By: Davis of Harris, et al. H.B. No. 1111
(Senate Sponsor - Kolkhorst)
(In the Senate - Received from the House April 30, 2019;
May 7, 2019, read first time and referred to Committee on Health &
Human Services; May 20, 2019, reported adversely, with favorable
Committee Substitute by the following vote: Yeas 9, Nays 0;
May 20, 2019, sent to printer.)
Click here to see the committee vote
COMMITTEE SUBSTITUTE FOR H.B. No. 1111 By: Campbell
A BILL TO BE ENTITLED
AN ACT
relating to maternal and newborn health care.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02163 to read as follows:
Sec. 531.02163. STUDY ON PROVIDING CERTAIN MATERNAL CARE
MEDICAID SERVICES THROUGH TELEMEDICINE MEDICAL SERVICES AND
TELEHEALTH SERVICES. (a) Not later than September 1, 2020, the
commission shall conduct a study on the benefits and costs of
permitting reimbursement under Medicaid for prenatal and
postpartum care delivered through telemedicine medical services
and telehealth services.
(b) This section expires September 1, 2021.
SECTION 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.0996 to read as follows:
Sec. 531.0996. PREGNANCY MEDICAL HOME PILOT PROGRAM. (a)
The commission shall develop a pilot program to establish pregnancy
medical homes that provide coordinated evidence-based maternity
care management to women who reside in a pilot program area and are
recipients of Medicaid through a Medicaid managed care model or
arrangement under Chapter 533. The commission shall implement the
pilot program in:
(1) at least two counties with populations of more
than two million;
(2) at least one county with a population of more than
100,000 and less than 500,000; and
(3) at least one rural county with high rates of
maternal mortality and morbidity as determined by the commission in
consultation with the Maternal Mortality and Morbidity Task Force
established under Chapter 34, Health and Safety Code.
(b) In implementing the pilot program, the commission shall
ensure each pregnancy medical home provides a maternity management
team that:
(1) consists of health care providers, including
obstetricians, gynecologists, family physicians, physician
assistants, certified nurse midwives, nurse practitioners, and
social workers, who provide health care services at the same
location in:
(A) a zip code with a high rate of maternal
mortality and morbidity; or
(B) an area with limited access to health care
providers who provide obstetrical care;
(2) conducts a risk assessment of each pilot program
participant on her entry into the program to determine the risk
classification for her pregnancy based on recognized maternal
mortality and morbidity risk assessment tools that indicate the
participant's:
(A) maternal age;
(B) maternal race;
(C) prior pregnancies that resulted in a live
birth, stillbirth, or miscarriage; and
(D) family history of disease;
(3) based on the assessment conducted under
Subdivision (2), establishes an individual pregnancy care plan for
each participant; and
(4) follows each participant throughout her pregnancy
and for a reasonable amount of time postpartum to reduce poor birth
outcomes and pregnancy-related maternal deaths occurring
postpartum.
(c) The commission may incorporate as a component of the
pilot program financial incentives for health care providers who
participate in a maternity management team. The commission may
consider as a criteria for the financial incentives whether the
health care provider in a maternity management team will implement
strategies and best practices recommended by the Maternal Mortality
and Morbidity Task Force established under Chapter 34, Health and
Safety Code, for reducing maternal mortality rates and maternal
health disparities for African American women in this state.
(d) The commission may waive a requirement of this section
for a pregnancy medical home located in a rural county.
(e) Notwithstanding Section 531.02176, the commission may:
(1) provide home telemonitoring services and
necessary durable medical equipment to pilot program participants
who are at risk of experiencing pregnancy-related complications, as
determined by a physician, to the extent the commission anticipates
the services and equipment will reduce unnecessary emergency room
visits or hospitalizations; and
(2) reimburse providers under Medicaid for the
provision of home telemonitoring services and durable medical
equipment under the pilot program.
(f) Not later than January 1, 2021, the commission shall
submit to the legislature a report on the pilot program. The report
must include:
(1) an evaluation of the pilot program's success in
reducing poor birth outcomes; and
(2) a recommendation on whether the pilot program
should continue, be expanded, or be terminated.
(f-1) The report required under Subsection (f) may include
statistical information and findings based on confidential
information collected under Section 34.019, Health and Safety Code,
provided the information and findings:
(1) are aggregated; and
(2) do not include any personally identifying
information of a woman, her family, or a health care provider.
(g) The executive commissioner shall:
(1) adopt rules to implement this section; and
(2) adopt and implement policies and procedures to
ensure that confidential information obtained under this section is
not disclosed in violation of state or federal law.
(h) This section expires September 1, 2023.
SECTION 3. Section 33.004(f), Health and Safety Code, is
amended to read as follows:
(f) The executive commissioner by rule shall [may]
establish the amounts charged for newborn screening fees, including
fees assessed for follow-up services, tracking confirmatory
testing, and diagnosis. In adopting rules under this subsection,
the executive commissioner shall ensure that amounts charged for
newborn screening fees are sufficient to cover the costs of
performing the screening.
SECTION 4. Chapter 33, Health and Safety Code, is amended by
adding Subchapter D to read as follows:
SUBCHAPTER D. NEWBORN SCREENING PRESERVATION ACCOUNT
Sec. 33.051. DEFINITION. In this subchapter, "account"
means the newborn screening preservation account established under
Section 33.052.
Sec. 33.052. CREATION OF ACCOUNT. (a) The newborn
screening preservation account is a dedicated account in the
general revenue fund. The account is created solely for the
perpetual care and preservation of newborn screening in this state.
(b) Money in the account may be appropriated only to the
department and only for the purpose of carrying out the newborn
screening program established under this chapter.
(c) On November 1 of each year, the department shall
transfer to the account any unexpended and unencumbered money from
Medicaid reimbursements collected by the department for newborn
screening services during the preceding state fiscal year.
(d) The account is composed of:
(1) money transferred to the account under Subsection
(c);
(2) gifts, grants, donations, and legislative
appropriations; and
(3) interest earned on the investment of money in the
account.
(e) Section 403.0956, Government Code, does not apply to the
account.
(f) The department administers the account. The department
may solicit and receive gifts, grants, and donations from any
source for the benefit of the account.
Sec. 33.053. DEDICATED USE. (a) The department may use any
money remaining in the account after paying the costs of operating
the newborn screening program established under this chapter only
to:
(1) pay for capital assets, improvements, equipment,
and renovations for the laboratory established by the department to
ensure the continuous operation of the newborn screening program;
and
(2) pay for necessary renovations, construction,
capital assets, equipment, supplies, staff, and training
associated with providing additional newborn screening tests not
offered under this chapter before September 1, 2019, including the
operational costs incurred during the first year of implementing
the additional tests.
(b) The department may not use money from the account for
the department's general operating expenses.
Sec. 33.054. REPORT. If the department requires an
additional newborn screening test under Subchapter B the costs of
which are funded with money appropriated from the newborn screening
preservation account, the department shall, not later than December
31 of the first even-numbered year following the addition of the
test, prepare and submit a written report regarding the actions
taken by the department to fund and implement the test during the
preceding two years to:
(1) the governor;
(2) the lieutenant governor;
(3) the speaker of the house of representatives; and
(4) each standing committee of the legislature having
primary jurisdiction over the department.
SECTION 5. Chapter 34, Health and Safety Code, is amended by
adding Sections 34.0158 and 34.0159 to read as follows:
Sec. 34.0158. REPORT ON ACTIONS TO ADDRESS MATERNAL
MORTALITY RATES. Not later than December 1 of each even-numbered
year, the commission shall submit to the governor, the lieutenant
governor, the speaker of the house of representatives, the
Legislative Budget Board, and the appropriate standing committees
of the legislature a written report summarizing the actions taken
to address maternal morbidity and reduce maternal mortality rates.
The report must include information from programs and initiatives
created to address maternal morbidity and reduce maternal mortality
rates in this state, including:
(1) Medicaid;
(2) the children's health insurance program, including
the perinatal program;
(3) the Healthy Texas Women program;
(4) the Family Planning Program;
(5) this state's program under the Maternal and Child
Health Services Block Grant Act (42 U.S.C. Section 701 et seq.);
(6) the Perinatal Advisory Council;
(7) state health plans; and
(8) the Healthy Texas Babies program.
Sec. 34.0159. PROGRAM EVALUATIONS. The commission, in
collaboration with the task force and other interested parties,
shall:
(1) explore options for expanding the pilot program
for pregnancy medical homes established under Section 531.0996,
Government Code;
(2) explore methods for increasing the benefits
provided under Medicaid, including specialty care and
prescriptions, for women at greater risk of a high-risk pregnancy
or premature delivery;
(3) evaluate the impact of supplemental payments made
to obstetrics providers for pregnancy risk assessments on
increasing access to maternal health services;
(4) evaluate a waiver to fund managed care
organization payments for case management and care coordination
services for women at high risk of severe maternal morbidity on
conclusion of their eligibility for Medicaid;
(5) evaluate the average time required for pregnant
women to complete the Medicaid enrollment process;
(6) evaluate the use of Medicare codes for Medicaid
care coordination;
(7) study the impact of programs funded from the Teen
Pregnancy Prevention Program federal grant and evaluate whether the
state should continue funding the programs; and
(8) evaluate the use of telemedicine medical services
for women during pregnancy and the postpartum period.
SECTION 6. Chapter 34, Health and Safety Code, is amended by
adding Sections 34.019, 34.020, and 34.021 to read as follows:
Sec. 34.019. DATA COLLECTION. The task force, under the
direction of the department, shall annually collect information
relating to maternity care and postpartum depression in this state.
The information must be based on statistics for the preceding year
and include the:
(1) total number of live births;
(2) number of births by Medicaid recipients;
(3) number of births by women with health benefit plan
coverage;
(4) number of Medicaid recipients screened for
postpartum depression;
(5) number of women screened for postpartum depression
under health benefit plan coverage;
(6) number of women treated for postpartum depression
under health benefit plan coverage;
(7) number of women screened for postpartum depression
under the Healthy Texas Women program;
(8) number of women treated for postpartum depression
under the Healthy Texas Women program;
(9) number of claims for postpartum depression
treatment paid by the Healthy Texas Women program;
(10) number of claims for postpartum depression
treatment rejected by the Healthy Texas Women program;
(11) postpartum depression screening and treatment
billing codes and the number of claims for each billing code under
the Healthy Texas Women program;
(12) average number of days from the date of a
postpartum depression screening to the date the patient begins
treatment under Medicaid;
(13) average number of days from the date of a
postpartum depression screening to the date the patient begins
treatment under the Healthy Texas Women program;
(14) number of women who screened positive for
postpartum depression under Medicaid and the average number of days
following childbirth for the screening to occur;
(15) number of women who screened positive for
postpartum depression under health benefit plan coverage and the
average number of days following childbirth for the screening to
occur; and
(16) number of women who screened positive for
postpartum depression under the Healthy Texas Women program and the
average number of days following childbirth for the screening to
occur.
Sec. 34.020. PROGRAM TO DELIVER PRENATAL AND POSTPARTUM
CARE THROUGH TELEHEALTH OR TELEMEDICINE MEDICAL SERVICES IN CERTAIN
COUNTIES. (a) In this section:
(1) "Postpartum care" and "prenatal care" have the
meanings assigned by Section 32.002.
(2) "Telehealth service" and "telemedicine medical
service" have the meanings assigned by Section 111.001, Occupations
Code.
(b) The commission, in consultation with the task force,
shall develop a program to deliver prenatal and postpartum care
through telehealth services or telemedicine medical services to
pregnant women with a low risk of experiencing pregnancy-related
complications, as determined by a physician. The commission shall
implement the program in:
(1) at least two counties with populations of more
than two million;
(2) at least one county with a population of more than
100,000 and less than 500,000; and
(3) at least one rural county with high rates of
maternal mortality and morbidity as determined by the commission in
consultation with the task force.
(c) The commission shall develop criteria for selecting
participants for the program by analyzing information in the
reports prepared by the task force under this chapter and the
outcomes of the study conducted under Section 531.02163, Government
Code.
(d) In developing and administering the program, the
commission shall endeavor to use innovative, durable medical
equipment to monitor fetal and maternal health.
(e) Notwithstanding Section 531.02176, Government Code, and
if the commission determines it is feasible and cost-effective, the
commission may:
(1) provide home telemonitoring services and
necessary durable medical equipment to women participating in the
program to the extent the commission anticipates the services and
equipment will reduce unnecessary emergency room visits or
hospitalizations; and
(2) reimburse providers under Medicaid for the
provision of home telemonitoring services and durable medical
equipment under the program.
(f) Not later than January 1, 2021, the commission shall
submit to the legislature a report on the program that evaluates the
program's success in delivering prenatal and postpartum care
through telehealth services or telemedicine medical services under
Subsection (b). This subsection expires September 1, 2023.
Sec. 34.021. APPLICATION FOR FEDERAL GRANTS. (a) The
executive commissioner shall apply to the United States Department
of Health and Human Services for grants under the federal
Preventing Maternal Deaths Act of 2018 (Pub. L. No. 115-344).
(b) This section expires September 1, 2027.
SECTION 7. Section 81.090(c), Health and Safety Code, is
amended to read as follows:
(c) A physician or other person in attendance at a delivery
shall:
(1) take or cause to be taken a sample of blood or
other appropriate specimen from the mother on admission for
delivery; and
(2) submit the sample to an appropriately certified
laboratory for diagnostic testing approved by the United States
Food and Drug Administration for hepatitis B infection and
syphilis.
SECTION 8. Section 241.183(a), Health and Safety Code, is
amended to read as follows:
(a) The executive commissioner, in consultation with the
department, shall adopt rules:
(1) establishing the levels of care for neonatal and
maternal care to be assigned to hospitals;
(2) prescribing criteria for designating levels of
neonatal and maternal care, respectively, including specifying the
minimum requirements to qualify for each level designation;
(3) establishing a process for the assignment of
levels of care to a hospital for neonatal and maternal care,
respectively;
(4) establishing a process for amending the level of
care designation requirements, including a process for assisting
facilities in implementing any changes made necessary by the
amendments;
(5) dividing the state into neonatal and maternal care
regions;
(6) facilitating transfer agreements through regional
coordination;
(7) requiring payment, other than quality or
outcome-based funding, to be based on services provided by the
facility, regardless of the hospital's [facility's] level of care
designation; [and]
(8) prohibiting the denial of a neonatal or maternal
level of care designation to a hospital that meets the minimum
requirements for that level of care designation;
(9) establishing a process through which a hospital
may obtain a limited follow-up survey by an independent third party
to appeal the level of care designation assigned to the hospital;
(10) permitting a hospital to satisfy any requirement
for a Level I or II level of care designation that relates to an
obstetrics or gynecological physician by:
(A) granting maternal care privileges to a family
physician with obstetrics training or experience; and
(B) developing and implementing a plan for
responding to obstetrical emergencies that require services or
procedures outside the scope of privileges granted to the family
physician described by Paragraph (A);
(11) clarifying that, regardless of a hospital's level
of care designation, a health care provider at a designated
facility or hospital may provide the full range of health care
services:
(A) that the provider is authorized to provide
under state law; and
(B) for which the hospital has granted privileges
to the provider; and
(12) requiring the department to provide to each
hospital that receives a level of care designation a written
explanation of the basis for the designation, including, as
applicable, specific reasons that prevented the hospital from
receiving a higher level of care designation.
SECTION 9. Subchapter H, Chapter 241, Health and Safety
Code, is amended by adding Sections 241.1835, 241.1836, and
241.1865 to read as follows:
Sec. 241.1835. USE OF TELEMEDICINE MEDICAL SERVICES.
(a) In this section, "telemedicine medical service" has the
meaning assigned by Section 111.001, Occupations Code.
(b) The rules adopted under Section 241.183 must allow the
use of telemedicine medical services by a physician providing
on-call services to satisfy certain requirements identified by the
executive commissioner in the rules for a Level I, II, or III level
of care designation.
(c) In identifying a requirement for a level of care
designation that may be satisfied through the use of telemedicine
medical services under Subsection (b), the executive commissioner,
in consultation with the department, physicians of appropriate
specialties, statewide hospital associations, and other
appropriate interested persons, must ensure that the provision of a
service or procedure through the use of telemedicine medical
services is in accordance with the standard of care applicable to
the provision of the same service or procedure in an in-person
setting.
(d) Telemedicine medical services must be administered
under this section by a physician licensed to practice medicine
under Subtitle B, Title 3, Occupations Code.
(e) This section does not waive other requirements for a
level of care designation.
Sec. 241.1836. APPEAL PROCESS. (a) The rules adopted
under Section 241.183 establishing the appeal process for a level
of care designation assigned to a hospital must allow a hospital to
appeal to a three-person panel that includes:
(1) a representative of the department;
(2) a representative of the commission; and
(3) an independent person who:
(A) has expertise in the specialty area for which
the hospital is seeking a level of care designation;
(B) is not an employee of or affiliated with
either the department or the commission; and
(C) does not have a conflict of interest with the
hospital, department, or commission.
(b) The independent person on the panel described by
Subsection (a) must rotate after each appeal from a list of five to
seven similarly qualified persons. The department shall solicit
persons to be included on the list. A person must apply to the
department on a form prescribed by the department and be approved by
the commissioner to be included on the list.
Sec. 241.1865. WAIVER FROM LEVEL OF CARE DESIGNATION
REQUIREMENTS; CONDITIONAL DESIGNATION. (a) The department shall
develop and implement a process through which a hospital may
request and enter into an agreement with the department to:
(1) receive or maintain a level of care designation
for which the hospital does not meet all requirements conditioned
on the hospital, in accordance with a plan approved by the
department and outlined under the agreement, satisfying all
requirements for the level of care designation within a time
specified under the agreement, which may not exceed the first
anniversary of the effective date of the agreement; or
(2) waive one specific requirement for a level of care
designation in accordance with Subsection (c).
(b) A hospital may submit a written request under Subsection
(a) at any time. The department may make a determination on a
request submitted under that subsection at any time.
(c) The department may enter into an agreement with a
hospital to waive a requirement under Subsection (a)(2) only if the
department determines the waiver is justified considering:
(1) the expected impact on the accessibility of care
in the geographical area served by the hospital if the waiver is not
granted;
(2) the expected impact on quality of care;
(3) the expected impact on patient safety; and
(4) whether health care services related to the
requirement can be provided through telemedicine medical services
under Section 241.1835.
(d) A waiver agreement entered into under Subsection (a):
(1) must expire not later than at the end of each
designation cycle but may be renewed on expiration by the
department under the same or different terms; and
(2) may specify any conditions for ongoing reporting
and monitoring during the agreement.
(e) A hospital that enters into a waiver agreement under
Subsection (a) is required to satisfy all other requirements for a
level of care designation that are not waived in the agreement.
(f) The department shall post on the department's Internet
website and periodically update:
(1) a list of hospitals that enter into an agreement
with the department under this section; and
(2) an aggregated list of the requirements
conditionally met or waived in agreements entered into under this
section.
(g) A hospital that enters into an agreement with the
department under this section shall post on the hospital's Internet
website the nature and general terms of the agreement.
SECTION 10. Section 241.187, Health and Safety Code, is
amended by amending Subsection (l) and adding Subsections (m) and
(n) to read as follows:
(l) The advisory council is subject to Chapter 325,
Government Code (Texas Sunset Act). The advisory council shall be
reviewed during the period in which the Department of State Health
Services is reviewed [Unless continued in existence as provided by
that chapter, the advisory council is abolished and this section
expires September 1, 2025].
(m) The department, in consultation with the advisory
council, shall:
(1) conduct a strategic review of the practical
implementation of rules adopted in consultation with the department
under this subchapter that at a minimum identifies:
(A) barriers to a hospital obtaining its
requested level of care designation;
(B) whether the barriers identified under
Paragraph (A) are appropriate to ensure and improve neonatal and
maternal care;
(C) requirements for a level of care designation
that relate to gestational age; and
(D) whether, in making a level of care
designation for a hospital, the department or the perinatal
advisory council should consider:
(i) the geographic area in which the
hospital is located; and
(ii) regardless of the number of patients
of a particular gestational age treated by the hospital, the
hospital's capabilities in providing care to patients of a
particular gestational age;
(2) based on the review conducted under Subdivision
(1), recommend a modification of rules adopted under this
subchapter, as appropriate, to improve the process and methodology
of assigning level of care designations; and
(3) prepare and submit to the legislature:
(A) not later than December 31, 2019, a written
report that summarizes the department's review of neonatal care
conducted under Subdivision (1) and on actions taken by the
department and executive commissioner based on that review; and
(B) not later than December 31, 2020, a written
report that summarizes the department's review of maternal care
conducted under Subdivision (1) and on actions taken by the
department and executive commissioner based on that review.
(n) Subsection (m) and this subsection expire September 1,
2021.
SECTION 11. Chapter 1001, Health and Safety Code, is
amended by adding Subchapter K to read as follows:
SUBCHAPTER K. HIGH-RISK MATERNAL CARE COORDINATION SERVICES PILOT
PROGRAM
Sec. 1001.261. DEFINITIONS. In this subchapter:
(1) "Pilot program" means the high-risk maternal care
coordination services pilot program established under this
subchapter.
(2) "Promotora" or "community health worker" has the
meaning assigned by Section 48.001.
Sec. 1001.262. ESTABLISHMENT OF PILOT PROGRAM; RULES. (a)
The department shall develop and implement a high-risk maternal
care coordination services pilot program in one or more geographic
areas in this state.
(b) In implementing the pilot program, the department
shall:
(1) conduct a statewide assessment of training courses
provided by promotoras or community health workers that target
women of childbearing age;
(2) study existing models of high-risk maternal care
coordination services;
(3) identify, adapt, or create a risk assessment tool
to identify pregnant women who are at a higher risk for poor
pregnancy, birth, or postpartum outcomes; and
(4) create educational materials for promotoras and
community health workers that include information on the:
(A) assessment tool described by Subdivision
(3); and
(B) best practices for high-risk maternal care.
(c) The executive commissioner shall adopt rules as
necessary to implement this subchapter and prescribe the types of
information to be collected during the course of the pilot program
and included in the report described by Section 1001.264.
Sec. 1001.263. DUTIES OF DEPARTMENT. (a) The department
shall provide to each geographic area selected for the pilot
program the support, resources, technical assistance, training,
and guidance necessary to:
(1) screen all or a sample of pregnant patients with
the assessment tool described by Section 1001.262(b)(3); and
(2) integrate community health worker services for
women with high-risk pregnancies in:
(A) providing patient education on
health-enhancing behaviors and chronic disease management and
prevention;
(B) facilitating care coordination and
navigation activities; and
(C) identifying and reducing barriers to the
women's access to health care.
(b) The department shall develop training courses to
prepare promotoras and community health workers in educating and
supporting women at high risk for serious complications during the
pregnancy and postpartum periods.
Sec. 1001.264. PILOT PROGRAM REPORT. (a) Not later than
December 1 of each even-numbered year, the department shall prepare
and submit a report on the pilot program to the executive
commissioner and the chairs of the standing committees of the
senate and the house of representatives with primary jurisdiction
over public health and human services. The report may be submitted
with the report required under Section 34.0156.
(b) The report submitted under this section must include an
evaluation from the commissioner of the pilot program's
effectiveness.
(c) The report submitted under this section must include a
recommendation from the department on whether the pilot program
should continue, be expanded, or be terminated.
Sec. 1001.265. EXPIRATION. This subchapter expires
September 1, 2023.
SECTION 12. (a) The executive commissioner of the Health
and Human Services Commission shall adopt the rules required by:
(1) Section 33.004(f), Health and Safety Code, as
amended by this Act, and Section 1001.262(c), Health and Safety
Code, as added by this Act, not later than December 1, 2019, subject
to Subsection (b) of this section; and
(2) Section 241.183, Health and Safety Code, as
amended by this Act, as soon as practicable after the effective date
of this Act.
(b) Notwithstanding Subchapter K, Chapter 1001, Health and
Safety Code, as added by this Act, the Department of State Health
Services and the executive commissioner of the Health and Human
Services Commission are not required to comply with that subchapter
unless a specific appropriation for the implementation of the
subchapter is provided in a general appropriations act of the 86th
Legislature.
SECTION 13. (a) The executive commissioner of the Health
and Human Services Commission shall complete for each hospital in
this state the maternal level of care designation required under
Subchapter H, Chapter 241, Health and Safety Code, as amended by
this Act, not later than August 31, 2021.
(b) Notwithstanding Section 241.186, Health and Safety
Code, a hospital is not required to have a maternal level of care
designation as a condition of reimbursement for maternal services
through the Medicaid program before September 1, 2021.
(c) A hospital that submits an application to the Department
of State Health Services for a maternal level of care designation
under Subchapter H, Chapter 241, Health and Safety Code, before the
effective date of this Act may amend the application to reflect the
applicable changes in law made by this Act.
SECTION 14. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall apply to the United States Department of
Health and Human Services for grants as required by Section 34.021,
Health and Safety Code, as added by this Act.
SECTION 15. 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 may delay implementing that provision until the
waiver or authorization is granted.
SECTION 16. 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.
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