By: Harris of Tarrant, Moncrief S.B. No. 207
Zaffirini
A BILL TO BE ENTITLED
AN ACT
1-1 relating to the regulation of the provision of mental health and
1-2 chemical dependency services and of billing for health services.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 ARTICLE 1
1-5 SECTION 1.01. Chapter 571, Health and Safety Code, is
1-6 amended by adding Section 571.0065 to read as follows:
1-7 Sec. 571.0065. PRESCRIPTION MEDICATION INFORMATION.
1-8 (a) The board by rule shall require a mental health facility that
1-9 admits a patient under this subtitle to provide to the patient in
1-10 the patient's primary language, if possible, information relating
1-11 to prescription medications ordered by the patient's treating
1-12 physician.
1-13 (b) At a minimum, the required information must:
1-14 (1) identify the major types of prescription
1-15 medications; and
1-16 (2) specify for each major type:
1-17 (A) the conditions the medications are commonly
1-18 used to treat;
1-19 (B) the beneficial effects on those conditions
1-20 generally expected from the medications;
1-21 (C) side effects and risks associated with the
1-22 medications;
1-23 (D) commonly used examples of medications of the
1-24 major type; and
2-1 (E) sources of detailed information concerning a
2-2 particular medication.
2-3 (c) The facility shall also provide the information to the
2-4 patient's family on request, but only to the extent not otherwise
2-5 prohibited by state or federal confidentiality laws.
2-6 SECTION 1.02. Subsection (b), Section 572.003, Health and
2-7 Safety Code, is amended to read as follows:
2-8 (b) In addition to the rights provided by this subtitle
2-9 <Sections 572.004, 576.001, 576.006, 576.007, 576.008, 576.009, and
2-10 576.021>, a person voluntarily admitted to an inpatient mental
2-11 health facility under this chapter has the right:
2-12 (1) to be reviewed periodically to determine the
2-13 person's need for continued inpatient treatment; and
2-14 (2) to have an application for court-ordered mental
2-15 health services filed only as provided by Section 572.005.
2-16 SECTION 1.03. (a) Chapter 572, Health and Safety Code, is
2-17 amended by adding Section 572.0022 to read as follows:
2-18 Sec. 572.0022. INFORMATION ON MEDICATIONS. (a) A mental
2-19 health facility shall provide to a patient in the patient's primary
2-20 language, if possible, and in accordance with rules adopted under
2-21 Section 571.0065 information relating to prescription medication
2-22 ordered by the patient's treating physician.
2-23 (b) The facility shall also provide the information to the
2-24 patient's family on request, but only to the extent not otherwise
2-25 prohibited by state or federal confidentiality laws.
2-26 (b) This section takes effect May 1, 1994.
2-27 SECTION 1.04. Section 572.005, Health and Safety Code, is
3-1 amended to read as follows:
3-2 Sec. 572.005. APPLICATION FOR COURT-ORDERED TREATMENT.
3-3 (a) An application for court-ordered mental health services may
3-4 not be filed against a patient receiving voluntary inpatient
3-5 services unless:
3-6 (1) a request for release of the patient has been
3-7 filed with the facility administrator; or
3-8 (2) in the <facility administrator's> opinion of the
3-9 physician responsible for the patient's treatment, the patient
3-10 meets the criteria for court-ordered mental health services and:
3-11 (A) is absent from the facility without
3-12 authorization; <or>
3-13 (B) <refuses or> is unable to consent to
3-14 appropriate and necessary psychiatric treatment; or
3-15 (C) refuses to consent to necessary and
3-16 appropriate treatment recommended by the physician responsible for
3-17 the patient's treatment and that physician completes a certificate
3-18 of medical examination for mental illness that, in addition to the
3-19 information required by Section 574.011, includes the opinion of
3-20 the physician that:
3-21 (i) there is no reasonable alternative to
3-22 the treatment recommended by the physician; and
3-23 (ii) the patient will not benefit from
3-24 continued inpatient care without the recommended treatment.
3-25 (b) The physician responsible for the patient's treatment
3-26 shall notify the patient if the physician intends to file an
3-27 application for court-ordered mental health services.
4-1 SECTION 1.05. (a) Subchapter D, Chapter 574, Health and
4-2 Safety Code, is amended by adding Section 574.0415 to read as
4-3 follows:
4-4 Sec. 574.0415. INFORMATION ON MEDICATIONS. (a) A mental
4-5 health facility shall provide to a patient in the patient's primary
4-6 language, if possible, and in accordance with rules adopted under
4-7 Section 571.0065 information relating to prescription medication
4-8 ordered by the patient's treating physician.
4-9 (b) The facility shall also provide the information to the
4-10 patient's family on request, but only to the extent not otherwise
4-11 prohibited by state or federal confidentiality laws.
4-12 (b) This section takes effect May 1, 1994.
4-13 SECTION 1.06. Section 576.006, Health and Safety Code, is
4-14 amended to read as follows:
4-15 Sec. 576.006. RIGHTS SUBJECT TO LIMITATION <BY FACILITY
4-16 ADMINISTRATOR>. (a) A patient in an inpatient mental health
4-17 facility has the right to:
4-18 (1) receive visitors;
4-19 (2) communicate with a person outside the facility by
4-20 telephone and by uncensored and sealed mail; and
4-21 (3) communicate by telephone and by uncensored and
4-22 sealed mail with legal counsel, the department, the courts, and the
4-23 state attorney general.
4-24 (b) The rights provided in Subsection (a) are subject to the
4-25 general rules of the facility. The physician ultimately
4-26 responsible for the patient's treatment <facility administrator>
4-27 may also restrict a right only to the extent <the facility
5-1 administrator determines> that the restriction is necessary to the
5-2 patient's welfare or to protect another person but may not restrict
5-3 the right to communicate with legal counsel, the department, the
5-4 courts, or the state attorney general <if an attorney-client
5-5 relationship has been established>.
5-6 (c) If a <A> restriction is imposed under this section, the
5-7 physician ultimately responsible for the patient's treatment shall
5-8 document the clinical <by the facility administrator for the
5-9 patient's welfare and the> reasons for the restriction and the
5-10 duration of the restriction in <shall be made a part of> the
5-11 patient's clinical record. That physician shall inform the patient
5-12 and, if appropriate, the patient's parent, managing conservator, or
5-13 guardian of the clinical reasons for the restriction and the
5-14 duration of the restriction.
5-15 SECTION 1.07. Section 576.009, Health and Safety Code, is
5-16 amended to read as follows:
5-17 Sec. 576.009. NOTIFICATION OF RIGHTS. A patient receiving
5-18 involuntary inpatient mental health services shall be informed of
5-19 the rights provided by this subtitle <in Sections 576.001, 576.006,
5-20 576.007, 576.008, and 576.021>:
5-21 (1) orally, in simple, nontechnical terms, and in
5-22 writing that, if possible, is in the person's primary language; or
5-23 (2) through the use of a means reasonably calculated
5-24 to communicate with a hearing impaired or visually impaired person,
5-25 if applicable.
5-26 SECTION 1.08. Chapter 574, Health and Safety Code, is
5-27 amended by adding Subchapter G to read as follows:
6-1 SUBCHAPTER G. ADMINISTRATION OF MEDICATION
6-2 TO PATIENT UNDER ORDER FOR INPATIENT MENTAL HEALTH SERVICES
6-3 Sec. 574.101. DEFINITIONS. In this subchapter:
6-4 (1) "Capacity" means a patient's ability to:
6-5 (A) understand the nature and consequences of a
6-6 proposed treatment, including the benefits, risks, and alternatives
6-7 to the proposed treatment; and
6-8 (B) make a decision whether to undergo the
6-9 proposed treatment.
6-10 (2) "Medication-related emergency" means a situation
6-11 in which it is immediately necessary to administer medication to a
6-12 patient to prevent:
6-13 (A) imminent probable death or substantial
6-14 bodily harm to the patient because the patient:
6-15 (i) overtly or continually is threatening
6-16 or attempting to commit suicide or serious bodily harm; or
6-17 (ii) is behaving in a manner that
6-18 indicates that the patient is unable to satisfy the patient's need
6-19 for nourishment, essential medical care, or self-protection; or
6-20 (B) imminent physical or emotional harm to
6-21 another because of threats, attempts, or other acts the patient
6-22 overtly or continually makes or commits.
6-23 (3) "Psychoactive medication" means a medication
6-24 prescribed for the treatment of symptoms of psychosis or other
6-25 severe mental or emotional disorders and that is used to exercise
6-26 an effect on the central nervous system to influence and modify
6-27 behavior, cognition, or affective state when treating the symptoms
7-1 of mental illness. "Psychoactive medication" includes the
7-2 following categories when used as described in this subdivision:
7-3 (A) antipsychotics or neuroleptics;
7-4 (B) antidepressants;
7-5 (C) agents for control of mania or depression;
7-6 (D) antianxiety agents;
7-7 (E) sedatives, hypnotics, or other
7-8 sleep-promoting drugs; and
7-9 (F) psychomotor stimulants.
7-10 Sec. 574.102. APPLICATION OF SUBCHAPTER. This subchapter
7-11 applies only to the application of medication to a patient subject
7-12 to an order for inpatient mental health services under Section
7-13 574.034 or 574.035 who is receiving those services in a mental
7-14 health facility operated or funded by the department.
7-15 Sec. 574.103. ADMINISTRATION OF MEDICATION TO PATIENT UNDER
7-16 COURT-ORDERED MENTAL HEALTH SERVICES. A person may not administer
7-17 a psychoactive medication to a patient who refuses to take the
7-18 medication voluntarily unless:
7-19 (1) the patient is having a medication-related
7-20 emergency; or
7-21 (2) the patient is under an order issued under Section
7-22 574.106 authorizing the administration of the medication regardless
7-23 of the patient's refusal.
7-24 Sec. 574.104. PHYSICIAN'S PETITION FOR ORDER TO COMPEL
7-25 PSYCHOACTIVE MEDICATION; DATE OF HEARING. (a) A physician who is
7-26 treating a patient may petition a probate court or a court with
7-27 probate jurisdiction for an order to authorize the administration
8-1 of a psychoactive medication regardless of the patient's refusal
8-2 if:
8-3 (1) the physician believes that the patient lacks the
8-4 capacity to make a decision regarding the administration of the
8-5 psychoactive medication;
8-6 (2) the physician determines that the medication is
8-7 the proper course of treatment for the patient; and
8-8 (3) the patient is under an order for temporary or
8-9 extended mental health services under Section 574.034 or 574.035
8-10 and the patient, verbally or by other indication, refuses to take
8-11 the medication voluntarily.
8-12 (b) A petition filed under this section must state:
8-13 (1) that the physician believes that the patient lacks
8-14 the capacity to make a decision regarding administration of the
8-15 psychoactive medication and the reasons for that belief;
8-16 (2) each medication the physician wants the court to
8-17 compel the patient to take;
8-18 (3) whether the current order for inpatient mental
8-19 health services for the patient was issued under Section 574.034 or
8-20 under Section 574.035; and
8-21 (4) the physician's diagnosis of the patient.
8-22 (c) A petition filed under this section is separate from an
8-23 application for court-ordered mental health services.
8-24 (d) The court with which a petition is filed under this
8-25 section shall set a hearing on the petition to be held not later
8-26 than the seventh day after the date the petition is filed. The
8-27 hearing on the petition may be held on the date of a hearing on an
9-1 application for court-ordered extended mental health services under
9-2 Section 574.035. The hearing on the petition may not be held on
9-3 the date of a hearing on an application for court-ordered temporary
9-4 mental health services under Section 574.034 unless the patient and
9-5 the patient's attorney agree in writing to have the hearing on that
9-6 date.
9-7 (e) The court may grant one continuance on a party's motion
9-8 and for good cause shown. The court may grant more than one
9-9 continuance only with the agreement of the parties.
9-10 Sec. 574.105. RIGHTS OF PATIENT. A patient for whom a
9-11 petition for an order to authorize the administration of a
9-12 psychoactive medication is filed is entitled to:
9-13 (1) representation by a court-appointed attorney who
9-14 is knowledgeable about issues to be adjudicated at the hearing;
9-15 (2) meet with that attorney as soon as is practicable
9-16 to prepare for the hearing and to discuss any of the patient's
9-17 questions or concerns;
9-18 (3) receive, immediately after the time of the hearing
9-19 is set, a copy of the petition and written notice of the time,
9-20 place, and date of the hearing;
9-21 (4) be told, at the time personal notice of the
9-22 hearing is given, of the patient's right to a hearing and right to
9-23 the assistance of an attorney to prepare for the hearing and to
9-24 answer any questions or concerns;
9-25 (5) be present at the hearing;
9-26 (6) request from the court an independent expert; and
9-27 (7) oral notification, at the conclusion of the
10-1 hearing, of the court's determinations of the patient's capacity
10-2 and best interests.
10-3 Sec. 574.106. HEARING ON PATIENT'S CAPACITY AND ORDER
10-4 AUTHORIZING PSYCHOACTIVE MEDICATION. (a) The court may issue an
10-5 order authorizing the administration of one or more classes of
10-6 psychoactive medication only if the court finds by clear and
10-7 convincing evidence after the hearing that:
10-8 (1) the patient lacks the capacity to make a decision
10-9 regarding the administration of the proposed medication; and
10-10 (2) treatment with the proposed medication is in the
10-11 best interest of the patient.
10-12 (b) In making its findings, the court shall consider:
10-13 (1) the patient's expressed preferences regarding
10-14 treatment with psychoactive medication;
10-15 (2) the patient's religious beliefs;
10-16 (3) the risks and benefits, from the perspective of
10-17 the patient, of taking psychoactive medication;
10-18 (4) the consequences to the patient if the
10-19 psychoactive medication is not administered;
10-20 (5) the prognosis for the patient if the patient is
10-21 treated with psychoactive medication; and
10-22 (6) alternatives to treatment with psychoactive
10-23 medication.
10-24 (c) A hearing under this subchapter shall be conducted by
10-25 the probate judge or judge with probate jurisdiction, except as
10-26 provided by Subsection (d).
10-27 (d) A judge may refer a hearing to a magistrate or
11-1 court-appointed master who has training regarding psychoactive
11-2 medications.
11-3 (e) A party is entitled to a hearing by the judge if an
11-4 appeal of the magistrate's or master's report is filed with the
11-5 court within three days after the report is issued.
11-6 (f) If a hearing or an appeal of a master's or magistrate's
11-7 report is to be held in a county court in which the judge is not a
11-8 licensed attorney, the proposed patient or the proposed patient's
11-9 attorney may request that the proceeding be transferred to a court
11-10 with a judge who is licensed to practice law in this state. The
11-11 county judge shall transfer the case after receiving the request,
11-12 and the receiving court shall hear the case as if it had been
11-13 originally filed in that court.
11-14 (g) As soon as practicable after the conclusion of the
11-15 hearing, the patient is entitled to have provided to the patient
11-16 and the patient's attorney written notification of the court's
11-17 determinations under this section. The notification shall include
11-18 a statement of the evidence on which the court relied and the
11-19 reasons for the court's determinations.
11-20 (h) An order entered under this section shall authorize the
11-21 administration to a patient, regardless of the patient's refusal,
11-22 of one or more classes of psychoactive medications specified in the
11-23 petition and consistent with the patient's diagnosis. The order
11-24 shall permit an increase or decrease in a medication's dosage,
11-25 restitution of medication authorized but discontinued during the
11-26 period the order is valid, or the substitution of a medication
11-27 within the same class.
12-1 (i) The classes of psychoactive medications in the order
12-2 must conform to classes determined by the department.
12-3 (j) An order issued under this section may be reauthorized
12-4 or modified on the petition of a party. The order remains in
12-5 effect pending action on a petition for reauthorization or
12-6 modification. For the purpose of this subsection, "modification"
12-7 means a change of a class of medication authorized in the order.
12-8 Sec. 574.107. APPEAL. (a) A patient may appeal an order
12-9 under this subchapter in the manner provided by Section 574.070 for
12-10 an appeal of an order requiring court-ordered mental health
12-11 services.
12-12 (b) An order authorizing the administration of medication
12-13 regardless of the refusal of the patient is effective pending an
12-14 appeal of the order.
12-15 Sec. 574.108. EFFECT OF ORDER. (a) A person's consent to
12-16 take a psychoactive medication is not valid and may not be relied
12-17 on if the person is subject to an order issued under Section
12-18 574.106.
12-19 (b) The issuance of an order under Section 574.106 is not a
12-20 determination or adjudication of mental incompetency and does not
12-21 limit in any other respect that person's rights as a citizen or the
12-22 person's property rights or legal capacity.
12-23 Sec. 574.109. EXPIRATION AND REVIEW OF ORDER. (a) The
12-24 court annually shall review an order issued under Section 574.106.
12-25 (b) An order issued under Section 574.106 expires on the
12-26 expiration or termination date of the order for temporary or
12-27 extended mental health services in effect when the order for
13-1 psychoactive medication is issued.
13-2 SECTION 1.09. Subchapter B, Chapter 576, Health and Safety
13-3 Code, is amended by adding Sections 576.025 and 576.026 to read as
13-4 follows:
13-5 Sec. 576.025. ADMINISTRATION OF PSYCHOACTIVE MEDICATION.
13-6 (a) A person may not administer a psychoactive medication to a
13-7 patient receiving voluntary or involuntary mental health services
13-8 who does not consent to the administration unless:
13-9 (1) the patient is having a medication-related
13-10 emergency;
13-11 (2) the patient is younger than 16 years of age and
13-12 the patient's parent, managing conservator, or guardian consents to
13-13 the administration on behalf of the patient;
13-14 (3) the patient does not have the capacity to consent
13-15 and the patient's representative authorized by law to consent on
13-16 behalf of the patient has consented to the administration; or
13-17 (4) the administration of the medication regardless of
13-18 the patient's refusal is authorized by an order issued under
13-19 Section 574.106.
13-20 (b) Consent to the administration of psychoactive medication
13-21 given by a patient or by a person authorized by law to consent on
13-22 behalf of the patient is valid only if:
13-23 (1) the consent is given voluntarily and without
13-24 coercive or undue influence;
13-25 (2) the treating physician or a person designated by
13-26 the physician provided the following information, in a standard
13-27 format approved by the department, to the patient and, if
14-1 applicable, to the patient's representative authorized by law to
14-2 consent on behalf of the patient:
14-3 (A) the specific condition to be treated;
14-4 (B) the beneficial effects on that condition
14-5 expected from the medication;
14-6 (C) the probable health and mental health
14-7 consequences of not consenting to the medication;
14-8 (D) the probable clinically significant side
14-9 effects and risks associated with the medication;
14-10 (E) the generally accepted alternatives to the
14-11 medication, if any, and why the physician recommends that they be
14-12 rejected; and
14-13 (F) the proposed course of the medication;
14-14 (3) the patient and, if appropriate, the patient's
14-15 representative authorized by law to consent on behalf of the
14-16 patient is informed in writing that consent may be revoked; and
14-17 (4) the consent is evidenced in the patient's clinical
14-18 record by a signed form prescribed by the facility or by a
14-19 statement of the treating physician or a person designated by the
14-20 physician that documents that consent was given by the appropriate
14-21 person and the circumstances under which the consent was obtained.
14-22 (c) If the treating physician designates another person to
14-23 provide the information under Subsection (b), then, not later than
14-24 two working days after that person provides the information,
14-25 excluding weekends and legal holidays, the physician shall meet
14-26 with the patient and, if appropriate, the patient's representative
14-27 who provided the consent, to review the information and answer any
15-1 questions.
15-2 (d) A patient's refusal or attempt to refuse to receive
15-3 psychoactive medication, whether given verbally or by other
15-4 indications or means, shall be documented in the patient's clinical
15-5 record.
15-6 (e) In prescribing psychoactive medication, a treating
15-7 physician shall:
15-8 (1) prescribe, consistent with clinically appropriate
15-9 medical care, the medication that has the fewest side effects or
15-10 the least potential for adverse side effects, unless the class of
15-11 medication has been demonstrated or justified not to be effective
15-12 clinically; and
15-13 (2) administer the smallest therapeutically acceptable
15-14 dosages of medication for the patient's condition.
15-15 (f) If a physician issues an order to administer
15-16 psychoactive medication to a patient without the patient's consent
15-17 because the patient is having a medication-related emergency:
15-18 (1) the physician shall document in the patient's
15-19 clinical record in specific medical or behavioral terms the
15-20 necessity of the order and that the physician has evaluated but
15-21 rejected other generally accepted, less intrusive forms of
15-22 treatment, if any; and
15-23 (2) treatment of the patient with the psychoactive
15-24 medication shall be provided in the manner, consistent with
15-25 clinically appropriate medical care, least restrictive of the
15-26 patient's personal liberty.
15-27 (g) In this section, "medication-related emergency" and
16-1 "psychoactive medication" have the meanings assigned by Section
16-2 574.101.
16-3 Sec. 576.026. INDEPENDENT EVALUATION. (a) A patient
16-4 receiving inpatient mental health services under this subtitle is
16-5 entitled to obtain at the patient's cost an independent
16-6 psychiatric, psychological, or medical examination or evaluation by
16-7 a psychiatrist, physician, or nonphysician mental health
16-8 professional chosen by the patient. The facility administrator
16-9 shall allow the patient to obtain the examination or evaluation at
16-10 any reasonable time.
16-11 (b) If the patient is a minor, the minor and the minor's
16-12 parent, legal guardian, or managing or possessory conservator is
16-13 entitled to obtain the examination or evaluation. The cost of the
16-14 examination or evaluation shall be billed by the professional who
16-15 performed the examination or evaluation to the person responsible
16-16 for payment of the minor's treatment as a cost of treatment.
16-17 SECTION 1.10. Subchapter B, Chapter 576, Health and Safety
16-18 Code, is amended by adding Section 576.027 to read as follows:
16-19 Sec. 576.027. LIST OF MEDICATIONS. (a) The facility
16-20 administrator of an inpatient mental health facility shall provide
16-21 to a patient, a person designated by the patient, and the patient's
16-22 legal guardian or managing conservator, if any, a list of the
16-23 medications prescribed for administration to the patient while the
16-24 patient is in the facility. The list must include for each
16-25 medication:
16-26 (1) the name of the medication;
16-27 (2) the dosage and schedule prescribed for the
17-1 administration of the medication; and
17-2 (3) the name of the physician who prescribed the
17-3 medication.
17-4 (b) The list must be provided within four hours after the
17-5 facility administrator receives a written request for the list from
17-6 the patient, a person designated by the patient, or the patient's
17-7 legal guardian or managing conservator and on the discharge of the
17-8 patient. If sufficient time to prepare the list before discharge
17-9 is not available, the list may be mailed within 24 hours after
17-10 discharge to the patient, a person designated by the patient, and
17-11 the patient's legal guardian or managing conservator.
17-12 (c) A patient or the patient's legal guardian or managing
17-13 conservator, if any, may waive the right of any person to receive
17-14 the list of medications while the patient is participating in a
17-15 research project if release of the list would jeopardize the
17-16 results of the project.
17-17 SECTION 1.11. Subsection (b), Section 611.002, Health and
17-18 Safety Code, is amended to read as follows:
17-19 (b) Confidential communications or records may not be
17-20 disclosed except as provided by Section 611.004 or 611.0045.
17-21 SECTION 1.12. Chapter 611, Health and Safety Code, is
17-22 amended by adding Section 611.0045 to read as follows:
17-23 Sec. 611.0045. RIGHT TO MENTAL HEALTH RECORD. (a) Except
17-24 as otherwise provided by this section, a patient is entitled to
17-25 have access to the content of a confidential record made about the
17-26 patient.
17-27 (b) The professional may deny access to any portion of a
18-1 record if the professional determines that release of that portion
18-2 would be harmful to the patient's physical, mental, or emotional
18-3 health.
18-4 (c) If the professional denies access to any portion of a
18-5 record, the professional shall give the patient a signed and dated
18-6 written statement that having access to the record would be harmful
18-7 to the patient's physical, mental, or emotional health and shall
18-8 include a copy of the written statement in the patient's records.
18-9 The statement must specify the portion of the record to which
18-10 access is denied, the reason for denial, and the duration of the
18-11 denial.
18-12 (d) The professional who denies access to a portion of a
18-13 record under this section shall redetermine the necessity for the
18-14 denial at least quarterly and at each time a request for the denied
18-15 portion is made. If the professional again denies access, the
18-16 professional shall notify the patient of the denial and document
18-17 the denial as prescribed by Subsection (c).
18-18 (e) If a professional denies access to a portion of a
18-19 confidential record, the professional shall allow examination and
18-20 copying of the record by another professional if the patient
18-21 selects the professional to treat the patient for the same or a
18-22 related condition as the professional denying access.
18-23 (f) The content of a confidential record shall be made
18-24 available to a person listed by Section 611.004(a)(4) or (5) who is
18-25 acting on the patient's behalf.
18-26 (g) A professional shall delete confidential information
18-27 about another person who has not consented to the release, but may
19-1 not delete information relating to the patient that another person
19-2 has provided, the identity of the person responsible for that
19-3 information, or the identity of any person who provided information
19-4 that resulted in the patient's commitment, admission, or treatment.
19-5 (h) If a summary or narrative of a confidential record is
19-6 requested by the patient or other person requesting release under
19-7 this section, the professional shall prepare the summary or
19-8 narrative.
19-9 (i) The professional or other entity that has possession or
19-10 control of the record shall grant access to any portion of the
19-11 record to which access is not specifically denied under this
19-12 section within a reasonable time and may charge a reasonable fee.
19-13 (j) Notwithstanding Section 5.08, Medical Practice Act
19-14 (Article 4495b, Vernon's Texas Civil Statutes), this section
19-15 applies to the release of a confidential record created or
19-16 maintained by a professional, including a physician, that relates
19-17 to the diagnosis, evaluation, or treatment of a mental or emotional
19-18 condition or disorder, including alcoholism or drug addiction.
19-19 (k) The denial of a patient's access to any portion of a
19-20 record by the professional or other entity that has possession or
19-21 control of the record suspends, until the release of that portion
19-22 of the record, the running of an applicable statute of limitations
19-23 on a cause of action in which evidence relevant to the cause of
19-24 action is in that portion of the record.
19-25 SECTION 1.13. Section 611.005, Health and Safety Code, is
19-26 amended to read as follows:
19-27 Sec. 611.005. LEGAL REMEDIES FOR IMPROPER DISCLOSURE OR
20-1 FAILURE TO DISCLOSE. (a) A person aggrieved by the improper
20-2 disclosure of or failure to disclose confidential communications or
20-3 records in <a> violation of this chapter may petition the district
20-4 court of the county in which the person resides for appropriate
20-5 <injunctive> relief, including injunctive relief. The person may
20-6 petition a district court of Travis County if the person is not a
20-7 resident of this state.
20-8 (b) In a suit contesting the denial of access under Section
20-9 611.0045, the burden of proving that the denial was proper is on
20-10 the professional who denied the access.
20-11 (c) The aggrieved person also has a civil cause of action
20-12 for damages.
20-13 SECTION 1.14. Subchapter A, Chapter 462, Health and Safety
20-14 Code, is amended by adding Section 462.009 to read as follows:
20-15 Sec. 462.009. CONSENT TO TREATMENT. (a) A patient
20-16 receiving treatment in a treatment facility is entitled to refuse a
20-17 medication, therapy, or treatment unless:
20-18 (1) the patient is younger than 16 years of age and
20-19 the patient's parent, managing conservator, or guardian consents to
20-20 the medication, therapy, or treatment on behalf of the patient;
20-21 (2) the patient has been adjudicated to be incompetent
20-22 to manage the patient's personal affairs or to make a decision to
20-23 refuse the medication, therapy, or treatment and the patient's
20-24 guardian of the person or another person legally authorized to
20-25 consent to medical treatment consents to the medication, therapy,
20-26 or treatment on behalf of the patient; or
20-27 (3) a physician treating the patient determines that
21-1 the medication is necessary to prevent imminent serious physical
21-2 harm to the patient or to another individual and the physician
21-3 issues a written order, or a verbal order if authenticated in
21-4 writing by the physician within 24 hours, to administer the
21-5 medication to the patient.
21-6 (b) The decision of a guardian or of a person legally
21-7 authorized to consent to medical treatment on the patient's behalf
21-8 under Subsection (a)(2) must be based on knowledge of what the
21-9 patient would desire, if known.
21-10 (c) A patient's refusal to receive medication, therapy, or
21-11 treatment under Subsection (a), or a patient's attempt to refuse if
21-12 the patient's right to refuse is limited by that subsection, shall
21-13 be documented in the patient's clinical record together with the
21-14 patient's expressed reason for refusal.
21-15 (d) If a physician orders a medication to be administered to
21-16 a patient under Subsection (a)(3), the physician shall document in
21-17 the patient's clinical record in specific medical and behavioral
21-18 terms the reasons for the physician's determination of the
21-19 necessity of the order.
21-20 (e) Consent given by a patient or by a person authorized by
21-21 law to consent to treatment on the patient's behalf for the
21-22 administration of a medication, therapy, or treatment is valid only
21-23 if:
21-24 (1) the consent is given voluntarily and without
21-25 coercive or undue influence;
21-26 (2) before administration of the medication, therapy,
21-27 or treatment, the treating physician explains to the patient and to
22-1 the person giving consent, in simple, nontechnical language:
22-2 (A) the specific condition to be treated;
22-3 (B) the beneficial effects on that condition
22-4 expected from the medication, therapy, or treatment;
22-5 (C) the probable health and mental health
22-6 consequences of not consenting to the medication, therapy, or
22-7 treatment;
22-8 (D) the side effects and risks associated with
22-9 the medication, therapy, or treatment;
22-10 (E) the generally accepted alternatives to the
22-11 medication, therapy, or treatment, if any, and whether an
22-12 alternative might be appropriate for the patient; and
22-13 (F) the proposed course of the medication,
22-14 therapy, or treatment; and
22-15 (3) the informed consent is evidenced in the patient's
22-16 clinical record by a signed form prescribed by the commission for
22-17 this purpose or by a statement of the treating physician that
22-18 documents that consent was given by the appropriate person and the
22-19 circumstances under which the consent was obtained.
22-20 (f) A person who consents to the administration of a
22-21 medication, therapy, or treatment may revoke the consent at any
22-22 time and for any reason, regardless of the person's capacity.
22-23 Revocation of consent is effective immediately and further
22-24 medication, therapy, or treatment may not be administered unless
22-25 new consent is obtained in accordance with this section.
22-26 (g) Consent given by a patient or by a person authorized by
22-27 law to consent to treatment on the patient's behalf applies to a
23-1 series of doses of medication or to multiple therapies or
23-2 treatments for which consent was previously granted. If the
23-3 treating physician obtains new information relating to a
23-4 medication, therapy, or treatment for which consent was previously
23-5 obtained, the physician must explain the new information and obtain
23-6 new consent.
23-7 SECTION 1.15. Section 462.024, Health and Safety Code, is
23-8 amended to read as follows:
23-9 Sec. 462.024. APPLICATION FOR COURT-ORDERED TREATMENT DURING
23-10 VOLUNTARY INPATIENT CARE. (a) An application for court-ordered
23-11 treatment may not be filed against a patient receiving voluntary
23-12 care under this subchapter unless:
23-13 (1) a request for release of the patient has been
23-14 filed; or
23-15 (2) in the <facility administrator's> opinion of the
23-16 physician responsible for the patient's treatment, the patient
23-17 meets the criteria for court-ordered treatment and:
23-18 (A) is absent from the facility without
23-19 authorization; <or>
23-20 (B) <refuses or> is unable to consent to
23-21 appropriate and necessary treatment; or
23-22 (C) refuses to consent to necessary and
23-23 appropriate treatment recommended by the physician responsible for
23-24 the patient's treatment and that physician completes a certificate
23-25 of medical examination for chemical dependency that, in addition to
23-26 the information required by Section 462.064, includes the opinion
23-27 of the physician that:
24-1 (i) there is no reasonable alternative to
24-2 the treatment recommended by the physician; and
24-3 (ii) the patient will not benefit from
24-4 continued inpatient care without the recommended treatment.
24-5 (b) The physician responsible for the patient's treatment
24-6 shall notify the patient if the physician intends to file an
24-7 application for court-ordered treatment.
24-8 SECTION 1.16. (a) Not later than October 31, 1993, the
24-9 Texas Board of Mental Health and Mental Retardation shall appoint
24-10 an advisory task force on prescription medications composed of at
24-11 least the following persons:
24-12 (1) one licensed psychiatrist;
24-13 (2) one licensed psychologist;
24-14 (3) one certified social worker;
24-15 (4) one licensed professional counselor;
24-16 (5) one licensed chemical dependency counselor;
24-17 (6) two persons who have received mental health
24-18 services, either voluntarily or involuntarily, during the two years
24-19 preceding the date of the person's appointment;
24-20 (7) one member from each of two private associations
24-21 of persons who advocate on the behalf of or in the interest of
24-22 persons with mental illness;
24-23 (8) one licensed psychiatric nurse; and
24-24 (9) one licensed pharmacist.
24-25 (b) The board may appoint additional members as it considers
24-26 appropriate.
24-27 (c) The advisory task force shall designate one member to
25-1 serve as presiding officer.
25-2 (d) The advisory task force shall recommend to the Texas
25-3 Board of Mental Health and Mental Retardation information
25-4 concerning different types of prescription medications, based on
25-5 generally accepted clinical and medical standards and practices,
25-6 that shall be provided to each person who may receive prescription
25-7 medication while receiving inpatient mental health services. The
25-8 task force shall make its recommendations not later than February
25-9 1, 1994.
25-10 (e) The advisory task force may conduct public hearings on
25-11 desirable information to be provided to a person who may receive
25-12 prescription medication.
25-13 (f) Members of the advisory task force receive no
25-14 compensation but are entitled to reimbursement for reasonable
25-15 expenses incurred in performing official duties in accordance with
25-16 the General Appropriations Act.
25-17 (g) In adopting rules under Section 571.0065, Health and
25-18 Safety Code, as added by this Act, the Texas Board of Mental Health
25-19 and Mental Retardation shall consider the recommendations of the
25-20 advisory task force on prescription medications appointed under
25-21 this section. The board shall adopt rules under Section 571.0065,
25-22 Health and Safety Code, not later than May 1, 1994.
25-23 SECTION 1.17. (a) The changes in law made by this article
25-24 apply only to consent for the administration of a medication,
25-25 therapy, or treatment to a person that is given on or after the
25-26 effective date of this article.
25-27 (b) Valid consent for the administration of a medication,
26-1 therapy, or treatment to a person that is given before the
26-2 effective date of this article remains valid and continues in
26-3 effect until consent is withdrawn by the person who gave consent or
26-4 by a person who is entitled to refuse the medication, therapy, or
26-5 treatment.
26-6 ARTICLE 2
26-7 SECTION 2.01. Section 311.002, Health and Safety Code, is
26-8 amended by amending Subsections (d), (e), and (f) and adding
26-9 Subsections (g) and (h) to read as follows:
26-10 (d) A hospital shall provide an itemized statement of billed
26-11 services to a third party payor who is actually or potentially
26-12 responsible for paying all or part of the billed services provided
26-13 to a patient and who has received a claim for payment of those
26-14 services. To be entitled to receive a statement, the third party
26-15 payor must request the statement from the hospital and must have
26-16 received a claim for payment. The request must be made not later
26-17 than one year after the date on which the payor received the claim
26-18 for payment. The hospital shall provide the statement to the payor
26-19 not later than the 10th day after the date on which the payor
26-20 requests the statement. If a third party payor receives a claim
26-21 for payment of part but not all of the billed services, the third
26-22 party payor may request an itemized statement of only the billed
26-23 services for which payment is claimed or to which any deduction or
26-24 copayment applies.
26-25 (e) If a person, including a third party payor, requests
26-26 more than two copies of the statement, the hospital may charge a
26-27 reasonable fee for the third and subsequent copies provided to that
27-1 person. The fee may not exceed the hospital's cost to copy,
27-2 process, and deliver the copy to the person.
27-3 (f) <(e)> The Texas Department of Health or other
27-4 appropriate licensing agency may enforce this section by injunction
27-5 or by any other appropriate remedy, including suspending, revoking,
27-6 or refusing to renew a hospital's license.
27-7 (g) In this section, "hospital" includes:
27-8 (1) a treatment facility licensed under Chapter 464;
27-9 and
27-10 (2) a mental health facility licensed under Chapter
27-11 577.
27-12 (h) <(f)> This section does not apply to a hospital
27-13 maintained or operated by the federal government.
27-14 SECTION 2.02. Subchapter A, Chapter 311, Health and Safety
27-15 Code, is amended by adding Section 311.0025 to read as follows:
27-16 Sec. 311.0025. AUDITS OF BILLING. (a) A hospital,
27-17 treatment facility, mental health facility, or health care
27-18 professional may not submit to a patient or a third party payor a
27-19 bill for a treatment that the hospital, facility, or professional
27-20 knows was not provided or knows was improper, unreasonable, or
27-21 medically or clinically unnecessary.
27-22 (b) If the appropriate licensing agency receives a complaint
27-23 alleging a violation of Subsection (a), the agency may audit the
27-24 billings and patient records of the hospital, treatment facility,
27-25 mental health facility, or health care professional.
27-26 (c) A hospital, treatment facility, mental health facility,
27-27 or health care professional that violates Subsection (a) is subject
28-1 to disciplinary action, including denial, revocation, suspension,
28-2 or nonrenewal of the license of the hospital, facility, or
28-3 professional. Disciplinary action taken under this section is in
28-4 addition to any other civil, administrative, or criminal penalty
28-5 provided by law.
28-6 (d) A health care professional may not order or direct a
28-7 hospital, treatment facility, or mental health facility to provide
28-8 treatment that the professional knows is improper, unreasonable, or
28-9 medically or clinically unnecessary. If a hospital or facility is
28-10 denied reimbursement for treatment because a health care
28-11 professional orders or directs treatment in violation of this
28-12 subsection, the professional shall reimburse the hospital or
28-13 facility for the treatment not later than the 30th day after the
28-14 date on which the professional receives a final determination of
28-15 violation.
28-16 (e) Each health care regulatory agency by rule shall
28-17 prescribe what constitutes "improper, unreasonable, or medically or
28-18 clinically unnecessary" treatment.
28-19 (f) In this section:
28-20 (1) "Health care professional" means an individual
28-21 licensed, certified, or regulated by a health care regulatory
28-22 agency who is eligible for reimbursement for treatment ordered or
28-23 rendered by that professional.
28-24 (2) "Hospital" means a hospital licensed under Chapter
28-25 241.
28-26 (3) "Mental health facility" means a mental health
28-27 facility licensed under Chapter 577.
29-1 (4) "Treatment facility" means a treatment facility
29-2 licensed under Chapter 464.
29-3 ARTICLE 3
29-4 SECTION 3.01. Except as otherwise provided by this Act, this
29-5 Act takes effect immediately.
29-6 SECTION 3.02. The importance of this legislation and the
29-7 crowded condition of the calendars in both houses create an
29-8 emergency and an imperative public necessity that the
29-9 constitutional rule requiring bills to be read on three several
29-10 days in each house be suspended, and this rule is hereby suspended,
29-11 and that this Act take effect and be in force according to its
29-12 terms, and it is so enacted.