By: Harris, Chris S.B. No. 207
73R2134 JJT/CBH-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the regulation of the provision of mental health and
1-3 chemical dependency services.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 ARTICLE 1
1-6 SECTION 1.01. Chapter 571, Health and Safety Code, is
1-7 amended by adding Section 571.0065 to read as follows:
1-8 Sec. 571.0065. PRESCRIPTION MEDICATION INFORMATION. (a)
1-9 The board by rule shall require a mental health facility that
1-10 admits a patient under this subtitle to provide to the patient in
1-11 the patient's primary language information relating to prescription
1-12 medications ordered by the patient's treating 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. Section 572.003(b), Health and Safety Code, is
2-7 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 and in accordance with rules adopted under Section
2-21 571.0065 information relating to prescription medication ordered by
2-22 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. (a)
3-3 An application for court-ordered mental health services may not be
3-4 filed against a patient receiving voluntary inpatient services
3-5 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 in-patient 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 and in accordance with rules adopted under Section
4-7 571.0065 information relating to prescription medication ordered by
4-8 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 professional 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 professional ultimately responsible for the patient's treatment
5-8 shall 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 professional shall inform the
5-12 patient of the clinical reasons for the restriction and the
5-13 duration of the restriction.
5-14 SECTION 1.07. Section 576.009, Health and Safety Code, is
5-15 amended to read as follows:
5-16 Sec. 576.009. NOTIFICATION OF RIGHTS. A patient receiving
5-17 involuntary inpatient mental health services shall be informed of
5-18 the rights provided by this subtitle <in Sections 576.001, 576.006,
5-19 576.007, 576.008, and 576.021>:
5-20 (1) orally, in simple, nontechnical terms, and in
5-21 writing that, if possible, is in the person's primary language; or
5-22 (2) through the use of a means reasonably calculated
5-23 to communicate with a hearing impaired or visually impaired person,
5-24 if applicable.
5-25 SECTION 1.08. Subchapter B, Chapter 576, Health and Safety
5-26 Code, is amended by adding Section 576.025 to read as follows:
5-27 Sec. 576.025. CONSENT TO TREATMENT. (a) A patient
6-1 receiving mental health services under this subtitle is entitled to
6-2 refuse a medication, therapy, or treatment unless:
6-3 (1) the patient is younger than 16 years of age and
6-4 the patient's parent, managing conservator, or guardian consents to
6-5 the medication, therapy, or treatment on behalf of the patient;
6-6 (2) the patient has been adjudicated to be incompetent
6-7 to manage the patient's personal affairs or to make a decision to
6-8 refuse the medication, therapy, or treatment and the patient's
6-9 guardian of the person or another person legally authorized to
6-10 consent to medical treatment consents to the medication, therapy,
6-11 or treatment on behalf of the patient; or
6-12 (3) a physician treating the patient determines that
6-13 the medication is necessary to prevent imminent serious physical
6-14 harm to the patient or to another individual and the physician
6-15 issues a written order, or a verbal order, if authenticated in
6-16 writing by the physician within 24 hours, to administer the
6-17 medication to the patient.
6-18 (b) The decision of a guardian or of a person legally
6-19 authorized to consent to medical treatment on the patient's behalf
6-20 under Subsection (a)(2) must be based on knowledge of what the
6-21 patient would desire, if known.
6-22 (c) A patient's refusal to receive medication, therapy, or
6-23 treatment under Subsection (a), or a patient's attempt to refuse if
6-24 the patient's right to refuse is limited by that subsection, shall
6-25 be documented in the patient's clinical record together with the
6-26 patient's expressed reason for refusal.
6-27 (d) If a physician orders a medication to be administered to
7-1 a patient under Subsection (a)(3), the physician shall document in
7-2 the patient's clinical record in specific medical and behavioral
7-3 terms the reasons for the physician's determination of the
7-4 necessity of the order.
7-5 (e) Consent given by a patient or by a person authorized by
7-6 law to consent to treatment on the patient's behalf for the
7-7 administration of a medication, therapy, or treatment is valid only
7-8 if:
7-9 (1) the consent is given voluntarily and without
7-10 coercive or undue influence;
7-11 (2) before administration of the medication, therapy,
7-12 or treatment, the treating physician explains to the patient and to
7-13 the person giving consent, in the person's primary language, if
7-14 possible, and in simple, nontechnical terms:
7-15 (A) the specific condition to be treated;
7-16 (B) the beneficial effects on that condition
7-17 expected from the medication, therapy, or treatment;
7-18 (C) the probable health and mental health
7-19 consequences of not consenting to the medication, therapy, or
7-20 treatment;
7-21 (D) the side effects and risks associated with
7-22 the medication, therapy, or treatment;
7-23 (E) the generally accepted alternatives to the
7-24 medication, therapy, or treatment, if any, and whether an
7-25 alternative might be appropriate for the patient; and
7-26 (F) the proposed course of the medication,
7-27 therapy, or treatment;
8-1 (3) before administration of a psychoactive
8-2 medication, the treating physician or facility personnel provide to
8-3 the patient information relating to the medication from the United
8-4 States Pharmacopeia Dispensing Information, Volume II, or a similar
8-5 reference guide approved by the board; and
8-6 (4) the informed consent is evidenced in the patient's
8-7 clinical record by a signed form prescribed by the department for
8-8 this purpose or by a statement of the treating physician that
8-9 documents that consent was given by the appropriate person and the
8-10 circumstances under which the consent was obtained.
8-11 (f) A person who consents to the administration of a
8-12 medication, therapy, or treatment may revoke the consent at any
8-13 time and for any reason. Revocation of consent is effective
8-14 immediately and further medication, therapy, or treatment may not
8-15 be administered unless new consent is obtained in accordance with
8-16 this section.
8-17 (g) Consent given by a patient or by a person authorized by
8-18 law to consent to treatment on the patient's behalf applies to a
8-19 series of doses of medication or to multiple treatments for which
8-20 consent was previously granted. If the treating physician obtains
8-21 new information relating to a medication, therapy, or treatment for
8-22 which consent was previously obtained, the physician must explain
8-23 the new information and obtain new consent.
8-24 SECTION 1.09. Subchapter B, Chapter 576, Health and Safety
8-25 Code, is amended by adding Section 576.026 to read as follows:
8-26 Sec. 576.026. INDEPENDENT EVALUATION. (a) A patient
8-27 receiving inpatient mental health services under this subtitle is
9-1 entitled to obtain at the patient's cost an independent
9-2 psychiatric, psychological, or medical examination or evaluation by
9-3 a psychiatrist, physician, or nonphysician mental health
9-4 professional chosen by the patient. The facility administrator
9-5 shall allow the patient to obtain the examination or evaluation at
9-6 any reasonable time.
9-7 (b) If the patient is a minor, the minor and the minor's
9-8 parent, legal guardian, or managing or possessory conservator is
9-9 entitled to obtain the examination or evaluation. The cost of the
9-10 examination or evaluation shall be billed to the person responsible
9-11 for payment of the minor's treatment as a cost of treatment.
9-12 SECTION 1.10. Subchapter B, Chapter 576, Health and Safety
9-13 Code, is amended by adding Section 576.027 to read as follows:
9-14 Sec. 576.027. LIST OF MEDICATIONS. (a) The facility
9-15 administrator of an inpatient mental health facility shall provide
9-16 to a patient, a person designated by the patient, and the patient's
9-17 legal guardian or managing conservator, if any, a list of the
9-18 medications prescribed for administration to the patient while the
9-19 patient is in the facility. The list must include for each
9-20 medication:
9-21 (1) the name of the medication;
9-22 (2) the dosage and schedule prescribed for the
9-23 administration of the medication; and
9-24 (3) the name of the physician who prescribed the
9-25 medication.
9-26 (b) The list must be provided within four hours after the
9-27 facility administrator receives a written request for the list from
10-1 the patient, a person designated by the patient, or the patient's
10-2 legal guardian or managing conservator and on the discharge of the
10-3 patient. If sufficient time to prepare the list before discharge
10-4 is not available, the list may be mailed within 24 hours after
10-5 discharge to the patient, a person designated by the patient, and
10-6 the patient's legal guardian or managing conservator.
10-7 (c) A patient or the patient's legal guardian or managing
10-8 conservator, if any, may waive the right of any person to receive
10-9 the list of medications while the patient is participating in a
10-10 research project if release of the list would jeopardize the
10-11 results of the project.
10-12 SECTION 1.11. Section 611.002(b), Health and Safety Code, is
10-13 amended to read as follows:
10-14 (b) Confidential communications or records may not be
10-15 disclosed except as provided by Section 611.004 or 611.0045.
10-16 SECTION 1.12. Chapter 611, Health and Safety Code, is
10-17 amended by adding Section 611.0045 to read as follows:
10-18 Sec. 611.0045. RIGHT TO MENTAL HEALTH RECORD. (a) Except
10-19 as otherwise provided by this section, a patient is entitled to
10-20 have access to the content of a confidential record made about the
10-21 patient.
10-22 (b) The professional responsible for supervising the
10-23 patient's care may deny access to any portion of a record if the
10-24 professional determines that release of that portion would be
10-25 harmful to the patient's physical, mental, or emotional health.
10-26 (c) If the professional denies access to any portion of a
10-27 record, the professional shall give the patient a signed and dated
11-1 written statement that having access to the record would be harmful
11-2 to the patient's physical, mental, or emotional health and shall
11-3 include a copy of the written statement in the patient's records.
11-4 The statement must specify the portion of the record to which
11-5 access is denied, the reason for denial, and the duration of the
11-6 denial.
11-7 (d) The professional who denies access to a portion of a
11-8 record under this section shall redetermine the necessity for the
11-9 denial at least monthly and at each time a request for the denied
11-10 portion is made. If the professional again denies access, the
11-11 professional shall notify the patient of the denial and document
11-12 the denial as prescribed by Subsection (c).
11-13 (e) If a professional denies access to a portion of a
11-14 confidential record, the professional shall allow examination and
11-15 copying of the record by another professional if the patient
11-16 selects the professional to treat the patient for the same or a
11-17 related condition as the professional denying access.
11-18 (f) The content of a confidential record shall be made
11-19 available to a person listed by Section 611.004(a)(4) or (a)(5) who
11-20 is acting on the patient's behalf.
11-21 (g) A professional shall delete confidential information
11-22 about another person who has not consented to the release, but may
11-23 not delete information relating to the patient that another person
11-24 has provided, the identity of the person responsible for that
11-25 information, or the identity of any person who provided information
11-26 that resulted in the patient's commitment, admission, or treatment.
11-27 (h) If a summary or narrative of a confidential record is
12-1 requested by the patient or other person requesting release under
12-2 this section, the professional shall prepare the summary or
12-3 narrative.
12-4 (i) The professional or other entity that has possession or
12-5 control of the record shall grant access to any portion of the
12-6 record to which access is not specifically denied under this
12-7 section within a reasonable time and may charge a reasonable fee.
12-8 (j) Notwithstanding Section 5.08, Medical Practice Act
12-9 (Article 4495b, Vernon's Texas Civil Statutes), this section
12-10 applies to the release of a confidential record created or
12-11 maintained by a professional, including a physician, that relates
12-12 to the diagnosis, evaluation, or treatment of a mental or emotional
12-13 condition or disorder, including alcoholism or drug addiction.
12-14 SECTION 1.13. Section 611.005, Health and Safety Code, is
12-15 amended to read as follows:
12-16 Sec. 611.005. LEGAL REMEDIES FOR IMPROPER DISCLOSURE OR
12-17 FAILURE TO DISCLOSE. (a) A person aggrieved by the improper
12-18 disclosure of or failure to disclose confidential communications or
12-19 records in <a> violation of this chapter may petition the district
12-20 court of the county in which the person resides for appropriate
12-21 <injunctive> relief, including injunctive relief. The person may
12-22 petition a district court of Travis County if the person is not a
12-23 resident of this state.
12-24 (b) In a suit contesting the denial of access under Section
12-25 611.0045, the burden of proving that the denial was proper is on
12-26 the professional who denied the access.
12-27 (c) The aggrieved person also has a civil cause of action
13-1 for damages.
13-2 SECTION 1.14. Subchapter A, Chapter 462, Health and Safety
13-3 Code, is amended by adding Section 462.009 to read as follows:
13-4 Sec. 462.009. CONSENT TO TREATMENT. (a) A patient
13-5 receiving treatment in a treatment facility is entitled to refuse a
13-6 medication, therapy, or treatment unless:
13-7 (1) the patient is younger than 16 years of age and
13-8 the patient's parent, managing conservator, or guardian consents to
13-9 the medication, therapy, or treatment on behalf of the patient;
13-10 (2) the patient has been adjudicated to be incompetent
13-11 to manage the patient's personal affairs or to make a decision to
13-12 refuse the medication, therapy, or treatment and the patient's
13-13 guardian of the person or another person legally authorized to
13-14 consent to medical treatment consents to the medication, therapy,
13-15 or treatment on behalf of the patient; or
13-16 (3) a physician treating the patient determines that
13-17 the medication is necessary to prevent imminent serious physical
13-18 harm to the patient or to another individual and the physician
13-19 issues a written order, or a verbal order, if authenticated in
13-20 writing by the physician within 24 hours, to administer the
13-21 medication to the patient.
13-22 (b) The decision of a guardian or of a person legally
13-23 authorized to consent to medical treatment on the patient's behalf
13-24 under Subsection (a)(2) must be based on knowledge of what the
13-25 patient would desire, if known.
13-26 (c) A patient's refusal to receive medication, therapy, or
13-27 treatment under Subsection (a), or a patient's attempt to refuse if
14-1 the patient's right to refuse is limited by that subsection, shall
14-2 be documented in the patient's clinical record together with the
14-3 patient's expressed reason for refusal.
14-4 (d) If a physician orders a medication to be administered to
14-5 a patient under Subsection (a)(3), the physician shall document in
14-6 the patient's clinical record in specific medical and behavioral
14-7 terms the reasons for the physician's determination of the
14-8 necessity of the order.
14-9 (e) Consent given by a patient or by a person authorized by
14-10 law to consent to treatment on the patient's behalf for the
14-11 administration of a medication, therapy, or treatment is valid only
14-12 if:
14-13 (1) the consent is given voluntarily and without
14-14 coercive or undue influence;
14-15 (2) before administration of the medication, therapy,
14-16 or treatment, the treating physician explains to the patient and to
14-17 the person giving consent, in simple, nontechnical language:
14-18 (A) the specific condition to be treated;
14-19 (B) the beneficial effects on that condition
14-20 expected from the medication, therapy, or treatment;
14-21 (C) the probable health and mental health
14-22 consequences of not consenting to the medication, therapy, or
14-23 treatment;
14-24 (D) the side effects and risks associated with
14-25 the medication, therapy, or treatment;
14-26 (E) the generally accepted alternatives to the
14-27 medication, therapy, or treatment, if any, and whether an
15-1 alternative might be appropriate for the patient; and
15-2 (F) the proposed course of the medication,
15-3 therapy, or treatment; and
15-4 (3) the informed consent is evidenced in the patient's
15-5 clinical record by a signed form prescribed by the commission for
15-6 this purpose or by a statement of the treating physician that
15-7 documents that consent was given by the appropriate person and the
15-8 circumstances under which the consent was obtained.
15-9 (f) A person who consents to the administration of a
15-10 medication, therapy, or treatment may revoke the consent at any
15-11 time and for any reason. Revocation of consent is effective
15-12 immediately and further medication, therapy, or treatment may not
15-13 be administered unless new consent is obtained in accordance with
15-14 this section.
15-15 (g) Consent given by a patient or by a person authorized by
15-16 law to consent to treatment on the patient's behalf applies to a
15-17 series of doses of medication or to multiple treatments for which
15-18 consent was previously granted. If the treating physician obtains
15-19 new information relating to a medication, therapy, or treatment for
15-20 which consent was previously obtained, the physician must explain
15-21 the new information and obtain new consent.
15-22 SECTION 1.15. Section 462.024, Health and Safety Code, is
15-23 amended to read as follows:
15-24 Sec. 462.024. APPLICATION FOR COURT-ORDERED TREATMENT DURING
15-25 VOLUNTARY INPATIENT CARE. (a) An application for court-ordered
15-26 treatment may not be filed against a patient receiving voluntary
15-27 care under this subchapter unless:
16-1 (1) a request for release of the patient has been
16-2 filed; or
16-3 (2) in the <facility administrator's> opinion of the
16-4 physician responsible for the patient's treatment, the patient
16-5 meets the criteria for court-ordered treatment and:
16-6 (A) is absent from the facility without
16-7 authorization; <or>
16-8 (B) <refuses or> is unable to consent to
16-9 appropriate and necessary treatment; or
16-10 (C) refuses to consent to necessary and
16-11 appropriate treatment recommended by the physician responsible for
16-12 the patient's treatment and that physician completes a certificate
16-13 of medical examination for chemical dependency that, in addition to
16-14 the information required by Section 462.064, includes the opinion
16-15 of the physician that:
16-16 (i) there is no reasonable alternative to
16-17 the treatment recommended by the physician; and
16-18 (ii) the patient will not benefit from
16-19 continued inpatient care without the recommended treatment.
16-20 (b) The physician responsible for the patient's treatment
16-21 shall notify the patient if the physician intends to file an
16-22 application for court-ordered treatment.
16-23 SECTION 1.16. (a) Not later than October 31, 1993, the
16-24 Texas Board of Mental Health and Mental Retardation shall appoint
16-25 an advisory task force on prescription medications composed of at
16-26 least the following persons:
16-27 (1) one licensed psychiatrist;
17-1 (2) one licensed psychologist;
17-2 (3) one certified social worker;
17-3 (4) one licensed professional counselor;
17-4 (5) one licensed chemical dependency counselor;
17-5 (6) two persons who have received mental health
17-6 services, either voluntarily or involuntarily, during the two years
17-7 preceding the date of the person's appointment; and
17-8 (7) one member from each of two private associations
17-9 of persons who advocate on the behalf of or in the interest of
17-10 persons with mental illness.
17-11 (b) The board may appoint additional members as it considers
17-12 appropriate.
17-13 (c) The advisory task force shall designate one member to
17-14 serve as presiding officer.
17-15 (d) The advisory task force shall recommend to the Texas
17-16 Board of Mental Health and Mental Retardation information
17-17 concerning different types of prescription medications that shall
17-18 be provided to each person who may receive prescription medication
17-19 while receiving inpatient mental health services. The task force
17-20 shall make its recommendations not later than February 1, 1994.
17-21 (e) The advisory task force may conduct public hearings on
17-22 desirable information to be provided to a person who may receive
17-23 prescription medication.
17-24 (f) Members of the advisory task force receive no
17-25 compensation but are entitled to reimbursement for reasonable
17-26 expenses incurred in performing official duties in accordance with
17-27 the General Appropriations Act.
18-1 (g) In adopting rules under Section 571.0065, Health and
18-2 Safety Code, as added by this Act, the Texas Board of Mental Health
18-3 and Mental Retardation shall consider the recommendations of the
18-4 advisory task force on prescription medications appointed under
18-5 this section. The board shall adopt rules under Section 571.0065,
18-6 Health and Safety Code, not later than May 1, 1994.
18-7 SECTION 1.17. (a) The changes in law made by this article
18-8 apply only to consent for the administration of a medication,
18-9 therapy, or treatment to a person that is given on or after the
18-10 effective date of this article.
18-11 (b) Valid consent for the administration of a medication,
18-12 therapy, or treatment to a person that is given before the
18-13 effective date of this article remains valid and continues in
18-14 effect until consent is withdrawn by the person who gave consent or
18-15 by a person who is entitled to refuse the medication, therapy, or
18-16 treatment.
18-17 ARTICLE 2
18-18 SECTION 2.01. Sections 311.002(d)-(f), Health and Safety
18-19 Code, are amended to read as follows:
18-20 (d) A hospital shall provide an itemized statement of billed
18-21 services to a third party payor who is actually or potentially
18-22 responsible for paying all or part of the billed services provided
18-23 to a patient and who has received a claim for payment of those
18-24 services. To be entitled to receive a statement, the third party
18-25 payor must request the statement from the hospital and must have
18-26 received a claim for payment. The request must be made not later
18-27 than one year after the date on which the payor received the claim
19-1 for payment. The hospital shall provide the statement to the payor
19-2 not later than the 10th day after the date on which the payor
19-3 requests the statement. If a third party payor receives a claim
19-4 for payment of part but not all of the billed services, the third
19-5 party payor may request an itemized statement of only the billed
19-6 services for which payment is claimed or to which any deduction or
19-7 copayment applies.
19-8 (e) If a person, including a third party payor, requests
19-9 more than two copies of the statement, the hospital may charge a
19-10 reasonable fee for the third and subsequent copies provided to that
19-11 person. The fee may not exceed the hospital's cost to copy,
19-12 process, and deliver the copy to the person.
19-13 (f) <(e)> The Texas Department of Health or other
19-14 appropriate licensing agency may enforce this section by injunction
19-15 or by any other appropriate remedy, including suspending, revoking,
19-16 or refusing to renew a hospital's license.
19-17 (g) In this section, "hospital" includes:
19-18 (1) a treatment facility licensed under Chapter 464;
19-19 and
19-20 (2) a mental health facility licensed under Chapter
19-21 577.
19-22 (h) <(f)> This section does not apply to a hospital
19-23 maintained or operated by the federal government.
19-24 SECTION 2.02. Subchapter A, Chapter 311, Health and Safety
19-25 Code, is amended by adding Section 311.0025 to read as follows:
19-26 Sec. 311.0025. AUDITS OF BILLING. (a) A hospital,
19-27 treatment facility, mental health facility, or health care
20-1 professional may not submit to a patient or a third party payor a
20-2 bill for a treatment that the hospital, facility, or professional
20-3 knows was not provided or that was improper, unreasonable, or
20-4 medically or clinically unnecessary.
20-5 (b) If the appropriate licensing agency receives a complaint
20-6 alleging a violation of Subsection (a), the agency may audit the
20-7 billings and patient records of the hospital, treatment facility,
20-8 mental health facility, or health care professional.
20-9 (c) A hospital, treatment facility, mental health facility,
20-10 or health care professional that violates Subsection (a) is subject
20-11 to disciplinary action, including denial, revocation, suspension,
20-12 or nonrenewal of the license of the hospital, facility, or
20-13 professional. Disciplinary action taken under this section is in
20-14 addition to any other civil, administrative, or criminal penalty
20-15 provided by law.
20-16 (d) A health care professional may not order or direct a
20-17 hospital, treatment facility, or mental health facility to provide
20-18 treatment that the professional knows is improper, unreasonable, or
20-19 medically or clinically unnecessary. If a hospital or facility is
20-20 denied reimbursement for treatment because a health care
20-21 professional orders or directs treatment in violation of this
20-22 subsection, the professional shall reimburse the hospital or
20-23 facility for the treatment not later than the 30th day after the
20-24 date on which the professional receives a final determination of
20-25 violation.
20-26 (e) Each health care regulatory agency by rule shall
20-27 prescribe what constitutes "improper, unreasonable, or medically or
21-1 clinically unnecessary" treatment.
21-2 (f) In this section:
21-3 (1) "Health care professional" means an individual
21-4 licensed, certified, or regulated by a health care regulatory
21-5 agency who is eligible for reimbursement for treatment ordered or
21-6 rendered by that professional.
21-7 (2) "Hospital" means a hospital licensed under Chapter
21-8 241.
21-9 (3) "Mental health facility" means a mental health
21-10 facility licensed under Chapter 577.
21-11 (4) "Treatment facility" means a treatment facility
21-12 licensed under Chapter 464.
21-13 ARTICLE 3
21-14 SECTION 3.01. Except as otherwise provided by this Act, this
21-15 Act takes effect immediately.
21-16 SECTION 3.02. The importance of this legislation and the
21-17 crowded condition of the calendars in both houses create an
21-18 emergency and an imperative public necessity that the
21-19 constitutional rule requiring bills to be read on three several
21-20 days in each house be suspended, and this rule is hereby suspended,
21-21 and that this Act take effect and be in force according to its
21-22 terms, and it is so enacted.