Texas 2009 - 81st Regular

Texas House Bill HB1357 Compare Versions

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1	1	H.B. No. 1357
2	2
3	3
4	4	AN ACT
5	5	relating to the regulation of freestanding emergency medical care
6	6	facilities; providing an administrative penalty; creating an
7	7	offense.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Subtitle B, Title 4, Health and Safety Code, is
10	10	amended by adding Chapter 254 to read as follows:
11	11	CHAPTER 254. FREESTANDING EMERGENCY MEDICAL CARE FACILITIES
12	12	SUBCHAPTER A. GENERAL PROVISIONS
13	13	Sec. 254.001. DEFINITIONS. In this chapter:
14	14	(1) "Department" means the Department of State Health
15	15	Services.
16	16	(2) "Emergency care" has the meaning assigned by
17	17	Sections 843.002 and 1301.155, Insurance Code.
18	18	(3) "Executive commissioner" means the executive
19	19	commissioner of the Health and Human Services Commission.
20	20	(4) "Facility" means a freestanding emergency medical
21	21	care facility.
22	22	(5) "Freestanding emergency medical care facility"
23	23	means a facility, structurally separate and distinct from a
24	24	hospital that receives an individual and provides emergency care,
25	25	as defined by Subsection (2).
26	26	[Section 254.002-254.050 reserved for expansion]
27	27	SUBCHAPTER B. LICENSING
28	28	Sec. 254.051. LICENSE REQUIRED. (a) Except as provided by
29	29	Section 254.052, a person may not establish or operate a
30	30	freestanding emergency medical care facility in this state without
31	31	a license issued under this chapter.
32	32	(b) Except as provided by Section 254.052, a facility or
33	33	person may not hold itself out to the public as a freestanding
34	34	emergency medical care facility or use any similar term, as defined
35	35	by department rule, that would give the impression that the
36	36	facility or person is providing emergency care unless the facility
37	37	or person holds a license issued under this chapter. The use of the
38	38	term "emergency" or a similar term is also subject to Section
39	39	254.152.
40	40	(c) Each separate facility location must have a separate
41	41	license.
42	42	(d) A license issued under this chapter is not transferable
43	43	or assignable.
44	44	(e) The executive commissioner by rule shall establish a
45	45	classification for a facility that is in continuous operation 24
46	46	hours per day and 7 days per week and a classification for a
47	47	facility that is in operation 7 days per week and at least 12 hours
48	48	per day.
49	49	(f) A facility that is not in continuous operation 24 hours
50	50	per day and 7 days per week cannot be issued a license with a term
51	51	that extends beyond August 31, 2013.
52	52	Sec. 254.052. EXEMPTIONS FROM LICENSING REQUIREMENT. The
53	53	following facilities are not required to be licensed under this
54	54	chapter:
55	55	(1) an office or clinic owned and operated by a
56	56	manufacturing facility solely for the purposes of treating its
57	57	employees and contractors;
58	58	(2) temporary emergency clinics in disaster areas;
59	59	(3) an office or clinic of a licensed physician,
60	60	dentist, optometrist, or podiatrist;
61	61	(4) a licensed nursing home;
62	62	(5) a licensed hospital;
63	63	(6) a hospital that is owned and operated by this
64	64	state;
65	65	(7) a facility located within or connected to a
66	66	hospital described by Subsection (5) or (6);
67	67	(8) a facility that is owned or operated by a hospital
68	68	described by Subsection (5) or (6) and is:
69	69	(A) surveyed as a service of the hospital by an
70	70	organization that has been granted deeming authority as a national
71	71	accreditation program for hospitals by the Centers for Medicare and
72	72	Medicaid Services; or
73	73	(B) granted provider-based status by the Centers
74	74	for Medicare and Medicaid Services; or
75	75	(9) a licensed ambulatory surgical center.
76	76	Sec. 254.053. LICENSE APPLICATION AND ISSUANCE. (a) An
77	77	applicant for a license under this chapter must submit an
78	78	application to the department on a form prescribed by the
79	79	department.
80	80	(b) Each application must be accompanied by a nonrefundable
81	81	license fee in an amount set by the executive commissioner.
82	82	(c) The application must contain evidence that there is at
83	83	least one physician and one nurse on the staff of the facility who
84	84	are licensed by the appropriate state licensing board.
85	85	(d) The application must contain evidence that the facility
86	86	meets the minimum standards and requirements specified in Section
87	87	254.151.
88	88	(e) The department shall issue a license if, after
89	89	inspection and investigation, it finds that the applicant and the
90	90	facility meet the requirements of this chapter and the standards
91	91	adopted under this chapter.
92	92	(f) The license fee must be paid annually on renewal of the
93	93	license.
94	94	[Sections 254.054-254.100 reserved for expansion]
95	95	SUBCHAPTER C. EXECUTIVE COMMISSIONER AND DEPARTMENT POWERS AND
96	96	DUTIES
97	97	Sec. 254.101. ADOPTION OF RULES. The executive
98	98	commissioner shall adopt rules necessary to implement this chapter,
99	99	including requirements for the issuance, renewal, denial,
100	100	suspension, and revocation of a license to operate a facility.
101	101	Sec. 254.102. FEES. The executive commissioner shall set
102	102	fees imposed by this chapter in amounts reasonable and necessary to
103	103	defray the cost of administering this chapter.
104	104	Sec. 254.103. INSPECTIONS. The department may inspect a
105	105	facility at reasonable times as necessary to ensure compliance with
106	106	this chapter.
107	107	Sec. 254.104. FREESTANDING EMERGENCY MEDICAL CARE FACILITY
108	108	LICENSING FUND. All fees collected under this chapter shall be
109	109	deposited in the state treasury to the credit of the freestanding
110	110	emergency medical care facility licensing fund and may be
111	111	appropriated to the department only to administer and enforce this
112	112	chapter.
113	113	[Sections 254.105-254.150 reserved for expansion]
114	114	SUBCHAPTER D. REGULATION OF FACILITIES
115	115	Sec. 254.151. MINIMUM STANDARDS. (a) The executive
116	116	commissioner shall adopt rules necessary to implement this chapter,
117	117	including minimum standards for:
118	118	(1) the construction and design of the facility,
119	119	including plumbing, heating, lighting, ventilation, and other
120	120	design standards necessary to ensure the health and safety of
121	121	patients;
122	122	(2) the number, qualifications, and organization of
123	123	the professional staff and other personnel;
124	124	(3) the administration of the facility;
125	125	(4) the equipment essential to the health and welfare
126	126	of the patients;
127	127	(5) the sanitary and hygienic conditions within the
128	128	facility and its surroundings;
129	129	(6) the requirements for the contents, maintenance,
130	130	and release of medical records;
131	131	(7) the minimal level of care and standards for denial
132	132	of care;
133	133	(8) the provision of laboratory and radiological
134	134	services;
135	135	(9) the distribution and administration of drugs and
136	136	controlled substances;
137	137	(10) a quality assurance program for patient care;
138	138	(11) disclosure, if applicable, of the following:
139	139	(A) the name and social security number of the
140	140	sole proprietor, if the facility is a sole proprietor;
141	141	(B) the name and social security number of each
142	142	general partner who is an individual, if the facility is a
143	143	partnership;
144	144	(C) the name and social security number of any
145	145	individual who has an ownership interest of more than 25 percent in
146	146	the corporation, if the facility is a corporation; and
147	147	(D) the name and license numbers of any
148	148	physicians licensed by the Texas Medical Board who have a financial
149	149	interest in the facility or any entity which has an ownership
150	150	interest in the facility;
151	151	(12) transfer protocols for patients requiring
152	152	advanced medical care at a hospital; and
153	153	(13) any other aspect of the operation of a facility
154	154	that the executive commissioner considers necessary to protect the
155	155	facility's patients and the public.
156	156	(b) In adopting the rules required under Subsection (a)
157	157	concerning transfer protocols, the executive commissioner must
158	158	consult with physicians who provide emergency care, medical
159	159	consultant organizations, and organizations representing hospitals
160	160	licensed in this state.
161	161	(c) The minimum standards under this section shall apply to
162	162	facilities operating 24 hours a day and 7 days per week and
163	163	facilities operating less than 24 hours a day and 7 days per week.
164	164	Sec. 254.152. FACILITIES NOT IN CONTINUOUS OPERATION.
165	165	(a) A facility that is not in continuous operation shall display a
166	166	clearly visible sign that:
167	167	(1) indicates whether the facility is open or closed;
168	168	(2) provides information regarding the facility's
169	169	operating hours; and
170	170	(3) provides clear instructions directing a patient to
171	171	an emergency room in a licensed hospital or a freestanding
172	172	emergency room classified as a facility that is in continuous
173	173	operation within 10 miles of the facility that is not in continuous
174	174	operation.
175	175	(b) A facility that is not in continuous operation may not
176	176	advertise, market, or otherwise promote the services provided by
177	177	the facility using the term "emergency" or any similar term defined
178	178	by department rule.
179	179	(c) Notwithstanding Subsection (b), a facility that is not
180	180	in continuous operation is not required to comply with Subsection
181	181	(b) until the earlier of the second anniversary of the date the
182	182	facility is issued a license under this chapter or September 1,
183	183	2012. This subsection expires January 1, 2013.
184	184	(d) This section expires August 31, 2013.
185	185	Sec. 254.153. FACILITY CARE REQUIREMENTS. (a) A facility
186	186	shall provide to each facility patient, without regard to the
187	187	individual's ability to pay, an appropriate medical screening,
188	188	examination, and stabilization within the facility's capability,
189	189	including ancillary services routinely available to the facility,
190	190	to determine whether an emergency medical condition exists and any
191	191	necessary stabilizing treatment.
192	192	(b) Before a facility accepts any patient for treatment or
193	193	diagnosis, the facility shall enter into a referral, transmission,
194	194	or admission agreement with a hospital licensed in this state.
195	195	Sec. 254.154. COMPLAINTS. A person may file a complaint
196	196	with the department against a facility licensed under this chapter.
197	197	[Sections 254.155-254.200 reserved for expansion]
198	198	SUBCHAPTER E. ENFORCEMENT AND PENALTIES
199	199	Sec. 254.201. DENIAL, SUSPENSION, PROBATION, OR REVOCATION
200	200	OF LICENSE. (a) The department may deny, suspend, or revoke a
201	201	license for a violation of this chapter or a rule adopted under this
202	202	chapter.
203	203	(b) The denial, suspension, or revocation of a license by
204	204	the department and the appeal from that action are governed by the
205	205	procedures for a contested case hearing under Chapter 2001,
206	206	Government Code.
207	207	(c) If the department finds that a facility is in repeated
208	208	noncompliance with this chapter or rules adopted under this chapter
209	209	but that the noncompliance does not endanger public health and
210	210	safety, the department may schedule the facility for probation
211	211	rather than suspending or revoking the facility's license. The
212	212	department shall provide notice to the facility of the probation
213	213	and of the items of noncompliance not later than the 10th day before
214	214	the date the probation period begins. The department shall
215	215	designate a period of not less than 30 days during which the
216	216	facility remains under probation. During the probation period, the
217	217	facility must correct the items that were in noncompliance and
218	218	report the corrections to the department for approval.
219	219	(d) The department may suspend or revoke the license of a
220	220	facility that does not correct items that were in noncompliance or
221	221	that does not comply with this chapter or the rules adopted under
222	222	this chapter within the applicable probation period.
223	223	Sec. 254.202. EMERGENCY SUSPENSION. (a) The department
224	224	may issue an emergency order to suspend a license issued under this
225	225	chapter if the department has reasonable cause to believe that the
226	226	conduct of a license holder creates an immediate danger to the
227	227	public health and safety.
228	228	(b) An emergency suspension under this section is effective
229	229	immediately without a hearing on notice to the license holder.
230	230	(c) On written request of the license holder, the department
231	231	shall conduct a hearing not earlier than the 10th day or later than
232	232	the 30th day after the date the hearing request is received to
233	233	determine if the emergency suspension is to be continued, modified,
234	234	or rescinded.
235	235	(d) A hearing and any appeal under this section are governed
236	236	by the department's rules for a contested case hearing and Chapter
237	237	2001, Government Code.
238	238	Sec. 254.203. INJUNCTION. (a) The department may petition
239	239	a district court for a temporary restraining order to restrain a
240	240	continuing violation of the standards or licensing requirements
241	241	provided under this chapter if the department finds that the
242	242	violation creates an immediate threat to the health and safety of
243	243	the patients of a facility.
244	244	(b) A district court, on petition of the department and on a
245	245	finding by the court that a person is violating the standards or
246	246	licensing requirements provided under this chapter, may by
247	247	injunction:
248	248	(1) prohibit a person from continuing a violation of
249	249	the standards or licensing requirements provided under this
250	250	chapter;
251	251	(2) restrain or prevent the establishment or operation
252	252	of a facility without a license issued under this chapter; or
253	253	(3) grant any other injunctive relief warranted by the
254	254	facts.
255	255	(c) The attorney general shall institute and conduct a suit
256	256	authorized by this section at the request of the department.
257	257	(d) Venue for a suit brought under this section is in the
258	258	county in which the facility is located or in Travis County.
259	259	Sec. 254.204. CRIMINAL PENALTY. (a) A person commits an
260	260	offense if the person violates Section 254.051.
261	261	(b) An offense under this section is a Class C misdemeanor.
262	262	(c) Each day of a continuing violation constitutes a
263	263	separate offense.
264	264	Sec. 254.205. IMPOSITION OF ADMINISTRATIVE PENALTY.
265	265	(a) The department may impose an administrative penalty on a
266	266	person licensed under this chapter who violates this chapter or a
267	267	rule or order adopted under this chapter. A penalty collected under
268	268	this section or Section 254.206 shall be deposited in the state
269	269	treasury in the general revenue fund.
270	270	(b) A proceeding to impose the penalty is considered to be a
271	271	contested case under Chapter 2001, Government Code.
272	272	(c) The amount of the penalty may not exceed $1,000 for each
273	273	violation, and each day a violation continues or occurs is a
274	274	separate violation for purposes of imposing a penalty. The total
275	275	amount of the penalty assessed for a violation continuing or
276	276	occurring on separate days under this subsection may not exceed
277	277	$5,000.
278	278	(d) The amount shall be based on:
279	279	(1) the seriousness of the violation, including the
280	280	nature, circumstances, extent, and gravity of the violation;
281	281	(2) the threat to health or safety caused by the
282	282	violation;
283	283	(3) the history of previous violations;
284	284	(4) the amount necessary to deter a future violation;
285	285	(5) whether the violator demonstrated good faith,
286	286	including when applicable whether the violator made good faith
287	287	efforts to correct the violation; and
288	288	(6) any other matter that justice may require.
289	289	(e) If the department initially determines that a violation
290	290	occurred, the department shall give written notice of the report by
291	291	certified mail to the person.
292	292	(f) The notice under Subsection (e) must:
293	293	(1) include a brief summary of the alleged violation;
294	294	(2) state the amount of the recommended penalty; and
295	295	(3) inform the person of the person's right to a
296	296	hearing on the occurrence of the violation, the amount of the
297	297	penalty, or both.
298	298	(g) Within 20 days after the date the person receives the
299	299	notice under Subsection (e), the person in writing may:
300	300	(1) accept the determination and recommended penalty
301	301	of the department; or
302	302	(2) make a request for a hearing on the occurrence of
303	303	the violation, the amount of the penalty, or both.
304	304	(h) If the person accepts the determination and recommended
305	305	penalty or if the person fails to respond to the notice, the
306	306	commissioner of state health services by order shall approve the
307	307	determination and impose the recommended penalty.
308	308	(i) If the person requests a hearing, the commissioner of
309	309	state health services shall refer the matter to the State Office of
310	310	Administrative Hearings, which shall promptly set a hearing date
311	311	and give written notice of the time and place of the hearing to the
312	312	person. An administrative law judge of the State Office of
313	313	Administrative Hearings shall conduct the hearing.
314	314	(j) The administrative law judge shall make findings of fact
315	315	and conclusions of law and promptly issue to the commissioner of
316	316	state health services a proposal for a decision about the
317	317	occurrence of the violation and the amount of a proposed penalty.
318	318	(k) Based on the findings of fact, conclusions of law, and
319	319	proposal for a decision, the commissioner of state health services
320	320	by order may:
321	321	(1) find that a violation occurred and impose a
322	322	penalty; or
323	323	(2) find that a violation did not occur.
324	324	(l) The notice of the order under Subsection (k) that is
325	325	sent to the person in accordance with Chapter 2001, Government
326	326	Code, must include a statement of the right of the person to
327	327	judicial review of the order.
328	328	Sec. 254.206. PAYMENT AND COLLECTION OF ADMINISTRATIVE
329	329	PENALTY; JUDICIAL REVIEW. (a) Within 30 days after the date an
330	330	order of the commissioner of state health services under Section
331	331	254.205(k) that imposes an administrative penalty becomes final,
332	332	the person shall:
333	333	(1) pay the penalty; or
334	334	(2) file a petition for judicial review of the
335	335	commissioner's order contesting the occurrence of the violation,
336	336	the amount of the penalty, or both.
337	337	(b) Within the 30-day period prescribed by Subsection (a), a
338	338	person who files a petition for judicial review may:
339	339	(1) stay enforcement of the penalty by:
340	340	(A) paying the penalty to the court for placement
341	341	in an escrow account; or
342	342	(B) giving the court a supersedeas bond approved
343	343	by the court that:
344	344	(i) is for the amount of the penalty; and
345	345	(ii) is effective until all judicial review
346	346	of the commissioner's order is final; or
347	347	(2) request the court to stay enforcement of the
348	348	penalty by:
349	349	(A) filing with the court a sworn affidavit of
350	350	the person stating that the person is financially unable to pay the
351	351	penalty and is financially unable to give the supersedeas bond; and
352	352	(B) sending a copy of the affidavit to the
353	353	executive commissioner by certified mail.
354	354	(c) If the commissioner of state health services receives a
355	355	copy of an affidavit under Subsection (b)(2), the commissioner may
356	356	file with the court, within five days after the date the copy is
357	357	received, a contest to the affidavit. The court shall hold a
358	358	hearing on the facts alleged in the affidavit as soon as practicable
359	359	and shall stay the enforcement of the penalty on finding that the
360	360	alleged facts are true. The person who files an affidavit has the
361	361	burden of proving that the person is financially unable to pay the
362	362	penalty or to give a supersedeas bond.
363	363	(d) If the person does not pay the penalty and the
364	364	enforcement of the penalty is not stayed, the penalty may be
365	365	collected. The attorney general may sue to collect the penalty.
366	366	(e) If the court sustains the finding that a violation
367	367	occurred, the court may uphold or reduce the amount of the penalty
368	368	and order the person to pay the full or reduced amount of the
369	369	penalty.
370	370	(f) If the court does not sustain the finding that a
371	371	violation occurred, the court shall order that a penalty is not
372	372	owed.
373	373	(g) If the person paid the penalty and if the amount of the
374	374	penalty is reduced or the penalty is not upheld by the court, the
375	375	court shall order, when the court's judgment becomes final, that
376	376	the appropriate amount plus accrued interest be remitted to the
377	377	person within 30 days after the date that the judgement of the court
378	378	becomes final. The interest accrues at the rate charged on loans to
379	379	depository institutions by the New York Federal Reserve Bank. The
380	380	interest shall be paid for the period beginning on the date the
381	381	penalty is paid and ending on the date the penalty is remitted.
382	382	(h) If the person gave a supersedeas bond and the penalty is
383	383	not upheld by the court, the court shall order, when the court's
384	384	judgment becomes final, the release of the bond. If the person gave
385	385	a supersedeas bond and the amount of the penalty is reduced, the
386	386	court shall order the release of the bond after the person pays the
387	387	reduced amount.
388	388	SECTION 2. Section 843.002, Insurance Code, is amended by
389	389	amending Subdivision (7) and adding Subdivision (9-a) to read as
390	390	follows:
391	391	(7) "Emergency care" means health care services
392	392	provided in a hospital emergency facility, freestanding emergency
393	393	medical care facility, or comparable emergency facility to evaluate
394	394	and stabilize medical conditions of a recent onset and severity,
395	395	including severe pain, that would lead a prudent layperson
396	396	possessing an average knowledge of medicine and health to believe
397	397	that the individual's condition, sickness, or injury is of such a
398	398	nature that failure to get immediate medical care could:
399	399	(A) place the individual's health in serious
400	400	jeopardy;
401	401	(B) result in serious impairment to bodily
402	402	functions;
403	403	(C) result in serious dysfunction of a bodily
404	404	organ or part;
405	405	(D) result in serious disfigurement; or
406	406	(E) for a pregnant woman, result in serious
407	407	jeopardy to the health of the fetus.
408	408	(9-a) "Freestanding emergency medical care facility"
409	409	means a facility licensed under Chapter 254, Health and Safety
410	410	Code.
411	411	SECTION 3. Section 1271.155(b), Insurance Code, is amended
412	412	to read as follows:
413	413	(b) A health care plan of a health maintenance organization
414	414	must provide the following coverage of emergency care:
415	415	(1) a medical screening examination or other
416	416	evaluation required by state or federal law necessary to determine
417	417	whether an emergency medical condition exists shall be provided to
418	418	covered enrollees in a hospital emergency facility or comparable
419	419	facility;
420	420	(2) necessary emergency care shall be provided to
421	421	covered enrollees, including the treatment and stabilization of an
422	422	emergency medical condition; and
423	423	(3) services originated in a hospital emergency
424	424	facility, freestanding emergency medical care facility, or
425	425	comparable emergency facility following treatment or stabilization
426	426	of an emergency medical condition shall be provided to covered
427	427	enrollees as approved by the health maintenance organization,
428	428	subject to Subsections (c) and (d).
429	429	SECTION 4. Section 1301.001, Insurance Code, is amended by
430	430	adding Subdivision (12) to read as follows:
431	431	(12) "Freestanding emergency medical care facility"
432	432	means a facility licensed under Chapter 254, Health and Safety
433	433	Code.
434	434	SECTION 5. Section 1301.155, Insurance Code, is amended to
435	435	read as follows:
436	436	Sec. 1301.155. EMERGENCY CARE. (a) In this section,
437	437	"emergency care" means health care services provided in a hospital
438	438	emergency facility, freestanding emergency medical care facility,
439	439	or comparable emergency facility to evaluate and stabilize a
440	440	medical condition of a recent onset and severity, including severe
441	441	pain, that would lead a prudent layperson possessing an average
442	442	knowledge of medicine and health to believe that the person's
443	443	condition, sickness, or injury is of such a nature that failure to
444	444	get immediate medical care could result in:
445	445	(1) placing the person's health in serious jeopardy;
446	446	(2) serious impairment to bodily functions;
447	447	(3) serious dysfunction of a bodily organ or part;
448	448	(4) serious disfigurement; or
449	449	(5) in the case of a pregnant woman, serious jeopardy
450	450	to the health of the fetus.
451	451	(b) If an insured cannot reasonably reach a preferred
452	452	provider, an insurer shall provide reimbursement for the following
453	453	emergency care services at the preferred level of benefits until
454	454	the insured can reasonably be expected to transfer to a preferred
455	455	provider:
456	456	(1) a medical screening examination or other
457	457	evaluation required by state or federal law to be provided in the
458	458	emergency facility of a hospital that is necessary to determine
459	459	whether a medical emergency condition exists;
460	460	(2) necessary emergency care services, including the
461	461	treatment and stabilization of an emergency medical condition; and
462	462	(3) services originating in a hospital emergency
463	463	facility or freestanding emergency medical care facility
464	464	following treatment or stabilization of an emergency medical
465	465	condition.
466	466	SECTION 6. (a) Not later than September 1, 2010, a
467	467	freestanding emergency medical care facility must obtain a license
468	468	as required by Chapter 254, Health and Safety Code, as added by this
469	469	Act.
470	470	(b) Not later than March 1, 2010, the executive commissioner
471	471	of the Health and Human Services Commission shall adopt rules as
472	472	required by Chapter 254, Health and Safety Code, as added by this
473	473	Act.
474	474	(c) The changes in law made by Sections 3, 4, and 5 of this
475	475	Act apply only to a health insurance policy or evidence of coverage
476	476	delivered, issued for delivery, or renewed on or after March 1,
477	477	2010. A health insurance policy or evidence of coverage delivered,
478	478	issued for delivery, or renewed before that date is governed by the
479	479	law in effect immediately before that date, and that law is
480	480	continued in effect for that purpose.
481	481	SECTION 7. (a) Except as provided by Subsections (b) and
482	482	(c) of this section, this Act takes effect September 1, 2009.
483	483	(b) Sections 254.201, 254.202, 254.203, 254.205, and
484	484	254.206, Health and Safety Code, as added by this Act, and Sections
485	485	843.002, 1271.155, 1301.001, and 1301.155, Insurance Code, as
486	486	amended by this Act, take effect March 1, 2010.
487	487	(c) Section 254.204, Health and Safety Code, as added by
488	488	this Act, takes effect September 1, 2010.
489	489	______________________________ ______________________________
490	490	President of the Senate Speaker of the House
491	491	I certify that H.B. No. 1357 was passed by the House on May
492	492	11, 2009, by the following vote: Yeas 145, Nays 0, 2 present, not
493	493	voting; that the House refused to concur in Senate amendments to
494	494	H.B. No. 1357 on May 29, 2009, and requested the appointment of a
495	495	conference committee to consider the differences between the two
496	496	houses; and that the House adopted the conference committee report
497	497	on H.B. No. 1357 on May 31, 2009, by the following vote: Yeas 141,
498	498	Nays 0, 1 present, not voting.
499	499	______________________________
500	500	Chief Clerk of the House
501	501	I certify that H.B. No. 1357 was passed by the Senate, with
502	502	amendments, on May 26, 2009, by the following vote: Yeas 31, Nays
503	503	0; at the request of the House, the Senate appointed a conference
504	504	committee to consider the differences between the two houses; and
505	505	that the Senate adopted the conference committee report on H.B. No.
506	506	1357 on May 31, 2009, by the following vote: Yeas 31, Nays 0.
507	507	______________________________
508	508	Secretary of the Senate
509	509	APPROVED: __________________
510	510	Date
511	511	__________________
512	512	Governor