Texas 2025 - 89th Regular

Texas House Bill HB5244 Compare Versions

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Old	New	Differences
1	1	89R11869 JG-F
2	2	By: Manuel H.B. No. 5244
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the development and implementation of the Texas Plan
10	10	demonstration program to fund the purchase by and provision to
11	11	certain eligible individuals of health care services.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Subtitle I, Title 4, Government Code, is amended
14	14	by adding Chapter 532A to read as follows:
15	15	CHAPTER 532A. TEXAS PLAN DEMONSTRATION PROGRAM
16	16	SUBCHAPTER A. GENERAL PROVISIONS
17	17	Sec. 532A.0001. DEFINITIONS. In this chapter:
18	18	(1) "Board" means the board of directors of the
19	19	med-pool.
20	20	(2) "Eligible individual" means an individual who is
21	21	eligible to participate in the program.
22	22	(3) "Health benefit account" means a health benefit
23	23	account the comptroller establishes for a participant under
24	24	Subchapter E.
25	25	(4) "Health care provider" means:
26	26	(A) a primary care provider;
27	27	(B) a specialty and major medical care provider;
28	28	and
29	29	(C) an integrated health care organization.
30	30	(5) "Integrated health care organization" means a
31	31	health care organization that provides all of a participant's
32	32	health care needs, including primary care and specialty and major
33	33	medical care services, using a capitated payment model.
34	34	(6) "Med-pool" means the risk pool established under
35	35	Subchapter F to provide specialty and major medical care services
36	36	to participants.
37	37	(7) "Nondiscriminatory price" means a fixed,
38	38	transparent, nonnegotiable price for a health care service that a
39	39	health care provider charges each individual for the service
40	40	regardless of the payment model used to pay for the service.
41	41	(8) "Participant" means an individual who is enrolled
42	42	in the program.
43	43	(9) "Primary care provider" means a provider of
44	44	primary care services.
45	45	(10) "Primary care services" includes whole-person,
46	46	integrated, and accessible health care provided by
47	47	interprofessional teams that are engaged to address the majority of
48	48	an individual's health and wellness needs across different health
49	49	care settings through sustained relationships with patients,
50	50	families, and communities in order to achieve better health
51	51	outcomes, better care, and lower health care prices.
52	52	(11) "Program" means the Texas Plan demonstration
53	53	program established under this chapter.
54	54	(12) "Specialty and major medical care provider" means
55	55	a provider of specialty and major medical care services.
56	56	(13) "Specialty and major medical care services" means
57	57	health care services other than primary care services. The term
58	58	includes:
59	59	(A) emergency care;
60	60	(B) urgent care;
61	61	(C) hospital care;
62	62	(D) allergy and immunology;
63	63	(E) anesthesiology;
64	64	(F) cardiology;
65	65	(G) dermatology;
66	66	(H) diagnostic radiology;
67	67	(I) medical genetics;
68	68	(J) nephrology;
69	69	(K) neurology;
70	70	(L) nuclear medicine;
71	71	(M) obstetrics and gynecology;
72	72	(N) oncology;
73	73	(O) ophthalmology;
74	74	(P) orthopedics;
75	75	(Q) pathology;
76	76	(R) pediatrics;
77	77	(S) physical medicine and rehabilitation;
78	78	(T) psychiatry;
79	79	(U) radiation oncology;
80	80	(V) surgery; and
81	81	(W) urology.
82	82	Sec. 532A.0002. FEDERAL AUTHORIZATION FOR PROGRAM. (a)
83	83	The executive commissioner shall develop and seek a waiver under
84	84	Section 1115 of the Social Security Act (42 U.S.C. Section 1315) or,
85	85	if available, a block grant or comparable funding system that may be
86	86	used for this purpose to obtain any federal money available for
87	87	implementing the Texas Plan demonstration program to assist
88	88	eligible individuals in obtaining health care services.
89	89	(b) The terms of the waiver the executive commissioner seeks
90	90	must:
91	91	(1) be designed to:
92	92	(A) make high value health care services more
93	93	accessible to eligible individuals;
94	94	(B) provide money to cover the costs of a
95	95	participant's primary care services, specialty and major medical
96	96	care services, dental health services, prescription drugs, and
97	97	other eligible out-of-pocket health care expenses;
98	98	(C) for the purpose of shifting costs from
99	99	hospital care to prevention, emphasize the provision of capitated,
100	100	whole-person, person-centered primary care, including case
101	101	management, mental health services, and health system navigation,
102	102	as a core component of the program's overall health goals;
103	103	(D) improve health outcomes of participants
104	104	based on the value of care the program offers, including by:
105	105	(i) when diagnosing and treating a
106	106	participant, considering nonmedical factors that impact the
107	107	participant's health, including nutrition, transportation,
108	108	housing, and employment; and
109	109	(ii) to the extent possible, coordinating
110	110	with community health organizations and other local resources
111	111	available to address the nonmedical factors;
112	112	(E) emphasize and encourage price and quality
113	113	transparency by program health care providers to enable:
114	114	(i) a participant to make informed
115	115	decisions regarding health care price and quality; and
116	116	(ii) the commission and board to collect
117	117	accurate and current pricing information for each provider,
118	118	including nondiscriminatory price information;
119	119	(F) provide a framework for the commission and
120	120	board to use existing data sources or develop new data sources to
121	121	obtain and publish information on high-value care that:
122	122	(i) identifies health care providers who
123	123	provide low health care prices and high quality of care, including
124	124	health care centers of excellence; and
125	125	(ii) facilitates a participant's ability to
126	126	navigate between health care providers to obtain high-value care;
127	127	and
128	128	(G) subject to Section 532A.0104, provide
129	129	continuous coverage for participants for the duration of the
130	130	program;
131	131	(2) because some participants may have limited primary
132	132	care options, recognize a broad range of primary care arrangements
133	133	and providers under the program, including:
134	134	(A) direct primary care, advanced primary care,
135	135	and similar primary care service arrangements provided virtually or
136	136	on-site;
137	137	(B) federally qualified health centers, as
138	138	defined by 42 U.S.C. Section 1396d(l)(2)(B); and
139	139	(C) commercial retailers that provide primary
140	140	care services at a published, nondiscriminatory price for each
141	141	offered service;
142	142	(3) allow health care services to be provided remotely
143	143	as telehealth services or telemedicine medical services; and
144	144	(4) allow for the operation of the program consistent
145	145	with the requirements of this chapter for a period of five years,
146	146	except to the extent deviation from the requirements is necessary
147	147	to obtain the waiver.
148	148	Sec. 532A.0003. FUNDING. (a) Subject to approval of the
149	149	waiver described by Section 532A.0002, the commission shall
150	150	implement the program using federal money obtained and state money
151	151	available for that purpose.
152	152	(b) The commission shall implement the program in
153	153	accordance with the following spending requirements:
154	154	(1) except as provided by Subdivision (2), the
155	155	commission shall use state money appropriated for the program to
156	156	cover:
157	157	(A) the administrative costs of implementing and
158	158	operating the program; and
159	159	(B) the costs of med-pool health care claims and
160	160	excess loss coverage to protect the med-pool against financial
161	161	losses that may place the med-pool's solvency in financial
162	162	jeopardy; and
163	163	(2) except as provided by Subsection (c), the
164	164	commission shall use federal money received for the program and an
165	165	amount of state money appropriated for the program that the
166	166	commission determines necessary to cover the costs of providing
167	167	health care services to program participants by distributing the
168	168	money among each participant on a per capita basis in the following
169	169	proportions and manner:
170	170	(A) 25 percent of allocated money must be:
171	171	(i) used to cover the costs of providing a
172	172	participant's primary care services, including dental health and
173	173	prescription drug costs related to those services; and
174	174	(ii) deposited into the participant's
175	175	health benefit account in accordance with Subchapter E; and
176	176	(B) 75 percent of allocated money must be:
177	177	(i) used to cover the costs of providing a
178	178	participant's specialty and major medical care services, including
179	179	prescription drug costs related to those services; and
180	180	(ii) disbursed to the med-pool.
181	181	(c) For a participant who receives all of the participant's
182	182	health care needs from an integrated health care organization, the
183	183	commission shall:
184	184	(1) disburse 96 percent of the per capita amount
185	185	described by Subsection (b)(2) to the organization to cover the
186	186	costs of providing the participant's health care services; and
187	187	(2) deposit the remaining four percent into the
188	188	participant's health benefit account in accordance with Subchapter
189	189	E to cover the costs of eligible out-of-pocket health care
190	190	expenses.
191	191	Sec. 532A.0004. EXPIRATION. The program concludes and this
192	192	chapter expires September 1, 2031.
193	193	SUBCHAPTER B. PROGRAM ADMINISTRATION
194	194	Sec. 532A.0051. PROGRAM OBJECTIVE. The program's objective
195	195	is to enable eligible individuals to obtain, and to provide money to
196	196	participants to cover the costs of, health care services, including
197	197	dental health services, and prescription drugs in a manner that:
198	198	(1) offers convenient access to high-value care;
199	199	(2) prioritizes whole-person, person-centered,
200	200	coordinated primary care services; and
201	201	(3) lowers the overall costs for providing health care
202	202	services to participants over the course of the program.
203	203	Sec. 532A.0052. PROGRAM PROMOTION. The commission shall
204	204	promote and provide information on the program to individuals who
205	205	are potentially eligible to participate in the program. The
206	206	commission shall ensure the program's promotion is designed in a
207	207	manner to reach as many eligible individuals as possible.
208	208	Sec. 532A.0053. COMMISSION'S AUTHORITY RELATED TO
209	209	ELIGIBILITY AND MEDICAID COORDINATION. The commission may:
210	210	(1) accept applications for program participation and
211	211	implement program eligibility screening and enrollment procedures;
212	212	(2) resolve grievances related to eligibility
213	213	determinations; and
214	214	(3) to the extent possible, coordinate the program
215	215	with Medicaid and any exchange offering a health benefit plan under
216	216	the Patient Protection and Affordable Care Act (Pub. L. No.
217	217	111-148), as amended by the Health Care and Education
218	218	Reconciliation Act of 2010 (Pub. L. No. 111-152).
219	219	SUBCHAPTER C. PROGRAM ELIGIBILITY
220	220	Sec. 532A.0101. ELIGIBILITY REQUIREMENTS. An individual is
221	221	eligible to participate in the program if:
222	222	(1) the individual is a:
223	223	(A) citizen or permanent resident of the United
224	224	States; and
225	225	(B) resident of this state;
226	226	(2) the individual is 19 years of age or older but
227	227	younger than 65 years of age;
228	228	(3) applying the eligibility criteria in effect in
229	229	this state on December 31, 2024, the individual is not eligible for
230	230	Medicaid; and
231	231	(4) federal money is available to provide benefits to
232	232	the individual under the program.
233	233	Sec. 532A.0102. APPLICATION FORM AND PROCEDURES. (a) The
234	234	executive commissioner shall adopt an application form and
235	235	application procedures for the program. The form and procedures
236	236	may be coordinated with Medicaid forms and procedures to ensure
237	237	there is a single consolidated application process to seek health
238	238	care services under the program or Medicaid.
239	239	(b) To the extent possible, the commission shall make the
240	240	application form available in languages other than English.
241	241	(c) The executive commissioner may permit an individual to
242	242	apply by mail, over the telephone, or through the Internet.
243	243	Sec. 532A.0103. ELIGIBILITY SCREENING AND ENROLLMENT. (a)
244	244	The executive commissioner shall adopt eligibility screening and
245	245	enrollment procedures or use the Texas Integrated Enrollment
246	246	Services eligibility determination system or a compatible or
247	247	successor system to screen individuals and enroll eligible
248	248	individuals in the program.
249	249	(b) The eligibility screening and enrollment procedures
250	250	must ensure that an individual applying for the program who appears
251	251	eligible for Medicaid is identified and assisted with obtaining
252	252	Medicaid coverage. If the individual is denied Medicaid coverage
253	253	but is otherwise determined eligible to participate in the program,
254	254	the commission shall enroll the individual in the program without
255	255	additional application or qualification.
256	256	(c) Not later than the 30th day after the date an individual
257	257	submits a complete application form and unless the individual is
258	258	identified and assisted with obtaining Medicaid coverage under
259	259	Subsection (b), the commission shall ensure that the individual's
260	260	eligibility to participate in the program is determined and that
261	261	the individual is enrolled in the program.
262	262	(d) At the time an eligible individual is enrolled in the
263	263	program and using the database the commission establishes under
264	264	Section 532A.0152, the commission shall assist the individual in
265	265	selecting an accessible, high-value primary care provider under the
266	266	program. A participant may:
267	267	(1) change the participant's primary care provider at
268	268	any time; and
269	269	(2) contact the commission for assistance in selecting
270	270	a new primary care provider.
271	271	Sec. 532A.0104. CONTINUOUS COVERAGE; ELIGIBILITY
272	272	REDETERMINATION AND DISENROLLMENT. (a) If authorized by the terms
273	273	of the waiver the executive commissioner seeks under Section
274	274	532A.0002, the commission shall ensure that an individual who is
275	275	initially determined to be eligible to participate in the program
276	276	remains enrolled in the program until the program concludes.
277	277	(b) If the terms of the waiver the executive commissioner
278	278	seeks under Section 532A.0002 do not authorize continuous coverage
279	279	described by Subsection (a), the commission shall:
280	280	(1) redetermine a participant's eligibility to
281	281	participate in the program during the later of the 12th month
282	282	following the date the participant is initially enrolled in the
283	283	program or was most recently redetermined eligible for the program;
284	284	(2) to the extent possible, conduct an eligibility
285	285	redetermination automatically without requiring information from
286	286	the participant using information from verifiable electronic data
287	287	sources or that is otherwise available to the commission;
288	288	(3) not later than the 60th day before the expiration
289	289	of a participant's coverage period, take all reasonable steps to
290	290	notify the participant regarding the eligibility redetermination
291	291	process and request documentation necessary to redetermine the
292	292	participant's eligibility;
293	293	(4) disenroll a participant from the program if:
294	294	(A) the participant does not submit the requested
295	295	eligibility redetermination documentation on or before the last day
296	296	of the participant's coverage period; or
297	297	(B) the commission, based on the submitted
298	298	documentation, determines the participant is no longer eligible to
299	299	participate in the program; and
300	300	(5) ensure the eligibility redetermination process is
301	301	as seamless and contains as little administrative burden for the
302	302	participant as possible to facilitate the participant's successful
303	303	eligibility redetermination.
304	304	SUBCHAPTER D. HEALTH CARE PROVIDERS AND PROVISION OF HEALTH CARE
305	305	UNDER PROGRAM
306	306	Sec. 532A.0151. HEALTH CARE PROVIDER REGISTRATION AND
307	307	PRICING INFORMATION. (a) The commission shall establish a
308	308	streamlined registration process through which a health care
309	309	provider may register to participate in the program.
310	310	(b) As part of the registration process, a health care
311	311	provider may submit to the commission:
312	312	(1) information on:
313	313	(A) the provider's office location; and
314	314	(B) specific pricing information the provider
315	315	charges for a health care service, including pricing information
316	316	on, as applicable:
317	317	(i) capitated arrangements;
318	318	(ii) bundled services;
319	319	(iii) fee-for-service prices; and
320	320	(iv) health care services for which the
321	321	provider charges a nondiscriminatory price; and
322	322	(2) other information or data the provider determines
323	323	relevant to allow the commission and board to assess the provider's
324	324	value of care based on metrics that include:
325	325	(A) patient-reported health outcomes for
326	326	patients the provider serves; and
327	327	(B) the provider's quality of care provided based
328	328	on objective clinical metrics.
329	329	(c) The commission shall ensure a health care provider is
330	330	able to easily and timely update any information the provider
331	331	submits.
332	332	(d) A primary care provider charging a monthly or annual
333	333	capitated rate may not charge a participant for a health care
334	334	service, regardless of the payment model used to pay for the
335	335	service, in an amount that is greater than the amount specified for
336	336	that service in the pricing information submitted under this
337	337	section but may charge participants different amounts in accordance
338	338	with price categories the provider establishes based on age or
339	339	gender only if the provider charges the same price for all
340	340	participants in those price categories.
341	341	(e) The commission, in collaboration with the board, may
342	342	develop processes to ensure information on a health care provider's
343	343	pricing and quality of care is accurate and up-to-date to enable the
344	344	commission and board to adequately and meaningfully measure and
345	345	assess the provider's value of services for the purpose of
346	346	compiling and processing data under Section 532A.0152.
347	347	Sec. 532A.0152. VALUE OF CARE METRICS AND DATA; PROVIDER
348	348	DATABASE. (a) The commission may develop and use metrics to
349	349	measure and assess the value of care provided by program health care
350	350	providers who submit to the commission the information described by
351	351	Section 532A.0151. The metrics may:
352	352	(1) include measurements that demonstrate
353	353	improvements in an individual's objective and subjective health
354	354	outcomes relative to the cost of achieving those improvements; and
355	355	(2) be designed to measure as broad a range of health
356	356	care services as is practicable, including:
357	357	(A) primary care services; and
358	358	(B) specialty and major medical care services.
359	359	(b) The commission may compile and process data on a health
360	360	care provider's value of care based on the measurements and
361	361	assessments submitted to the commission by the provider or based on
362	362	information independently obtained by the commission or board. The
363	363	commission shall ensure the data is sufficient to enable a
364	364	participant to make informed decisions in selecting, including at
365	365	the time the participant is initially enrolled in the program,
366	366	health care providers that:
367	367	(1) are accessible to the participant; and
368	368	(2) provide high-value care.
369	369	(c) The commission may develop and maintain a public
370	370	machine-readable database of high-value program health care
371	371	providers as the commission and board determine in accordance with
372	372	this section.
373	373	(d) The commission shall collaborate with the board in
374	374	implementing this section.
375	375	Sec. 532A.0153. SPECIALTY AND MAJOR MEDICAL CARE. (a) The
376	376	med-pool or integrated health care organization with which a
377	377	participant enrolls shall pay the costs for providing the
378	378	participant's specialty and major medical care services, including
379	379	prescription drug costs related to those services.
380	380	(b) The board and commission shall develop and implement
381	381	procedures for a participant to seek and obtain payment for
382	382	specialty and major medical care costs the participant incurs.
383	383	Sec. 532A.0154. EMERGENCY CARE PRICING. Unless the board
384	384	determines otherwise or contracts for a lesser rate, emergency care
385	385	services provided to a participant through the med-pool or an
386	386	integrated health care organization will be reimbursed at the same
387	387	rate at which those services are reimbursed under the Medicare
388	388	program.
389	389	SUBCHAPTER E. HEALTH BENEFIT ACCOUNTS
390	390	Sec. 532A.0201. ESTABLISHMENT OF HEALTH BENEFIT ACCOUNTS.
391	391	(a) The comptroller, in collaboration with the commission and
392	392	board, shall establish and maintain for each participant a health
393	393	benefit account that is funded in accordance with this subchapter.
394	394	The comptroller may contract with a qualified entity to perform the
395	395	comptroller's duties under this subchapter.
396	396	(b) The comptroller shall establish an electronic portal or
397	397	similar system through which a participant may electronically
398	398	access and manage money in and information regarding the
399	399	participant's health benefit account.
400	400	Sec. 532A.0202. HEALTH BENEFIT ACCOUNT FUNDING. Subject to
401	401	Section 532A.0003, the comptroller shall fund each participant's
402	402	health benefit account with federal and state money in accordance
403	403	with Section 532A.0003(b). The amount deposited must be:
404	404	(1) equal for each participant based on the program's
405	405	total funding and the spending requirements prescribed in Section
406	406	532A.0003; and
407	407	(2) in excess of money remaining in a participant's
408	408	health benefit account from a preceding coverage period, as
409	409	applicable.
410	410	Sec. 532A.0203. USE OF HEALTH BENEFIT ACCOUNT MONEY. (a) A
411	411	participant may use money in the participant's health benefit
412	412	account to pay primary care costs, including dental health costs,
413	413	prescription drug costs related to primary care services, and other
414	414	eligible out-of-pocket health care expenses. The comptroller shall
415	415	issue to the participant an electronic payment card that allows the
416	416	participant to use the card to pay costs described by this section.
417	417	(b) For purposes of this section, "eligible out-of-pocket
418	418	health care expense" means a health care-related expense not
419	419	covered by the primary care capitation rate, including copayments
420	420	for blood draws and other primary care services, over-the-counter
421	421	medications, vision care, and copayments that may be required for
422	422	specialty and major medical care services.
423	423	Sec. 532A.0204. CLOSING OF HEALTH BENEFIT ACCOUNT. If at
424	424	the end of a participant's coverage period the participant chooses
425	425	to cease participating in the program or is no longer eligible to
426	426	participate in the program, the comptroller shall close the
427	427	participant's health benefit account and the commission shall:
428	428	(1) recoup any money remaining in the account at the
429	429	time it is closed; and
430	430	(2) use the recouped money to continue to fund the
431	431	program in accordance with the spending requirements prescribed by
432	432	Section 532A.0003.
433	433	SUBCHAPTER F. MED-POOL
434	434	Sec. 532A.0251. ESTABLISHMENT. The med-pool is established
435	435	to provide specialty and major medical care services to
436	436	participants.
437	437	Sec. 532A.0252. BOARD OF DIRECTORS. (a) The med-pool is
438	438	governed by a board of directors. The board is composed of the
439	439	following seven members appointed by the executive commissioner:
440	440	(1) two members with appropriate expertise in health
441	441	insurance, risk pools, and the evaluation of risk within risk
442	442	pools;
443	443	(2) one member who is a licensed physician;
444	444	(3) one member with appropriate expertise in health
445	445	care technology;
446	446	(4) one member who is a representative of a federally
447	447	qualified health center;
448	448	(5) one member who is a representative of a community
449	449	health organization; and
450	450	(6) one public member.
451	451	(b) In making appointments under Subsection (a), the
452	452	executive commissioner shall make an effort to select board members
453	453	who reflect the ethnic and geographic diversity of this state.
454	454	(c) The board shall select from among the board members a
455	455	presiding officer.
456	456	Sec. 532A.0253. EXCESS LOSS COVERAGE AUTHORIZED. The board
457	457	may purchase excess loss coverage for the med-pool to the extent
458	458	available state money is insufficient to protect the med-pool
459	459	against actuarially projected financial losses the board
460	460	determines may place the med-pool's solvency in financial jeopardy.
461	461	Sec. 532A.0254. INVESTMENTS. (a) The board shall invest
462	462	med-pool money in accordance with Subchapter A, Chapter 2256,
463	463	Government Code, to the extent that law can be made applicable.
464	464	(b) In addition to investments authorized under Subchapter
465	465	A, Chapter 2256, Government Code, the board may invest med-pool
466	466	money in any investment authorized under Subtitle B, Title 9,
467	467	Property Code.
468	468	Sec. 532A.0255. AUDITS. (a) The board shall have the
469	469	med-pool's fiscal accounts and records audited annually by an
470	470	independent auditor. The audit must cover the med-pool's fiscal
471	471	year.
472	472	(b) The independent auditor must be a certified public
473	473	accountant or public accountant licensed by the Texas State Board
474	474	of Public Accountancy.
475	475	(c) The board shall file annually with the commission a copy
476	476	of the audit report. The commission shall make copies of the audit
477	477	reports available to the public on the commission's Internet
478	478	website.
479	479	Sec. 532A.0256. APPLICATION OF CERTAIN LAWS. The med-pool
480	480	is not:
481	481	(1) insurance or an insurer under the Insurance Code
482	482	and other laws of this state; or
483	483	(2) subject to regulation by the commissioner of
484	484	insurance or the Texas Department of Insurance.
485	485	Sec. 532A.0257. LOW-VALUE PROVIDER COPAYMENT. The med-pool
486	486	may require that a participant pay a copayment for services
487	487	received from a provider that the commission has designated as a
488	488	low-value provider unless a high-value provider is not available to
489	489	the participant. The participant may use money in the participant's
490	490	health benefit account to pay this expense.
491	491	SECTION 2. (a) The executive commissioner of the Health and
492	492	Human Services Commission shall:
493	493	(1) apply for and actively pursue from the Centers for
494	494	Medicare and Medicaid Services or another appropriate federal
495	495	agency the waiver as required by Section 532A.0002, Government
496	496	Code, as added by this Act, as soon as practicable after the
497	497	effective date of this Act; and
498	498	(2) begin operating the Texas Plan demonstration
499	499	program under Chapter 532A, Government Code, as added by this Act,
500	500	not later than September 1, 2026.
501	501	(b) The Health and Human Services Commission may delay
502	502	implementing this Act until the waiver described by Subsection
503	503	(a)(1) of this section is granted.
504	504	SECTION 3. This Act takes effect immediately if it receives
505	505	a vote of two-thirds of all the members elected to each house, as
506	506	provided by Section 39, Article III, Texas Constitution. If this
507	507	Act does not receive the vote necessary for immediate effect, this
508	508	Act takes effect September 1, 2025.