
  medically ineffective in prolonging life, or be contrary to the
  patient's or surrogate's clearly documented desires.
         4.  If a transfer can be arranged, the patient will be
  responsible for the costs of the transfer.
         5.  If a provider cannot be found willing to give the
  requested treatment within 14 calendar [10] days, life-sustaining
  treatment may be withdrawn unless a court of law has granted an
  extension.
         6.  You may ask the appropriate district or county court to
  extend the 14-calendar-day [10-day] period if the court finds that
  there is a reasonable expectation that you may find a physician or
  health care facility willing to provide life-sustaining treatment
  if the extension is granted. Patient medical records will be
  provided to the patient or surrogate in accordance with Section
  241.154, Texas Health and Safety Code.
         *"Life-sustaining treatment" means treatment that, based on
  reasonable medical judgment, sustains the life of a patient and
  without which the patient will die. The term includes both
  life-sustaining medications and artificial life support, such as
  mechanical breathing machines, kidney dialysis treatment, and
  artificially administered nutrition and hydration. The term does
  not include the administration of pain management medication or the
  performance of a medical procedure considered to be necessary to
  provide comfort care, or any other medical care provided to
  alleviate a patient's pain.
         (b)  In cases in which the attending physician refuses to
  comply with an advance directive or treatment decision requesting
  the withholding or withdrawal of life-sustaining treatment, the
  statement required by Section 166.046(b)(4) [166.046(b)(3)(A)]
  shall be in substantially the following form:
  When There Is A Disagreement About Medical Treatment:  The
  Physician Recommends Life-Sustaining Treatment That You Wish To
  Stop
         You have been given this information because you have
  requested the withdrawal or withholding of life-sustaining
  treatment* for yourself as the patient or on behalf of the patient,
  as applicable, and the attending physician disagrees with and
  refuses to comply with that request. The information is being
  provided to help you understand state law, your rights, and the
  resources available to you in such circumstances. It outlines the
  process for resolving disagreements about treatment among
  patients, families, and physicians. It is based upon Section
  166.046 of the Texas Advance Directives Act, codified in Chapter
  166, Texas Health and Safety Code.
         When an attending physician refuses to comply with an advance
  directive or other request for withdrawal or withholding of
  life-sustaining treatment for any reason, the case will be reviewed
  by an ethics or medical committee.  Life-sustaining treatment will
  be provided through the review.
         You will receive notification of this review at least seven
  calendar days [48 hours] before a meeting of the committee related
  to your case. You are entitled to attend the meeting. With your
  agreement, the meeting may be held sooner than seven calendar days
  [48 hours], if possible.
         You are entitled to receive a written explanation of the
  decision reached during the review process.
         If you or the attending physician do not agree with the
  decision reached during the review process, and the attending
  physician still refuses to comply with your request to withhold or
  withdraw life-sustaining treatment, then the following procedure
  will occur:
         1.  The physician, with the help of the health care facility,
  will assist you in trying to find a physician and facility willing
  to withdraw or withhold the life-sustaining treatment.
         2.  You are being given a list of health care providers,
  licensed physicians, health care facilities, and referral groups
  that have volunteered their readiness to consider accepting
  transfer, or to assist in locating a provider willing to accept
  transfer, maintained by the Department of State Health
  Services.  You may wish to contact providers, facilities, or
  referral groups on the list or others of your choice to get help in
  arranging a transfer.
         *"Life-sustaining treatment" means treatment that, based on
  reasonable medical judgment, sustains the life of a patient and
  without which the patient will die.  The term includes both
  life-sustaining medications and artificial life support, such as
  mechanical breathing machines, kidney dialysis treatment, and
  artificially administered nutrition and hydration.  The term does
  not include the administration of pain management medication or the
  performance of a medical procedure considered to be necessary to
  provide comfort care, or any other medical care provided to
  alleviate a patient's pain.
         SECTION 5.  Subchapter B, Chapter 166, Health and Safety
  Code, is amended by adding Section 166.054 to read as follows:
         Sec. 166.054.  REPORTING REQUIREMENTS REGARDING ETHICS OR
  MEDICAL COMMITTEE PROCESSES. (a)  On submission of a health care
  facility's application to renew its license, a facility in which
  one or more meetings of an ethics or medical committee are held
  under this chapter shall file a report with the department that
  contains aggregate information regarding the number of cases
  initiated by an ethics or medical committee under Section 166.046
  and the disposition of those cases by the facility.
         (b)  Aggregate data submitted to the department under this
  section may include only the following:
               (1)  the total number of patients for whom a review by
  the ethics or medical committee was initiated under Section
  166.046(b);
               (2)  the number of patients under Subdivision (1) who
  were transferred to:
                     (A)  another physician within the same facility;
  or
                     (B)  a different facility;
               (3)  the number of patients under Subdivision (1) who
  were discharged to home;
               (4)  the number of patients under Subdivision (1) for
  whom treatment was withheld or withdrawn pursuant to surrogate
  consent:
                     (A)  before the decision was rendered following a
  review under Section 166.046(b);
                     (B)  after the decision was rendered following a
  review under Section 166.046(b); or
                     (C)  during or after the 14-calendar-day period
  described by Section 166.046(e);
               (5)  the average length of stay before a review meeting
  is held under Section 166.046(b); and
               (6)  the number of patients under Subdivision (1) who
  died while still receiving life-sustaining treatment:
                     (A)  before the review meeting under Section
  166.046(b);
                     (B)  during the 14-calendar-day period described
  by Section 166.046(e); or
                     (C)  during any extension of the 14-calendar-day
  period described by Section 166.046(e).
         (c)  The report required by this section may not contain any
  data specific to an individual patient or physician.
         (d)  The executive commissioner shall adopt rules to:
               (1)  establish a standard form for the reporting
  requirements of this section; and
               (2)  post on the department's Internet website the data
  submitted under Subsection (b) in the format provided by rule.
         (e)  Data collected as required by, or submitted to the
  department under, this section:
               (1)  is not admissible in a civil or criminal
  proceeding in which a physician, health care professional acting
  under the direction of a physician, or health care facility is a
  defendant; and
               (2)  may not be used in relation to any disciplinary
  action by a licensing board or other body with professional or
  administrative oversight over a physician, health care
  professional acting under the direction of a physician, or health
  care facility.
         SECTION 6.  Section 166.202(a), Health and Safety Code, is
  amended to read as follows:
         (a)  This subchapter applies to a DNR order issued for a
  patient who has been admitted to [in] a health care facility or
  hospital.
         SECTION 7.  Sections 166.203(a), (b), and (c), Health and
  Safety Code, are amended to read as follows:
         (a)  A DNR order issued for a patient is valid only if a
  physician providing direct care to the patient [patient's attending
  physician] issues the order, the order is dated, and the order:
               (1)  is issued in compliance with:
                     (A)  the written and dated directions of a patient
  who was competent at the time the patient wrote the directions;
                     (B)  the oral directions of a competent patient
  delivered to or observed by two competent adult witnesses, at least
  one of whom must be a person not listed under Section 166.003(2)(E)
  or (F);
                     (C)  the directions in an advance directive
  enforceable under Section 166.005 or executed in accordance with
  Section 166.032, 166.034, [or] 166.035, 166.082, 166.084, or
  166.085;
                     (D)  the directions of:
                           (i)  a patient's legal guardian;
                           (ii)  a patient's [or] agent under a medical
  power of attorney acting in accordance with Subchapter D; or
                           (iii)  a patient's proxy as designated and
  authorized by a directive executed or issued in accordance with
  Subchapter B to make a treatment decision for the patient if the
  patient becomes incompetent or otherwise mentally or physically
  incapable of communication; or
                     (E)  a treatment decision made in accordance with
  Section 166.039; or
               (2)  is not contrary to the directions of a patient who
  was competent at the time the patient conveyed the directions and,
  in the reasonable medical judgment of the [patient's attending]
  physician issuing the order:
                     (A)  the patient's death is imminent, regardless
  of the provision of cardiopulmonary resuscitation; and
                     (B)  the DNR order is medically appropriate.
         (b)  The DNR order:
               (1)  may be issued and entered in any format acceptable
  under the policies of the health care facility or hospital; and
               (2)  takes effect at the time the order is issued,
  provided the order is placed in the patient's medical record as soon
  as practicable.
         (c)  Unless notice has already been provided in accordance
  with Section 166.204(a-1), before [Before] placing in a patient's
  medical record a DNR order issued under Subsection (a)(2), a [the]
  physician, a physician assistant, a nurse, or another [other]
  person acting on behalf of a health care facility or hospital shall:
               (1)  inform the patient of the order's issuance; or
               (2)  if the patient is incompetent, make a reasonably
  diligent effort to contact or cause to be contacted and inform of
  the order's issuance:
                     (A)  the patient's known agent under a medical
  power of attorney or legal guardian; or
                     (B)  for a patient who does not have a known agent
  under a medical power of attorney or legal guardian, a person
  described by Section 166.039(b)(1), (2), or (3).
         SECTION 8.  Section 166.204, Health and Safety Code, is
  amended by amending Subsection (a) and adding Subsection (a-1) to
  read as follows:
         (a)  If a physician issues a DNR order under Section
  166.203(a)(2), a physician, a physician assistant, a nurse, or
  another person acting on behalf of a health care facility or
  hospital shall provide notice of the order to the appropriate
  persons in accordance with Subsection (a-1) of this section or
  Section 166.203(c).
         (a-1)  Unless notice has already been provided in accordance
  with Section 166.203(c), if [If] an individual arrives at a health
  care facility or hospital that is treating a patient for whom a DNR
  order is issued under Section 166.203(a)(2) and the individual
  notifies a physician, physician assistant, or nurse providing
  direct care to the patient of the individual's arrival, the
  physician, physician assistant, or nurse who has actual knowledge
  of the order shall disclose the order to the individual, provided
  the individual is:
               (1)  the patient's known agent under a medical power of
  attorney or legal guardian; or
               (2)  for a patient who does not have a known agent under
  a medical power of attorney or legal guardian, a person described by
  Section 166.039(b)(1), (2), or (3).
         SECTION 9.  Sections 166.205(a), (b), and (c), Health and
  Safety Code, are amended to read as follows:
         (a)  A physician providing direct care to a patient for whom
  a DNR order is issued shall revoke the patient's DNR order if:
               (1)  the advance directive on which the DNR order is
  based is properly revoked in accordance with applicable provisions
  of this chapter; or
               (2)  the patient or the individual at whose direction
  the DNR order was issued[, as applicable, the patient's agent under
  a medical power of attorney or the patient's legal guardian if the
  patient is incompetent:
               [(1)  effectively revokes an advance directive, in
  accordance with Section 166.042, for which a DNR order is issued
  under Section 166.203(a); or
               [(2)]  expresses to any person providing direct care to
  the patient a revocation of consent to or intent to revoke a DNR
  order issued under Section 166.203(a).
         (b)  A person providing direct care to a patient under the
  supervision of a physician shall notify the physician of the
  revocation of the advance directive or the request to revoke a DNR
  order under Subsection (a).
         (c)  The [A patient's attending] physician who issued [may at
  any time revoke] a DNR order issued under Section 166.203(a)(2), or
  any other attending physician providing direct care to the patient
  in accordance with applicable hospital policies, may at any time
  revoke the DNR order.
         SECTION 10.  Sections 166.206(a) and (b), Health and Safety
  Code, are amended to read as follows:
         (a)  If a [an attending] physician, health care facility, or
  hospital does not wish to execute or comply with a DNR order or the
  patient's instructions concerning the provision of cardiopulmonary
  resuscitation, the physician, facility, or hospital shall inform
  the patient, the legal guardian or qualified relatives of the
  patient, or the agent of the patient under a medical power of
  attorney of the benefits and burdens of cardiopulmonary
  resuscitation.
         (b)  If, after receiving notice under Subsection (a), the
  patient or another person authorized to act on behalf of the patient
  and the [attending] physician, health care facility, or hospital
  remain in disagreement, the physician, facility, or hospital shall
  make a reasonable effort to transfer the patient to another
  physician, facility, or hospital willing to execute or comply with
  a DNR order or the patient's instructions concerning the provision
  of cardiopulmonary resuscitation.
         SECTION 11.  Section 166.209, Health and Safety Code, is
  amended to read as follows:
         Sec. 166.209.  ENFORCEMENT. (a) Subject to Sections
  166.205(d), 166.207, and 166.208, a [A] physician, physician
  assistant, nurse, or other person commits an offense if, with the
  specific intent to violate the requirements of this subchapter, the
  person intentionally:
               (1)  conceals, cancels, effectuates, or falsifies
  another person's DNR order; or
               (2)  [if the person intentionally] conceals or
  withholds personal knowledge of another person's revocation of a
  DNR order [in violation of this subchapter].
         (a-1)  An offense under Subsection (a) [this subsection] is a
  Class A misdemeanor. This section [subsection] does not preclude
  prosecution for any other applicable offense.
         (b)  Subject to Sections 166.205(d), 166.207, and 166.208, a
  [A] physician, health care professional, health care facility,
  hospital, or entity is subject to review and disciplinary action by
  the appropriate licensing authority for intentionally:
               (1)  failing to effectuate a DNR order in violation of
  this subchapter; or
               (2)  issuing a DNR order in violation of this
  subchapter.
         SECTION 12.  Section 313.004(a), Health and Safety Code, is
  amended to read as follows:
         (a)  If an adult patient of a home and community support
  services agency or in a hospital or nursing home, or an adult inmate
  of a county or municipal jail, is comatose, incapacitated, or
  otherwise mentally or physically incapable of communication and
  does not have a legal guardian or an agent under a medical power of
  attorney who can concur with the patient's attending physician, an
  adult surrogate from the following list, in order of priority, who
  has decision-making capacity, is available after a reasonably
  diligent inquiry, and is willing to consent to medical treatment on
  behalf of the patient, may consent to medical treatment on behalf of
  the patient in concurrence with the patient's attending physician:
               (1)  the patient's spouse;
               (2)  the patient's reasonably available adult children
  [an adult child of the patient who has the waiver and consent of all
  other qualified adult children of the patient to act as the sole
  decision-maker];
               (3)  [a majority of] the patient's parents [reasonably
  available adult children];
               (4)  the patient's nearest living relative [parents];
  or
               (5)  if the patient does not have a legal guardian or an
  agent under a medical power of attorney and a person listed in this
  subsection is not available, another licensed physician who is not
  involved in the direct treatment of the patient [the individual
  clearly identified to act for the patient by the patient before the
  patient became incapacitated, the patient's nearest living
  relative, or a member of the clergy].
         SECTION 13.  Not later than March 1, 2022, the executive
  commissioner of the Health and Human Services Commission shall
  adopt the rules necessary to implement the changes in law made by
  this Act to Chapter 166, Health and Safety Code.
         SECTION 14.  Chapter 166, Health and Safety Code, as amended
  by this Act, applies only to a review, consultation, disagreement,
  or other action relating to a health care or treatment decision made
  on or after April 1, 2022. A review, consultation, disagreement, or
  other action relating to a health care or treatment decision made
  before April 1, 2022, is governed by the law in effect immediately
  before the effective date of this Act, and the former law is
  continued in effect for that purpose.
         SECTION 15.  Chapter 166, Health and Safety Code, as amended
  by this Act, applies only to a do-not-resuscitate order issued on or
  after the effective date of this Act. A do-not-resuscitate order
  issued before the effective date of this Act is governed by the law
  in effect on the date the order was issued, and that law is
  continued in effect for that purpose.
         SECTION 16.  (a)  A health care facility shall adopt the
  policy required by Section 166.0465, Health and Safety Code, as
  added by this Act, not later than April 1, 2022.
         (b)  A policy adopted under Section 166.0465, Health and
  Safety Code, as added by this Act, applies only to an ethics or
  medical committee review conducted on or after April 1, 2022.
         SECTION 17.  This Act takes effect September 1, 2021.