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A BILL TO BE ENTITLED
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AN ACT
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relating to the price charged by a health care provider for a health |
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care service or supply; providing penalties. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. This Act may be cited as the Texas Health Care |
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Pricing Disclosure Act. |
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SECTION 2. The heading to Subchapter H, Chapter 101, |
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Occupations Code, is amended to read as follows: |
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SUBCHAPTER H. BILLING AND PRICING INFORMATION |
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SECTION 3. Subchapter H, Chapter 101, Occupations Code, is |
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amended by adding Section 101.3515 to read as follows: |
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Sec. 101.3515. PRICING INFORMATION. (a) In this section: |
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(1) "Bundled health care services and supplies" means |
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for pricing purposes the grouping of multiple health care services |
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and supplies provided by a health care provider to a patient during |
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one visit to or treatment by the provider. |
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(2) "Health care price" means the total amount of |
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compensation a health care provider accepts as payment in full for a |
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health care service or supply or bundled health care services and |
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supplies provided to a patient. |
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(3) "Health care provider" means: |
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(A) a health care professional who performs a |
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health care service or provides a health care supply in this state |
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under a license, certificate, registration, or other authority |
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issued by this state to diagnose, prevent, alleviate, or cure a |
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human illness or injury, including a physician and dentist; |
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(B) a health care facility that provides a health |
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care service or supply in this state under a license, certificate, |
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registration, or other authority issued by this state to diagnose, |
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prevent, alleviate, or cure a human illness or injury, including an |
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institutional health care provider; or |
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(C) a person that provides to patients in this |
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state ancillary health care-related services and supplies under a |
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license, certificate, or registration issued by this state, or that |
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is otherwise authorized to provide to patients in this state |
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ancillary health care-related services and supplies ordered or |
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authorized by a licensed health care professional, to diagnose, |
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prevent, alleviate, or cure a human illness or injury, including |
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laboratory services, radiological services, and durable medical |
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equipment. |
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(4) "Pricing information list" means a list of: |
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(A) the health care price of each health care |
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service and each health care supply that may be provided by a health |
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care provider to a patient; and |
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(B) the health care price of each set of bundled |
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health care services and supplies that may be provided by the health |
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care provider to a patient. |
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(b) This section does not apply to a health care price of a |
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health care service or supply or bundled health care services and |
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supplies provided to: |
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(1) a patient for whom a health care provider has |
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accepted assignment for the health care service or supply from |
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Medicaid or Medicare or any other federal, state, or local |
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government-sponsored medical assistance program; or |
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(2) a financially or medically indigent person who |
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qualifies for indigent health care services based on: |
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(A) a sliding fee scale; or |
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(B) a health care provider's written charity care |
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policy. |
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(c) Each health care provider shall: |
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(1) compile a pricing information list; |
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(2) post on the provider's Internet website the |
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pricing information list and the effective date of the list before |
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providing a health care service or supply or bundled health care |
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services and supplies to a patient; and |
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(3) not less than 30 days before changing the health |
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care price of a health care service or supply or bundled health care |
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services and supplies provided by the provider to the patient, |
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provide notice of the price change by posting the notice on the |
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provider's Internet website. |
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(d) A health care provider may not: |
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(1) charge an amount that is different from the amount |
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listed as the health care price in the pricing information list for |
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a health care service or supply or bundled health care services and |
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supplies provided to a patient; or |
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(2) include a discount, bonus, fee, or other charge |
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that changes the health care price listed in the pricing |
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information list. |
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(e) A health care provider may accept from a patient a |
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payment that is less than the health care price listed in the |
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pricing information list if the health care provider determines, in |
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the provider's sole discretion, that payment of the listed price |
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would present a hardship to the patient. |
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(f) Except for a health care service or supply or bundled |
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health care services and supplies provided to a patient in an |
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emergency department of a hospital or as a result of an emergent |
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direct admission, a patient who receives a health care service or |
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supply or bundled health care services and supplies from a health |
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care provider whose health care price listed is greater than the |
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payment provided under the patient's health plan is personally |
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responsible for the amount that exceeds the listed price. |
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(g) A health care provider that violates this section is |
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subject to an administrative penalty, a civil penalty, or other |
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disciplinary action, as applicable, in the same manner as if the |
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provider violated the law under which the provider is licensed, |
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certified, registered, or authorized. |
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SECTION 4. Section 101.352(a), Occupations Code, is amended |
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to read as follows: |
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(a) A physician shall develop, implement, and enforce |
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written policies for the billing of health care services and |
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supplies. The policies must address: |
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(1) [any discounting of charges for health care
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services or supplies provided to an uninsured patient that is not
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covered by a patient's third-party payor, subject to Chapter 552,
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Insurance Code;
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[(2)] any discounting of charges for health care |
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services or supplies provided to an indigent patient who qualifies |
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for services or supplies based on a sliding fee scale or a written |
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charity care policy established by the physician; |
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(2) [(3)] whether interest will be applied to any |
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billed health care service or supply not covered by a third-party |
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payor and the rate of any interest charged; and |
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(3) [(4)] the procedure for handling complaints |
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relating to billed charges for health care services or supplies. |
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SECTION 5. Section 324.101(a), Health and Safety Code, is |
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amended to read as follows: |
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(a) Each facility shall develop, implement, and enforce |
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written policies for the billing of facility health care services |
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and supplies. The policies must address: |
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(1) [any discounting of facility charges to an
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uninsured consumer, subject to Chapter 552, Insurance Code;
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[(2)] any discounting of facility charges provided to |
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a financially or medically indigent consumer who qualifies for |
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indigent services based on a sliding fee scale or a written charity |
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care policy established by the facility and the documented income |
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and other resources of the consumer; |
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(2) [(3)
the providing of an itemized statement
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required by Subsection (e);
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[(4)] whether interest will be applied to any billed |
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service not covered by a third-party payor and the rate of any |
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interest charged; and |
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(3) [(5)] the procedure for handling complaints[;
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[(6)
the providing of a conspicuous written disclosure
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to a consumer at the time the consumer is first admitted to the
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facility or first receives services at the facility that:
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[(A)
provides confirmation whether the facility
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is a participating provider under the consumer's third-party payor
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coverage on the date services are to be rendered based on the
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information received from the consumer at the time the confirmation
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is provided;
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[(B)
informs consumers that a facility-based
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physician who may provide services to the consumer while the
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consumer is in the facility may not be a participating provider with
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the same third-party payors as the facility;
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[(C)
informs consumers that the consumer may
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receive a bill for medical services from a facility-based physician
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for the amount unpaid by the consumer's health benefit plan;
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[(D)
informs consumers that the consumer
may
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request a listing of facility-based physicians who have been
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granted medical staff
privileges to provide medical services at
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the facility; and
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[(E)
informs consumers that the consumer may
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request information from a facility-based physician on whether the
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physician has a contract with the consumer's health benefit plan
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and under what circumstances the consumer may be responsible for
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payment of any amounts not paid by the consumer's health benefit
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plan;
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[(7)
the requirement that a facility provide a list,
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on request, to a consumer to be admitted to, or who is expected to
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receive services from, the facility, that contains the name and
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contact information for each facility-based physician or
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facility-based physician group that has been granted medical staff
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privileges to provide medical services at the facility; and
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[(8)
if the facility operates a website that includes
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a listing of physicians who have been granted medical staff
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privileges to provide medical services at the facility, the posting
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on the facility's website of a list that contains the name and
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contact information for each facility-based physician or
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facility-based physician group that has been granted medical staff
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privileges to provide medical services at the facility and the
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updating of the list in any calendar quarter in which there are any
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changes to the list]. |
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SECTION 6. Sections 324.101(b) and (d), Health and Safety |
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Code, are repealed. |
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SECTION 7. Notwithstanding Section 101.3515, Occupations |
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Code, as added by this Act, Section 101.352, Occupations Code, as |
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amended by this Act, or Section 324.101, Health and Safety Code, as |
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amended by this Act, a health care provider is not required to |
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comply with the changes in law made by those sections until |
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September 1, 2012. |
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SECTION 8. This Act takes effect September 1, 2011. |