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AN ACT
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relating to adoption of certain information technology. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle J, Title 8, Insurance Code, is amended |
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by adding Chapter 1661 to read as follows: |
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CHAPTER 1661. INFORMATION TECHNOLOGY |
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Sec. 1661.001. DEFINITIONS. In this chapter: |
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(1) "Health benefit plan" means a plan that provides |
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benefits for medical or surgical expenses incurred as a result of a |
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health condition, accident, or sickness, including an individual, |
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group, blanket, or franchise insurance policy or insurance |
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agreement, a group hospital service contract, or an individual or |
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group evidence of coverage that is offered by: |
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(A) an insurance company; |
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(B) a group hospital service corporation |
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operating under Chapter 842; |
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(C) a fraternal benefit society operating under |
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Chapter 885; |
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(D) a stipulated premium company operating under |
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Chapter 884; |
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(E) a Lloyd's plan operating under Chapter 941; |
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(F) an exchange operating under Chapter 942; |
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(G) a health maintenance organization operating |
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under Chapter 843; |
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(H) a multiple employer welfare arrangement that |
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holds a certificate of authority under Chapter 846; |
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(I) an approved nonprofit health corporation |
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that holds a certificate of authority under Chapter 844; or |
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(J) an entity not authorized under this code or |
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another insurance law of this state that contracts directly for |
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health care services on a risk-sharing basis, including a |
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capitation basis. |
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(2) "Health benefit plan issuer" means an entity |
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authorized to issue a health benefit plan in this state. |
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(3) "Health care provider" means: |
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(A) an individual who is licensed, certified, or |
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otherwise authorized to provide health care services; or |
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(B) a hospital, emergency clinic, outpatient |
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clinic, or other facility providing health care services. |
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(4) "Participating provider" means a health care |
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provider who has contracted with a health benefit plan issuer to |
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provide services to enrollees. |
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Sec. 1661.002. USE OF CERTAIN INFORMATION TECHNOLOGY |
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REQUIRED. (a) A health benefit plan issuer shall use information |
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technology that provides a participating provider with real-time |
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information at the point of care concerning: |
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(1) the enrollee's: |
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(A) copayment and coinsurance; |
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(B) applicable deductibles; and |
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(C) covered benefits and services; and |
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(2) the enrollee's estimated total financial |
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responsibility for the care. |
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(b) A health benefit plan issuer shall use information |
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technology that provides an enrollee with information concerning |
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the enrollee's: |
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(1) copayment and coinsurance; |
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(2) applicable deductibles; |
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(3) covered benefits and services; and |
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(4) estimated financial responsibility for the health |
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care provided to the enrollee. |
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(c) Nothing in this section may be interpreted as a |
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guarantee of payment for health care services. |
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(d) A health benefit plan issuer's Internet website may be |
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used to meet the information technology requirements of this |
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chapter. |
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Sec. 1661.003. EXCEPTIONS. This chapter does not apply to: |
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(1) a health benefit plan that provides coverage only: |
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(A) for a specified disease or diseases or under |
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a limited benefit policy; |
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(B) for accidental death or dismemberment; |
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(C) as a supplement to a liability insurance |
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policy; or |
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(D) for dental or vision care; |
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(2) disability income insurance coverage; |
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(3) credit insurance coverage; |
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(4) a hospital confinement indemnity policy; |
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(5) a Medicare supplemental policy as defined by |
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Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); |
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(6) a workers' compensation insurance policy; |
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(7) medical payment insurance coverage provided under |
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a motor vehicle insurance policy; |
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(8) a long-term care insurance policy, including a |
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nursing home fixed indemnity policy, unless the commissioner |
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determines that the policy provides benefits so comprehensive that |
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the policy is a health benefit plan and should not be subject to the |
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exemption provided under this section; |
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(9) the child health plan program under Chapter 62, |
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Health and Safety Code, or the health benefits plan for children |
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under Chapter 63, Health and Safety Code; or |
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(10) a Medicaid managed care program operated under |
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Chapter 533, Government Code, or a Medicaid program operated under |
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Chapter 32, Human Resources Code. |
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Sec. 1661.004. REQUIRED USE OF TECHNOLOGY BY PROVIDERS. A |
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physician, hospital, or other health care provider shall use |
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information technology as required under this chapter beginning not |
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later than September 1, 2013. |
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Sec. 1661.005. REFUND OF OVERPAYMENT. A physician, |
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hospital, or other health care provider that receives an |
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overpayment from an enrollee must refund the amount of the |
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overpayment to the enrollee not later than the 30th day after the |
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date the physician, hospital, or health care provider determines |
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that an overpayment has been made. This section does not apply to an |
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overpayment subject to Section 843.350 or 1301.132. |
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Sec. 1661.0055. USE OF TECHNOLOGY: WAIVER. (a) |
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Notwithstanding Section 1661.004, physicians or health care |
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providers with fewer than five full-time-equivalent employees are |
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not required to use information technology as required under this |
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chapter. |
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(b) A health benefit plan issuer may not require, through |
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contract or otherwise, physicians or health care providers with |
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fewer than five full-time-equivalent employees to use information |
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technology as required under this chapter. |
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(c) A contract between the issuer of a health benefit plan |
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and a physician or health care provider must provide for a waiver of |
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any requirement for the use of information technology as |
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established or required under this chapter. |
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(d) The commissioner shall establish the circumstances |
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under which the requirements of this chapter do not apply to a |
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physician or health care provider including: |
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(1) undue hardship, including fiscal or operational |
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hardship; or |
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(2) any other special circumstance that would justify |
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an exclusion. |
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(e) The commissioner shall establish circumstances under |
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which a waiver under Subsection (c) is required, including: |
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(1) undue hardship, including fiscal or operational |
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hardship; or |
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(2) any other special circumstance that would justify |
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a waiver. |
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(f) Any physician or health care provider that is denied a |
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waiver by a health benefit plan issuer may appeal the denial to the |
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commissioner. The commissioner shall determine whether a waiver |
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must be granted. |
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(g) A health benefit plan issuer may not refuse to contract |
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or renew a contract with a physician or health care provider based |
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in whole or in part on the physician or provider requesting or |
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receiving a waiver or appealing a waiver determination. A health |
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benefit plan issuer may not refuse to contract or renew a contract |
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with a physician or health care provider based in whole or in part |
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on the physician or provider meeting the exemptions contained in |
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Subsections (a) and (b). |
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(h) A waiver approved under this section expires September |
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1, 2013. |
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Sec. 1661.006. HEALTH BENEFIT PLAN ISSUER CONDUCT. A |
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contract between a health benefit plan issuer and a physician, |
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hospital, or other health care provider may not prohibit the |
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physician, hospital, or health care provider from collecting, at |
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the time of care, the estimated amount for which the enrollee may be |
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financially responsible. |
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Sec. 1661.007. CERTAIN FEES PROHIBITED. A health benefit |
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plan issuer may not directly charge or collect from an enrollee or a |
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physician, or other health care provider, a fee to cover the costs |
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incurred by the health benefit plan issuer in complying with this |
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chapter. |
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Sec. 1661.008. WAIVER. (a) A health benefit plan issuer |
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may apply to the commissioner for a waiver of the requirement under |
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this chapter to use information technology. |
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(b) The commissioner by rule shall identify circumstances |
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that justify a waiver, including: |
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(1) undue hardship, including financial or |
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operational hardship; |
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(2) the geographical area in which the health benefit |
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plan issuer operates; |
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(3) the number of enrollees covered by a health |
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benefit plan issuer; and |
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(4) other special circumstances. |
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(c) The commissioner shall approve or deny a waiver |
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application under this section not later than the 60th day after the |
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date of receipt of the application. |
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(d) This section expires January 1, 2012. |
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(e) A waiver approved under this section expires September |
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1, 2013. |
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Sec. 1661.009. RULES. (a) The commissioner shall adopt |
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rules as necessary to implement this chapter, including rules that |
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ensure that the information technology used by a health benefit |
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plan issuer does not have legal or technical restrictions for |
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encoding, displaying, exchanging, reading, printing, transmitting, |
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or storing information or data in electronic form. |
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(b) Rules adopted by the commissioner must be consistent |
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with national standards established by the Workgroup for Electronic |
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Data Interchange or by other similar organizations recognized by |
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the commissioner. |
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SECTION 2. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect January 1, 2010. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I certify that H.B. No. 1342 was passed by the House on April |
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28, 2009, by the following vote: Yeas 149, Nays 0, 1 present, not |
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voting; and that the House concurred in Senate amendments to H.B. |
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No. 1342 on May 18, 2009, by the following vote: Yeas 139, Nays 0, |
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2 present, not voting. |
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______________________________ |
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Chief Clerk of the House |
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I certify that H.B. No. 1342 was passed by the Senate, with |
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amendments, on May 14, 2009, by the following vote: Yeas 31, Nays |
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0. |
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______________________________ |
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Secretary of the Senate |
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APPROVED: __________________ |
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Date |
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__________________ |
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Governor |