Texas 2023 - 88th Regular

Texas House Bill HB4867 Compare Versions

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11 88R12593 JCG-F
22 By: Guerra H.B. No. 4867
33
44
55 A BILL TO BE ENTITLED
66 AN ACT
77 relating to health care transparency, including advertising,
88 identification, and notice requirements for certain health
99 facilities and health professionals; authorizing administrative
1010 and civil penalties.
1111 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1212 SECTION 1. Title 2, Health and Safety Code, is amended by
1313 adding Subtitle J to read as follows:
1414 SUBTITLE J. PROVISION OF HEALTH CARE SERVICES
1515 CHAPTER 185. IDENTIFICATION AND NOTICE REQUIREMENTS FOR HEALTH
1616 FACILITIES AND HEALTH PROFESSIONALS
1717 Sec. 185.001. DEFINITIONS. In this chapter:
1818 (1) "Advertisement" means:
1919 (A) any printed, electronic, or oral statement,
2020 with respect to the provision of health care services by a health
2121 care professional:
2222 (i) that is communicated or disseminated to
2323 the public;
2424 (ii) that:
2525 (a) is intended to encourage a person
2626 to use the professional's services; or
2727 (b) for a commercial purpose, names
2828 the professional in connection with the practice, profession, or
2929 institution in which the professional provides health care
3030 services; and
3131 (iii) the preparation, communication, or
3232 dissemination of which is controlled by the professional or a group
3333 to which the professional is affiliated; and
3434 (B) any communication or statement not described
3535 by Paragraph (A) but that is used in the regular course of the
3636 professional's business for the purpose of promoting the
3737 professional's services to the public, including:
3838 (i) business cards;
3939 (ii) letterhead;
4040 (iii) signs;
4141 (iv) pamphlets;
4242 (v) brochures;
4343 (vi) e-mails and any other communication or
4444 statement transmitted through the Internet; or
4545 (vii) audio or video communications,
4646 including television or radio advertisements.
4747 (2) "Commission" means the Health and Human Services
4848 Commission.
4949 (3) "Health facility" means:
5050 (A) a solo or group medical practice; or
5151 (B) an urgent care facility.
5252 (4) "Health professional" and "professional" mean an
5353 individual licensed under Title 3, Occupations Code.
5454 (5) "Urgent care facility" means a facility providing
5555 health care that:
5656 (A) provides episodic ambulatory health care to
5757 individuals outside of a hospital emergency room setting;
5858 (B) does not require an individual to make an
5959 appointment;
6060 (C) provides some services typically provided in
6161 a primary care physician's office or emergency room; and
6262 (D) treats individuals requiring treatment of an
6363 illness or injury that requires immediate care but is not
6464 life-threatening.
6565 Sec. 185.002. PHOTO IDENTIFICATION BADGE REQUIRED. (a) A
6666 health facility shall adopt a policy requiring a health
6767 professional providing direct patient care at the facility to wear
6868 a photo identification badge during all patient encounters, unless
6969 wearing the badge is precluded by isolation or sterilization
7070 protocols adopted by the facility. The badge must be of sufficient
7171 size, be prominently worn and clearly visible, and include:
7272 (1) the professional's first and last name;
7373 (2) the facility department with which the
7474 professional is associated;
7575 (3) the type of license held by the professional under
7676 Title 3, Occupations Code, and no other title; and
7777 (4) if applicable, the professional's status as a
7878 student, intern, or trainee, or resident, but only if the
7979 professional is registered with the Texas Medical Board.
8080 (b) For purposes of Subsection (a)(3), the identification
8181 badge of a health professional licensed under Title 3, Occupations
8282 Code, must clearly state:
8383 (1) "physician," if the professional holds a license
8484 under Subtitle B of that title;
8585 (2) "acupuncturist," "chiropractor," "midwife,"
8686 "physician assistant," "podiatrist," or "surgical assistant," as
8787 applicable, if the professional holds a license under Subtitle C of
8888 that title;
8989 (3) "dental hygienist" or "dentist," as applicable, if
9090 the professional holds a license under Subtitle D of that title;
9191 (4) "advanced practice registered nurse," "licensed
9292 vocational nurse," "registered nurse," "nurse practitioner,"
9393 "nurse midwife," "nurse anesthetist," or "clinical nurse
9494 specialist," as applicable, if the professional holds a license
9595 under Subtitle E of that title;
9696 (5) "optometrist" or "therapeutic optometrist," as
9797 applicable, if the professional holds a license under Subtitle F of
9898 that title;
9999 (6) "audiologist" or "speech-language pathologist,"
100100 as applicable, if the professional holds a license under Subtitle G
101101 of that title;
102102 (7) "athletic trainer," "massage therapist,"
103103 "occupational therapist," "occupational therapy assistant,"
104104 "physical therapist," or "physical therapist assistant," as
105105 applicable, if the professional holds a license under Subtitle H of
106106 that title;
107107 (8) "pharmacist," if the professional holds a license
108108 under Subtitle J of that title;
109109 (9) "medical physicist," "medical radiologic
110110 technologist," "orthotist," "orthotist assistant,"
111111 "perfusionist," "prosthetist," "prosthetist assistant," or
112112 "respiratory care practitioner," as applicable, if the
113113 professional holds a license under Subtitle K of that title; or
114114 (10) "dietitian," if the professional holds a license
115115 under Subtitle M of that title.
116116 Sec. 185.003. NOTICE OF HEALTH PROFESSIONAL LICENSE. A
117117 health facility shall post in a conspicuous location in each office
118118 where a health professional provides health care services a written
119119 notice stating the type of license the professional holds. The
120120 notice must be printed using an easily readable font and type size.
121121 Sec. 185.004. HEALTH CARE SERVICES PROVIDED BY NONPHYSICIAN
122122 HEALTH PROFESSIONAL. (a) If a nonphysician health professional
123123 provides health care services in a health facility under the
124124 supervision of a physician, the facility shall post in a
125125 conspicuous location in each office where the professional provides
126126 health care services a written notice stating:
127127 (1) the name of the supervising physician;
128128 (2) the supervising physician's medical license
129129 number;
130130 (3) any board certification or specialty in which the
131131 physician is certified;
132132 (4) the physician's practice contact information,
133133 including the telephone number and address of the practice;
134134 (5) either:
135135 (A) the hours the physician is scheduled to be
136136 present at the practice location; or
137137 (B) if the physician is not scheduled to be
138138 present at the practice location, the statement: "No physician on
139139 site"; and
140140 (6) the statement: "Any patient may request treatment
141141 by a physician. Notify a staff member at this location if you want
142142 to request this option."
143143 (b) A patient may choose to be treated by the supervising
144144 physician of a nonphysician health professional. If the patient
145145 requests treatment by the supervising physician, the physician must
146146 see the patient not later than the 30th day after the date the
147147 patient makes the request. The physician may see the patient in
148148 person or through an acceptable telemedicine medical services
149149 platform.
150150 Sec. 185.005. PROHIBITED CONDUCT. A health professional
151151 may not:
152152 (1) knowingly aid, abet, permit, advise, or solicit a
153153 person who is not licensed to practice the health profession in
154154 which the professional is licensed to engage in an act contrary to
155155 that professional licensure; or
156156 (2) delegate to or contract with another health
157157 professional to provide health care services if the professional
158158 knows, or has reason to know, that the other professional is not
159159 authorized for delegation of or to contract for those services
160160 under the professional's license.
161161 Sec. 185.006. ADMINISTRATIVE PENALTY. (a) The commission
162162 or the regulatory agency for a health professional, including the
163163 Texas Medical Board, the Texas Physician Assistant Board, and the
164164 Texas Board of Nursing, may impose an administrative penalty
165165 against a health facility or professional regulated by the
166166 commission or agency who violates this chapter or a rule adopted
167167 under this chapter.
168168 (b) The amount of the penalty imposed may not exceed $1,000
169169 for each violation, and each day a violation continues or occurs is
170170 a separate violation for the purpose of imposing a penalty. The
171171 amount shall be based on:
172172 (1) the seriousness of the violation, including the
173173 nature, circumstances, extent, and gravity of the violation;
174174 (2) the history of previous violations;
175175 (3) the amount necessary to deter a future violation;
176176 (4) the efforts to correct the violation; and
177177 (5) any other matter that justice may require.
178178 (c) The enforcement of the penalty may be stayed during the
179179 time the order is under judicial review if the health facility or
180180 professional pays the penalty to the clerk of the court or files a
181181 supersedeas bond with the court in the amount of the penalty. A
182182 facility or professional that cannot afford to pay the penalty or
183183 file the bond may stay the enforcement by filing an affidavit in the
184184 manner required by the Texas Rules of Civil Procedure for a party
185185 who cannot afford to file security for costs, subject to the right
186186 of the commission or regulatory agency to contest the affidavit as
187187 provided by those rules.
188188 (d) The attorney general may sue to collect the penalty.
189189 The attorney general may recover reasonable expenses incurred in
190190 obtaining relief under this subsection, including court costs,
191191 reasonable attorney's fees, investigation costs, witness fees, and
192192 deposition expenses.
193193 (e) A proceeding to impose the penalty is considered to be a
194194 contested case under Chapter 2001, Government Code.
195195 Sec. 185.007. CIVIL PENALTY. (a) A health facility that
196196 violates this chapter is liable to the state for a civil penalty of
197197 not more than $1,000 for each violation. Each day of a continuing
198198 violation constitutes a separate ground for recovery.
199199 (b) The attorney general may sue to collect a civil penalty
200200 under this section. The attorney general may recover reasonable
201201 expenses incurred in obtaining relief under this section, including
202202 court costs, reasonable attorney's fees, investigation costs,
203203 witness fees, and deposition expenses.
204204 SECTION 2. The heading to Subchapter E, Chapter 101,
205205 Occupations Code, is amended to read as follows:
206206 SUBCHAPTER E. CERTAIN PRACTICES RELATED TO ADVERTISING AND BILLING
207207 PROHIBITED [GROUNDS FOR LICENSE REVOCATION OR DENIAL]
208208 SECTION 3. Section 101.201, Occupations Code, is amended by
209209 amending Subsection (b) and adding Subsections (c) and (d) to read
210210 as follows:
211211 (b) False, misleading, or deceptive advertising or
212212 advertising not readily subject to verification includes
213213 advertising that:
214214 (1) makes a material misrepresentation of fact or
215215 omits a fact necessary to make the statement as a whole not
216216 materially misleading;
217217 (2) makes a representation likely to create an
218218 unjustified expectation about the results of a health care service
219219 or procedure;
220220 (3) compares a health care professional's services
221221 with another health care professional's services unless the
222222 comparison can be factually substantiated;
223223 (4) contains a testimonial;
224224 (5) causes confusion or misunderstanding as to the
225225 credentials, education, or licensing of a health care professional,
226226 including using a title, term, or other words that misstate,
227227 falsely describe, falsely hold out, or falsely detail the health
228228 care professional's:
229229 (A) professional skills;
230230 (B) training;
231231 (C) expertise;
232232 (D) educational degree;
233233 (E) specialty certification; or
234234 (F) licensure;
235235 (6) represents that health care insurance deductibles
236236 or copayments may be waived or are not applicable to health care
237237 services to be provided if the deductibles or copayments are
238238 required;
239239 (7) represents that the benefits of a health benefit
240240 plan will be accepted as full payment when deductibles or
241241 copayments are required;
242242 (8) makes a representation that is designed to take
243243 advantage of the fears or emotions of a particularly susceptible
244244 type of patient; or
245245 (9) represents in the use of a professional name a
246246 title or professional identification that is associated with
247247 another profession and the health care professional is not licensed
248248 or otherwise authorized to practice that profession [expressly or
249249 commonly reserved to or used by another profession or
250250 professional].
251251 (c) For purposes of this section, advertising that does not
252252 include the name of the health care professional and the
253253 professional identification required by Section 104.003 is
254254 considered false, misleading, deceptive, or not readily subject to
255255 verification.
256256 (d) In this section, "advertising" includes:
257257 (1) any printed, electronic, or oral statement, with
258258 respect to the provision of health care services by a health care
259259 professional:
260260 (A) that is communicated or disseminated to the
261261 public;
262262 (B) that:
263263 (i) is intended to encourage a person to use
264264 the professional's services; or
265265 (ii) for a commercial purpose, names the
266266 professional in connection with the practice, profession, or
267267 institution in which the professional provides health care
268268 services; and
269269 (C) the preparation, communication, or
270270 dissemination of which is controlled by the professional or a group
271271 to which the professional is affiliated; and
272272 (2) any communication or statement not described by
273273 Subdivision (1) but that is used in the regular course of the
274274 professional's business for the purpose of promoting the
275275 professional's services to the public, including:
276276 (A) business cards;
277277 (B) letterhead;
278278 (C) signs;
279279 (D) pamphlets;
280280 (E) brochures;
281281 (F) e-mails and any other communication or
282282 statement transmitted through the Internet; or
283283 (G) audio or video communications, including
284284 television or radio advertisements.
285285 SECTION 4. Subchapter E, Chapter 101, Occupations Code, is
286286 amended by adding Section 101.205 to read as follows:
287287 Sec. 101.205. ADMINISTRATIVE PENALTY. (a) A health
288288 licensing agency that issues a license, certificate, or other
289289 authorization under this title, may impose an administrative
290290 penalty on a person who:
291291 (1) holds a license, certificate, or other
292292 authorization issued by the health licensing agency; and
293293 (2) violates Section 101.201.
294294 (b) The amount of an administrative penalty may not exceed
295295 $1,000 for each violation. Each day a violation continues or occurs
296296 is a separate violation for purposes of imposing a penalty.
297297 (c) A proceeding to impose an administrative penalty under
298298 this section is subject to Chapter 2001, Government Code.
299299 SECTION 5. Section 104.003, Occupations Code, is amended by
300300 amending Subsections (b) and (c) and adding Subsection (h) to read
301301 as follows:
302302 (b) A person who is licensed by the Texas Medical [State]
303303 Board [of Medical Examiners] and holds a doctor of medicine degree
304304 shall use:
305305 (1) physician or surgeon, M.D.;
306306 (2) doctor, M.D.; [or]
307307 (3) doctor of medicine, M.D.; or
308308 (4) a designation indicating that the person is
309309 certified or eligible for certification, as applicable, by a
310310 certifying board of the American Board of Medical Specialties, the
311311 American Board of Oral and Maxillofacial Surgery, the National
312312 Board of Physicians and Surgeons, or a successor organization to
313313 those organizations.
314314 (c) A person who is licensed by the Texas Medical [State]
315315 Board [of Medical Examiners] and holds a doctor of osteopathy
316316 degree shall use:
317317 (1) physician or surgeon, D.O.;
318318 (2) osteopathic physician or surgeon;
319319 (3) doctor, D.O.;
320320 (4) doctor of osteopathy;
321321 (5) doctor of osteopathic medicine;
322322 (6) osteopath; [or]
323323 (7) D.O.; or
324324 (8) a designation indicating that the person is
325325 certified or eligible for certification, as applicable, by a
326326 certifying board of the American Osteopathic Association, the
327327 American Board of Oral and Maxillofacial Surgery, the National
328328 Board of Physicians and Surgeons, or a successor organization to
329329 those organizations.
330330 (h) A person licensed under this title and not described by
331331 Subsection (b), (c), (d), (e), (f), or (g) may only use a title
332332 authorized by the law under which the person is licensed.
333333 SECTION 6. Chapter 104, Occupations Code, is amended by
334334 adding Section 104.0035 to read as follows:
335335 Sec. 104.0035. FALSE AND DECEPTIVE ADVERTISING. A healing
336336 art practitioner may not use advertising that is false, misleading,
337337 or deceptive, or not readily subject to verification as provided by
338338 Section 101.201.
339339 SECTION 7. Chapter 104, Occupations Code, is amended by
340340 adding Section 104.008 to read as follows:
341341 Sec. 104.008. ADMINISTRATIVE PENALTY. (a) A healing art
342342 licensing board that issues a license, certificate, or other
343343 authorization described by Section 104.003, may impose an
344344 administrative penalty on a person who:
345345 (1) holds a license, certificate, or other
346346 authorization issued by the healing art licensing board; and
347347 (2) violates this chapter.
348348 (b) The amount of an administrative penalty may not exceed
349349 $1,000 for each violation. Each day a violation continues or occurs
350350 is a separate violation for purposes of imposing a penalty.
351351 (c) A proceeding to impose an administrative penalty under
352352 this section is subject to Chapter 2001, Government Code.
353353 SECTION 8. Section 165.156, Occupations Code, is amended to
354354 read as follows:
355355 Sec. 165.156. MISREPRESENTATION REGARDING ENTITLEMENT TO
356356 PRACTICE MEDICINE. A person, partnership, trust, association, or
357357 corporation commits an offense if the person, partnership, trust,
358358 association, or corporation, through the use of any title,
359359 abbreviation, description of services, designation, letters,
360360 words, or terms, alone or in combination with any other title,
361361 affixed on stationery or on advertisements, or in any other manner,
362362 including oral or written communications, indicates or induces
363363 another to believe that the person, partnership, trust,
364364 association, or corporation is entitled to practice medicine if the
365365 person, partnership, trust, association, or corporation is not
366366 licensed to do so.
367367 SECTION 9. Subchapter D, Chapter 165, Occupations Code, is
368368 amended by adding Section 165.1565 to read as follows:
369369 Sec. 165.1565. USE OF TITLE. (a) In this section, "medical
370370 or medical specialty title" means:
371371 (1) "doctor of medicine" or "M.D.";
372372 (2) "doctor of osteopathy" or "D.O.";
373373 (3) "physician";
374374 (4) "surgeon";
375375 (5) "osteopathic physician";
376376 (6) "osteopathic surgeon";
377377 (7) "doctor";
378378 (8) "aesthetic surgeon";
379379 (9) "age management medicine physician";
380380 (10) "allergist";
381381 (11) "anesthesiologist";
382382 (12) "associate physician";
383383 (13) "cosmetic surgeon";
384384 (14) "dermatologist";
385385 (15) "emergency medicine doctor";
386386 (16) "emergency medicine physician";
387387 (17) "endocrinologist";
388388 (18) "environmental medicine physician";
389389 (19) "family medicine doctor";
390390 (20) "family medicine physician";
391391 (21) "family practice doctor";
392392 (22) "family practice physician";
393393 (23) "functional medicine doctor";
394394 (24) "functional medicine physician";
395395 (25) "gastroenterologist";
396396 (26) "general practitioner";
397397 (27) "geriatrician";
398398 (28) "graduate physician";
399399 (29) "gynecologist";
400400 (30) "hematologist";
401401 (31) "hepatologist";
402402 (32) "hospitalist";
403403 (33) "house officer";
404404 (34) "intensivist";
405405 (35) "internal medicine physician";
406406 (36) "intern";
407407 (37) "internist";
408408 (38) "laryngologist";
409409 (39) "neonatologist";
410410 (40) "nephrologist";
411411 (41) "neurologist";
412412 (42) "nocturnist";
413413 (43) "obstetrician";
414414 (44) "occupational health physician";
415415 (45) "occupational medicine doctor";
416416 (46) "occupational medicine physician";
417417 (47) "oncologist";
418418 (48) "ophthalmologist";
419419 (49) "orthopedic surgeon";
420420 (50) "orthopedist";
421421 (51) "osteopath";
422422 (52) "otolaryngologist";
423423 (53) "otologist";
424424 (54) "otorhinolaryngologist";
425425 (55) "pathologist";
426426 (56) "pediatrician";
427427 (57) "physiatrist";
428428 (58) "physical medicine and rehabilitation
429429 physician";
430430 (59) "physician associate";
431431 (60) "physician graduate";
432432 (61) "plastic surgeon";
433433 (62) "primary care doctor";
434434 (63) "primary care physician";
435435 (64) "proctologist";
436436 (65) "psychiatrist";
437437 (66) "radiologist";
438438 (67) "resident";
439439 (68) "rheumatologist";
440440 (69) "rhinologist";
441441 (70) "urogynecologist";
442442 (71) "urologist"; or
443443 (72) another title specified by board rule.
444444 (b) Except as provided by Section 104.004, a person who is
445445 not licensed to practice medicine by the board may not:
446446 (1) use or publicly display a medical or medical
447447 specialty title in connection with the person's name either alone
448448 or in combination with another word or title; or
449449 (2) indicate or induce another to believe that the
450450 person is an attending doctor or attending physician or practices
451451 medicine.
452452 (c) In a clinical setting, the terms "fellowship" and
453453 "residency" are reserved for postgraduate medical, dental,
454454 podiatric, and pharmacologic education and training. The terms may
455455 not be used to describe nursing or any nonmedical postgraduate
456456 training.
457457 (d) In a clinical setting, the terms "attending,"
458458 "attending doctor," and "attending physician" are reserved for
459459 physicians who are licensed to practice medicine and who have
460460 completed a postgraduate medical residency training program.
461461 (e) In a clinical setting, "physician associate,"
462462 "associate physician," and "physician graduate" are reserved for
463463 physicians licensed to practice medicine who:
464464 (1) are graduates of a board-approved medical school
465465 or osteopathic medical school; and
466466 (2) have passed the second component of the United
467467 States Medical Licensing Examination or the equivalent component of
468468 another board-approved licensing examination.
469469 SECTION 10. Section 204.203, Occupations Code, is amended
470470 to read as follows:
471471 Sec. 204.203. IDENTIFICATION REQUIREMENTS. A physician
472472 assistant shall:
473473 (1) keep the physician assistant's license available
474474 for inspection at the physician assistant's primary place of
475475 business; and
476476 (2) when engaged in the physician assistant's
477477 professional activities, wear a name tag identifying the license
478478 holder as a physician assistant by title or the initials "P.A.".
479479 SECTION 11. Subchapter E, Chapter 204, Occupations Code, is
480480 amended by adding Section 204.2035 to read as follows:
481481 Sec. 204.2035. FALSE AND DECEPTIVE ADVERTISING. A
482482 physician assistant may not use advertising that is false,
483483 misleading, deceptive, or not readily subject to verification as
484484 provided by Section 101.201.
485485 SECTION 12. Sections 301.351(a), (b), and (c), Occupations
486486 Code, are amended to read as follows:
487487 (a) A person who holds a license [as a registered nurse]
488488 under this chapter[:
489489 [(1)] is referred to as:
490490 (1) a registered nurse or[; and
491491 [(2) may use the abbreviation] "R.N.";
492492 (2) a licensed vocational nurse or "L.V.N.";
493493 (3) an advanced practice registered nurse or
494494 "A.P.R.N.";
495495 (4) a nurse practitioner or "N.P.";
496496 (5) a nurse midwife;
497497 (6) a certified registered nurse anesthetist or
498498 "C.R.N.A."; or
499499 (7) a clinical nurse specialist or "C.N.S.".
500500 (b) Except as provided by Section 104.004, a [A] person who
501501 holds a license [as a vocational nurse] under this chapter may not
502502 use the title "doctor" unless the person also holds a license issued
503503 by the Texas Medical Board under Subtitle B, as provided by Section
504504 165.1565.[:
505505 [(1) is referred to as a licensed vocational nurse or
506506 vocational nurse; and
507507 [(2) may use the abbreviation "L.V.N." or "V.N."]
508508 (c) While interacting with the public in a nursing role,
509509 each nurse shall wear a clearly legible insignia identifying the
510510 nurse in accordance with Subsection (a) [as a registered or
511511 vocational nurse]. The insignia may not contain information other
512512 than:
513513 (1) the appropriate [registered or vocational nurse]
514514 designation;
515515 (2) the nurse's name, certifications, academic
516516 degrees, or practice position;
517517 (3) the name of the employing facility or agency, or
518518 other employer;
519519 (4) a picture of the nurse; or
520520 (5) any other information authorized by the board.
521521 SECTION 13. Subchapter H, Chapter 301, Occupations Code, is
522522 amended by adding Section 301.3515 to read as follows:
523523 Sec. 301.3515. FALSE AND DECEPTIVE ADVERTISING. A nurse
524524 may not use advertising that is false, misleading, deceptive, or
525525 not readily subject to verification as provided by Section 101.201.
526526 SECTION 14. Section 104.007, Occupations Code, is repealed.
527527 SECTION 15. Each state regulatory agency that issues a
528528 license to a health professional or health facility, including the
529529 Texas Medical Board, Texas Physician Assistant Board, Texas Board
530530 of Nursing, and Health and Human Services Commission, shall adopt
531531 rules necessary to implement Chapter 185, Health and Safety Code,
532532 as added by this Act, and Chapters 101 and 104, Occupations Code, as
533533 amended by this Act, not later than January 1, 2024.
534534 SECTION 16. Chapter 185, Health and Safety Code, as added by
535535 this Act, applies to the provision of health care services on or
536536 after January 1, 2024.
537537 SECTION 17. The changes in law made by this Act apply only
538538 to conduct that occurs on or after the effective date of this Act.
539539 Conduct that occurs before that date is governed by the law in
540540 effect on the date the conduct occurred, and the former law is
541541 continued in effect for that purpose.
542542 SECTION 18. This Act takes effect September 1, 2023.