Bill Text: TX SB750 | 2019-2020 | 86th Legislature | Engrossed

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to maternal and newborn health care and the quality of services provided to women in this state under certain health care programs.

Spectrum: Bipartisan Bill

Status: (Passed) 2019-06-10 - Effective immediately [SB750 Detail]

Download: Texas-2019-SB750-Engrossed.html
 
 
  By: Kolkhorst, Lucio S.B. No. 750
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to maternal and newborn health care and the quality of
  services provided to women in this state under certain health care
  programs.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 531, Government Code, is
  amended by adding Section 531.0738 to read as follows:
         Sec. 531.0738.  APPLICATION FOR FUNDING TO IMPLEMENT MODEL
  OF CARE FOR CERTAIN MEDICAID RECIPIENTS. (a)  The commission shall
  apply to the Centers for Medicare and Medicaid Services to receive
  any federal money available to implement a model of care that
  improves the quality and accessibility of care for:
               (1)  pregnant women with opioid use disorder enrolled
  in Medicaid during the prenatal and postpartum periods; and
               (2)  their children after birth.
         (b)  This section expires September 1, 2021.
         SECTION 2.  Chapter 31, Health and Safety Code, is amended by
  adding Section 31.018 to read as follows:
         Sec. 31.018.  REFERRAL FROM HEALTHY TEXAS WOMEN PROGRAM TO
  PRIMARY HEALTH CARE SERVICES PROGRAM. (a)  In this section,
  "Healthy Texas Women program" means a program operated by the
  commission that is substantially similar to the demonstration
  project operated under former Section 32.0248, Human Resources
  Code, and that is intended to expand access to preventive health and
  family planning services for women in this state.
         (b)  The executive commissioner by rule shall ensure that
  women receiving services under the Healthy Texas Women program are
  referred to and provided with information on the primary health
  care services program.
         SECTION 3.  Chapter 32, Health and Safety Code, is amended by
  adding Subchapters E and F to read as follows:
  SUBCHAPTER E. ENHANCED PRENATAL AND POSTPARTUM CARE SERVICES
         Sec. 32.101.  ENHANCED PRENATAL SERVICES FOR CERTAIN WOMEN.
  The commission, in collaboration with managed care organizations
  that contract with the commission to provide health care services
  to medical assistance recipients under Chapter 533, Government
  Code, shall develop and implement cost-effective, evidence-based,
  and enhanced prenatal services for high-risk pregnant women covered
  under the medical assistance program.
         Sec. 32.102.  EVALUATION AND ENHANCEMENT OF POSTPARTUM CARE
  SERVICES FOR CERTAIN WOMEN. (a)  In this section, "Healthy Texas
  Women program" means a program operated by the commission that is
  substantially similar to the demonstration project operated under
  former Section 32.0248, Human Resources Code, and that is intended
  to expand access to preventive health and family planning services
  for women in this state.
         (b)  The commission shall evaluate postpartum care services
  provided to women enrolled in the Healthy Texas Women program after
  the first 60 days of the postpartum period.
         (c)  Based on the commission's evaluation under Subsection
  (b), the commission shall develop an enhanced, cost-effective, and
  limited postpartum care services package for women enrolled in the
  Healthy Texas Women program to be provided:
               (1)  after the first 60 days of the postpartum period;
  and
               (2)  for a period of not more than 12 months after the
  date of enrollment in the Healthy Texas Women program.
  SUBCHAPTER F. DELIVERY AND IMPROVEMENT OF MATERNAL HEALTH CARE
  SERVICES INVOLVING MANAGED CARE ORGANIZATIONS
         Sec. 32.151.  DEFINITIONS. In this subchapter:
               (1)  "Healthy Texas Women program" means a program
  operated by the commission that is substantially similar to the
  demonstration project operated under former Section 32.0248, Human
  Resources Code, and that is intended to expand access to preventive
  health and family planning services for women in this state.
               (2)  "Medicaid managed care organization" means a
  managed care organization as defined by Section 533.001, Government
  Code, that contracts with the commission under Chapter 533,
  Government Code, to provide health care services to medical
  assistance program recipients.
         Sec. 32.152.  ASSESSING PROVISION OF HEALTHY TEXAS WOMEN
  PROGRAM SERVICES THROUGH MANAGED CARE. (a)  The commission shall
  assess:
               (1)  the feasibility and cost-effectiveness of
  contracting with Medicaid managed care organizations to provide
  Healthy Texas Women program services through managed care in one or
  more health care service regions in this state if the Healthy Texas
  Women Section 1115 Demonstration Waiver is approved; and
               (2)  the potential impact of that delivery model on
  women receiving services under the program.
         (b)  This section expires September 1, 2021.
         Sec. 32.153.  CONTINUITY OF CARE FOR CERTAIN WOMEN ENROLLING
  IN HEALTHY TEXAS WOMEN PROGRAM. The commission shall develop and
  implement strategies to ensure the continuity of care for women who
  transition from the medical assistance program and enroll in the
  Healthy Texas Women program. In developing and implementing
  strategies under this section, the commission may collaborate with
  health care providers participating in the Healthy Texas Women
  program and Medicaid managed care organizations that provide health
  care services to pregnant women.
         Sec. 32.154.  POSTPARTUM DEPRESSION TREATMENT NETWORK.
  Using money from an available source designated by the commission,
  the commission, in collaboration with Medicaid managed care
  organizations and health care providers participating in the
  Healthy Texas Women program, shall develop and implement a
  postpartum depression treatment network for women enrolled in the
  medical assistance or Healthy Texas Women program.
         Sec. 32.155.  STATEWIDE INITIATIVES TO IMPROVE QUALITY OF
  MATERNAL HEALTH CARE. (a)  In this section, "social determinants
  of health" means the environmental conditions in which an
  individual lives that affect the individual's health and quality of
  life.
         (b)  The commission shall develop or enhance statewide
  initiatives to improve the quality of maternal health care services
  and outcomes for women in this state. The commission shall specify
  the initiatives that each managed care organization that contracts
  with the commission to provide health care services in this state
  must incorporate in the organization's managed care plans. The
  initiatives may address:
               (1)  prenatal and postpartum care rates;
               (2)  maternal health disparities that exist for
  minority women and other high-risk populations of women in this
  state;
               (3)  social determinants of health; or
               (4)  other priorities specified by the commission.
         (c)  A managed care organization required to incorporate the
  initiatives in the organization's managed care plans under
  Subsection (b) may incorporate any additional initiatives to
  improve the quality of maternal health care services for women
  receiving health care services through the organization.
         (d)  The commission shall prepare and submit to the
  legislature and make available to the public an annual report that
  summarizes:
               (1)  the commission's progress in developing or
  enhancing initiatives under this section; and
               (2)  each managed care organization's progress in
  incorporating the required initiatives in the organization's
  managed care plans.
         (e)  The commission may submit the report required under
  Subsection (d) with the report required under Section 536.008,
  Government Code.
         SECTION 4.  The heading to Chapter 34, Health and Safety
  Code, is amended to read as follows:
  CHAPTER 34. TEXAS MATERNAL MORTALITY AND MORBIDITY REVIEW
  COMMITTEE [TASK FORCE]
         SECTION 5.  Section 34.001, Health and Safety Code, is
  amended by adding Subdivision (12-a) to read as follows:
               (12-a)  "Review committee" means the Texas Maternal
  Mortality and Morbidity Review Committee.
         SECTION 6.  Sections 34.002, 34.003, 34.004, and 34.005,
  Health and Safety Code, are amended to read as follows:
         Sec. 34.002.  TEXAS MATERNAL MORTALITY AND MORBIDITY REVIEW
  COMMITTEE [TASK FORCE]. (a)  The Texas Maternal Mortality and
  Morbidity Review Committee [Task Force] is administered by the
  department.
         (b)  The review committee [task force] is a
  multidisciplinary advisory committee within the department and is
  composed of the following 17 members:
               (1)  15 members appointed by the commissioner as
  follows:
                     (A)  four physicians specializing in obstetrics,
  at least one of whom is a maternal fetal medicine specialist;
                     (B)  one certified nurse-midwife;
                     (C)  one registered nurse;
                     (D)  one nurse specializing in labor and delivery;
                     (E)  one physician specializing in family
  practice;
                     (F)  one physician specializing in psychiatry;
                     (G)  one physician specializing in pathology;
                     (H)  one epidemiologist, biostatistician, or
  researcher of pregnancy-related deaths;
                     (I)  one social worker or social service provider;
                     (J)  one community advocate in a relevant field;
                     (K)  one medical examiner or coroner responsible
  for recording deaths; and
                     (L)  one physician specializing in critical care;
               (2)  a representative of the department's family and
  community health programs; and
               (3)  the state epidemiologist for the department or the
  epidemiologist's designee.
         (c)  In appointing members to the review committee [task
  force], the commissioner shall:
               (1)  include members:
                     (A)  working in and representing communities that
  are diverse with regard to race, ethnicity, immigration status, and
  English proficiency; and
                     (B)  from differing geographic regions in the
  state, including both rural and urban areas;
               (2)  endeavor to include members who are working in and
  representing communities that are affected by pregnancy-related
  deaths and severe maternal morbidity and by a lack of access to
  relevant perinatal and intrapartum care services; and
               (3)  ensure that the composition of the review
  committee [task force] reflects the racial, ethnic, and linguistic
  diversity of this state.
         (d)  The commissioner shall appoint from among the review
  committee [task force] members a presiding officer.
         (e)  A member of the review committee [task force] appointed
  under Subsection (b)(1) is not entitled to compensation for service
  on the review committee [task force] or reimbursement for travel or
  other expenses incurred by the member while conducting the business
  of the review committee [task force].
         (f)  In carrying out its duties, the review committee [task
  force] may use technology, including teleconferencing or
  videoconferencing, to eliminate travel expenses.
         Sec. 34.003.  TERMS; VACANCY. (a)  Review committee [Task
  force] members appointed by the commissioner serve staggered
  six-year terms, with the terms of four or five members, as
  appropriate, expiring February 1 of each odd-numbered year.
         (b)  A review committee [task force] member may serve more
  than one term.
         (c)  A vacancy on the review committee [task force] shall be
  filled for the unexpired term in the same manner as the original
  appointment.
         Sec. 34.004.  MEETINGS. (a)  The review committee [task
  force] shall meet at least quarterly. The review committee [task
  force] may meet at other times at the call of the commissioner.
         (b)  Meetings of the review committee [task force] are
  subject to Chapter 551, Government Code, except that the review
  committee [task force] shall conduct a closed meeting to review
  cases under Section 34.007.
         (c)  The review committee [task force] shall:
               (1)  allow for public comment during at least one
  public meeting each year;
               (2)  present in open session recommendations made under
  Section 34.005 to help reduce the incidence of pregnancy-related
  deaths and severe maternal morbidity in this state; and
               (3)  post public notice for meetings conducted for the
  sole purpose of reviewing cases for selection under Section 34.007.
         Sec. 34.005.  DUTIES OF REVIEW COMMITTEE [TASK FORCE]. The
  review committee [task force] shall:
               (1)  study and review:
                     (A)  cases of pregnancy-related deaths;
                     (B)  trends, rates, or disparities in
  pregnancy-related deaths and severe maternal morbidity;
                     (C)  health conditions and factors that
  disproportionately affect the most at-risk population as
  determined in the joint biennial report required under Section
  34.015; and
                     (D)  best practices and programs operating in
  other states that have reduced rates of pregnancy-related deaths;
               (2)  compare rates of pregnancy-related deaths based on
  the socioeconomic status of the mother;
               (3)  determine the feasibility of the review committee
  [task force] studying cases of severe maternal morbidity; and
               (4)  in consultation with the Perinatal Advisory
  Council, make recommendations to help reduce the incidence of
  pregnancy-related deaths and severe maternal morbidity in this
  state.
         SECTION 7.  Section 34.0055(a), Health and Safety Code, is
  amended to read as follows:
         (a)  Using existing resources, the commission, in
  consultation with the review committee [task force], shall:
               (1)  make available to physicians and other persons
  licensed or certified to conduct a substance use screening and
  domestic violence screening of pregnant women information that
  includes:
                     (A)  guidance regarding best practices for
  verbally screening a pregnant woman for substance use and verbally
  screening a pregnant woman for domestic violence using a validated
  screening tool; and
                     (B)  a list of substance use treatment resources
  and domestic violence prevention and intervention resources in each
  geographic region of this state; and
               (2)  review and promote the use of educational
  materials on the consequences of opioid drug use and on domestic
  violence prevention and intervention during pregnancy.
         SECTION 8.  Section 34.006, Health and Safety Code, is
  amended to read as follows:
         Sec. 34.006.  CONSULTATIONS AND AGREEMENTS WITH OUTSIDE
  PARTIES. (a)  The department and review committee [task force] may
  consult with any relevant experts and stakeholders, including:
               (1)  anesthesiologists;
               (2)  intensivists or critical care physicians;
               (3)  nutritionists;
               (4)  substance abuse treatment specialists;
               (5)  hospital staff or employees;
               (6)  representatives of the state Medicaid program;
               (7)  paramedics or other emergency medical response
  personnel;
               (8)  hospital-based risk management specialists;
               (9)  representatives of local health departments and
  public health districts in this state;
               (10)  public health experts;
               (11)  government representatives or officials; and
               (12)  law enforcement officials.
         (b)  In gathering information, the department and review
  committee [task force] may consult with representatives of any
  relevant state professional associations and organizations,
  including:
               (1)  District XI of the American Congress of
  Obstetricians and Gynecologists;
               (2)  the Texas Association of Obstetricians and
  Gynecologists;
               (3)  the Texas Nurses Association;
               (4)  the Texas Section of the Association of Women's
  Health, Obstetric and Neonatal Nurses;
               (5)  the Texas Academy of Family Physicians;
               (6)  the Texas Pediatric Society;
               (7)  the Consortium of Texas Certified Nurse-Midwives;
               (8)  the Association of Texas Midwives;
               (9)  the Texas Hospital Association;
               (10)  the Texas Medical Association; and
               (11)  the Texas Public Health Association.
         (c)  In consulting with individuals or organizations under
  Subsection (a) or (b), a member of the review committee [task force]
  or employee of the department may not disclose any identifying
  information of a patient or health care provider.
         (d)  The department on behalf of the review committee [task
  force] may enter into agreements with institutions of higher
  education or other organizations consistent with the duties of the
  department or review committee [task force] under this chapter.
         SECTION 9.  Sections 34.007(a) and (c), Health and Safety
  Code, are amended to read as follows:
         (a)  The department shall determine a statistically
  significant number of cases of pregnancy-related deaths for review.
  The department shall either randomly select cases or select all
  cases for the review committee [task force] to review under this
  subsection to reflect a cross-section of pregnancy-related deaths
  in this state.
         (c)  If feasible, the department may select cases of severe
  maternal morbidity for review. In selecting cases under this
  subsection, the department shall randomly select cases for the
  review committee [task force] to review to reflect trends
  identified under Subsection (b).
         SECTION 10.  Sections 34.008(a) and (b), Health and Safety
  Code, are amended to read as follows:
         (a)  On selecting a case of pregnancy-related death or severe
  maternal morbidity for review, the department shall, in accordance
  with this section, obtain information relevant to the case to
  enable the review committee [task force] to review the case. The
  department shall provide the information to the review committee
  [task force].
         (b)  The information provided to the review committee [task
  force] may not include identifying information of a patient or
  health care provider, including:
               (1)  the name, address, or date of birth of the patient
  or a member of the patient's family; or
               (2)  the name or specific location of a health care
  provider that treated the patient.
         SECTION 11.  Section 34.009, Health and Safety Code, is
  amended by amending Subsections (b), (c), (d), (e), and (h) and
  adding Subsection (b-1) to read as follows:
         (b)  Except as provided by Subsection (b-1), confidential
  [Confidential] information that is acquired by the department and
  that includes identifying information of an individual or health
  care provider is privileged and may not be disclosed to any person.  
  Information that may not be disclosed under this subsection
  includes:
               (1)  the name and address of a patient or a member of
  the patient's family;
               (2)  any service received by the patient or a member of
  the patient's family;
               (3)  the social and economic condition of the patient
  or a member of the patient's family;
               (4)  medical, dental, and mental health care
  information related to the patient or a member of the patient's
  family, including diagnoses, conditions, diseases, or disability;
  and
               (5)  the identity of a health care provider that
  provided any services to the patient or a member of the patient's
  family.
         (b-1)  Confidential information that is acquired by the
  department under this section that includes identifying
  information of an individual or health care provider may be
  securely disclosed to an appropriate federal agency for the limited
  purpose of complying with applicable requirements under the federal
  Preventing Maternal Deaths Act of 2018 (Pub. L. No. 115-344).
         (c)  Review committee [Task force] work product or
  information obtained by the department under this chapter,
  including information contained in an electronic database
  established and maintained under Section 34.012, or any other
  document or record, is confidential. This subsection does not
  prevent the review committee [task force] or department from
  releasing information described by Subsection (d) or (e) or from
  submitting the report required by Section 34.015.
         (d)  Information is not confidential under this section if
  the information is general information that cannot be connected
  with any specific individual, case, or health care provider, such
  as:
               (1)  total expenditures made for specified purposes;
               (2)  the number of families served by particular health
  care providers or agencies;
               (3)  aggregated data on social and economic conditions;
               (4)  medical data and information related to health
  care services that do not include any identifying information
  relating to a patient or the patient's family;
               (5)  information, including the source, value, and
  purpose, related to gifts, grants, or donations to or for use by the
  review committee [task force]; and
               (6)  other statistical information.
         (e)  The review committee [task force] may publish
  statistical studies and research reports based on information that
  is confidential under this section, provided that the information:
               (1)  is published in the aggregate;
               (2)  does not identify a patient or the patient's
  family;
               (3)  does not include any information that could be
  used to identify a patient or the patient's family; and
               (4)  does not identify a health care provider.
         (h)  The review committee [task force] and the department
  shall comply with all state and federal laws and rules relating to
  the transmission of health information, including the Health
  Insurance Portability and Accountability Act of 1996 (Pub. L.
  No. 104-191) and rules adopted under that Act.
         SECTION 12.  Section 34.010, Health and Safety Code, is
  amended to read as follows:
         Sec. 34.010.  SUBPOENA AND DISCOVERY. Review committee
  [Task force] work product or information that is confidential under
  Section 34.009 is privileged, is not subject to subpoena or
  discovery, and may not be introduced into evidence in any
  administrative, civil, or criminal proceeding against a patient, a
  member of the family of a patient, or a health care provider.
         SECTION 13.  Section 34.011(a), Health and Safety Code, is
  amended to read as follows:
         (a)  A member of the review committee [task force] or a
  person employed by or acting in an advisory capacity to the review
  committee [task force] and who provides information, counsel, or
  services to the review committee [task force] is not liable for
  damages for an action taken within the scope of the functions of the
  review committee [task force].
         SECTION 14.  Sections 34.012(a) and (c), Health and Safety
  Code, are amended to read as follows:
         (a)  The department may establish and maintain an electronic
  database to track cases of pregnancy-related deaths and severe
  maternal morbidity to assist the department and review committee
  [task force] in performing functions under this chapter.
         (c)  The database may be accessed only by the department and
  the review committee [task force] for the purposes described in
  this chapter.
         SECTION 15.  Section 34.014, Health and Safety Code, is
  amended to read as follows:
         Sec. 34.014.  FUNDING. The department may accept gifts and
  grants from any source to fund the duties of the department and the
  review committee [task force] under this chapter.
         SECTION 16.  Sections 34.015(a) and (b), Health and Safety
  Code, are amended to read as follows:
         (a)  Not later than September 1 of each even-numbered year,
  the review committee [task force] and the department shall submit a
  joint report on the findings of the review committee [task force]
  under this chapter to the governor, lieutenant governor, speaker of
  the house of representatives, and appropriate committees of the
  legislature.
         (b)  The report must include the review committee's [task
  force's] recommendations under Section 34.005(4).
         SECTION 17.  Section 34.0155, Health and Safety Code, is
  amended to read as follows:
         Sec. 34.0155.  REPORT ON PREGNANCY-RELATED DEATHS, SEVERE
  MATERNAL MORBIDITY, AND POSTPARTUM DEPRESSION. The commission
  shall:
               (1)  evaluate options for reducing pregnancy-related
  deaths, focusing on the most prevalent causes of pregnancy-related
  deaths as identified in the joint biennial report required under
  Section 34.015, and for treating postpartum depression in
  economically disadvantaged women;
               (2)  in coordination with the department and the review
  committee [task force], identify strategies to:
                     (A)  lower costs of providing medical assistance
  under Chapter 32, Human Resources Code, related to severe maternal
  morbidity and chronic illness; and
                     (B)  improve quality outcomes related to the
  underlying causes of severe maternal morbidity and chronic illness;
  and
               (3)  not later than December 1 of each even-numbered
  year, 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 that includes:
                     (A)  a summary of the commission's and
  department's efforts to accomplish the tasks described by
  Subdivisions (1) and (2); and
                     (B)  a summary of the report required by Section
  34.0156.
         SECTION 18.  Section 34.0156(a), Health and Safety Code, is
  amended to read as follows:
         (a)  Using existing resources, the department, in
  collaboration with the review committee [task force], shall promote
  and facilitate the use among health care providers in this state of
  maternal health and safety informational materials, including
  tools and procedures related to best practices in maternal health
  and safety.
         SECTION 19.  Section 34.017(b), Health and Safety Code, is
  amended to read as follows:
         (b)  The department may not disclose the information
  described by Subsection (a) to the review committee [task force] or
  any other person.
         SECTION 20.  Section 34.018, Health and Safety Code, is
  amended to read as follows:
         Sec. 34.018.  SUNSET PROVISION. (a)  The review committee
  [task force] is subject to Chapter 325, Government Code (Texas
  Sunset Act). Unless continued in existence as provided by that
  chapter, the review committee [task force] is abolished and this
  chapter expires September 1, 2027 [2023].
         (b)  The Sunset Advisory Commission shall review the review
  committee during the two-year period preceding the date the
  department is scheduled for abolition under Section 1001.003, but
  the review committee is continued in existence until the date
  provided by Subsection (a). This subsection expires September 1,
  2025.
         SECTION 21.  Section 1001.0712(c), Health and Safety Code,
  is amended to read as follows:
         (c)  The department, in consultation with the Texas Maternal
  Mortality and Morbidity Review Committee [Task Force], shall
  examine national standards regarding the collection of death
  information and may convene a panel of experts to advise the
  department and the review committee [task force] in developing
  recommendations for improving the collection of accurate
  information related to cause of death.
         SECTION 22.  Section 34.001(14), Health and Safety Code, is
  repealed.
         SECTION 23.  (a)  In this section, "Healthy Texas Women
  program" means a program operated by the Health and Human Services
  Commission that is substantially similar to the demonstration
  project operated under former Section 32.0248, Human Resources
  Code, and that is intended to expand access to preventive health and
  family planning services for women in this state.
         (b)  If the Centers for Medicare and Medicaid Services
  approves the waiver submitted by the executive commissioner of the
  Health and Human Services Commission under Section 1115 of the
  federal Social Security Act (42 U.S.C. Section 1315) for the
  Healthy Texas Women Section 1115 Demonstration Waiver, the
  executive commissioner shall, as soon as practicable after the
  waiver is granted, seek an amendment to the waiver to provide
  enhanced services under the Healthy Texas Women program.
         SECTION 24.  As soon as practicable after the effective date
  of this Act:
               (1)  the executive commissioner of the Health and Human
  Services Commission shall adopt rules as necessary to implement the
  changes in law made by this Act; and
               (2)  the Health and Human Services Commission shall
  apply for any federal money available to implement the model of care
  described by Section 531.0738, Government Code, as added by this
  Act.
         SECTION 25.  On the effective date of this Act:
               (1)  the Maternal Mortality and Morbidity Task Force is
  renamed the Texas Maternal Mortality and Morbidity Review
  Committee; and
               (2)  a reference in law to the task force means the
  review committee.
         SECTION 26.  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 27.  The Health and Human Services Commission is
  required to implement a provision of this Act only if the
  legislature appropriates money specifically for that purpose. If
  the legislature does not appropriate money specifically for that
  purpose, the commission may, but is not required to, implement a
  provision of this Act using other appropriations available for that
  purpose.
         SECTION 28.  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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