BILL ANALYSIS
C.S.S.B. 667
By: Madla
Health and Human Services
04-27-95
Committee Report (Substituted)
BACKGROUND
In order to receive appropriate health care, a patient must often
share highly personal information with the health care provider.
In recent years, the emergence of third-party payment plans, the
use of healthcare information for non-healthcare purposes, and the
exponential increase in the use of computers and automated
information systems increasingly threaten traditional
confidentiality protections.
Current law affords some protection for physician offices, mental
health, and mental retardation records, but no similar legislation
exists for hospital medical records.
PURPOSE
As proposed, C.S.S.B. 667 sets forth guidelines for the disclosure
of certain health care information by a provider.
RULEMAKING AUTHORITY
It is the committee's opinion that rulemaking authority is granted
to the Texas State Board of Medical Examiners under SECTION 6
(Section 5.08(o), Article 4495b, V.T.C.S.) of this bill.
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Chapter 241, Health and Safety Code, by adding
Subchapter G, as follows:
SUBCHAPTER G. DISCLOSURE OF HEALTH CARE INFORMATION
Sec. 241.151. DEFINITIONS. Defines "health care
information," "health care provider," "institutional review
board," and "legally authorized representative."
Sec. 241.152. WRITTEN AUTHORIZATION FOR DISCLOSURE OF HEALTH
CARE INFORMATION. (a) Prohibits a hospital, or agent or
employee of a hospital, from disclosing health care
information about a patient without the written authorization
of the patient or the patient's legally authorized
representative, except as authorized by Section 241.153.
(b) Makes a disclosure authorization to a hospital valid
only if certain requirements are met.
(c) Makes a disclosure authorization valid until the 90th
day after the date it is signed, unless it provides
otherwise or is revoked.
(d) Authorizes a patient or legally authorized
representative to revoke a disclosure authorization to a
hospital at any time, except as provided by Subsection (e).
Makes a revocation valid only if it is dated later than the
date on the original authorization and is signed by the
patient or authorized representative.
(e) Prohibits a patient or a legally authorized
representative from revoking a disclosure that is required
for purposes of making payment to the hospital for health
care provided to the patient.
(f) Prohibits a patient from maintaining an action against
a hospital for a disclosure made in good-faith reliance on
an authorization, if the hospital's medical record
department did not have notice that the authorization was
revoked.
(g) Prohibits a hospital from charging a fee for providing
health care information under Subsection (c) to the extent
the fee is prohibited under Chapter 161M.
Sec. 241.153. DISCLOSURE WITHOUT WRITTEN AUTHORIZATION.
Authorizes a patient's health care information to be disclosed
without the patient's authorization, if the disclosure is made
under specific circumstances.
Sec. 241.154. AUTHORIZED REQUEST. (a) Requires a hospital,
not later than the 15th day after receipt of a request, to
make information available for examination and provide a copy
to the authorized requestor, if requested, or inform the
requestor if the information does not exist or cannot be
found.
(b) Authorizes the hospital to charge a reasonable fee for
providing the health care information. Declares that the
hospital is not required to permit examination or copying
until the fee is paid, unless there is a medical emergency.
Prohibits the fee from exceeding a certain sum.
(c) Requires the fee for providing health care information
as specified in this section, effective September 1, 1996,
and annually thereafter, to be adjusted accordingly based on
certain changes to the consumer price index.
Sec. 241.155. SAFEGUARDS FOR SECURITY OF HEALTH CARE
INFORMATION. Requires a hospital to adopt and implement
reasonable safeguards for the security of all health care
information it maintains.
Sec. 241.156. PATIENT REMEDIES. (a) Authorizes a person
aggrieved by a violation of this subchapter relating to the
unauthorized release of confidential information to bring an
action for appropriate injunctive relief and damages resulting
from the release.
(b) Requires an action under Subsection (a) to be brought in
the district court of the county in which the patient
resides; the district court of the county in which the
patient's legally authorized representative resides, if the
patient is deceased; or the district court of Travis County,
if the patient or a legally authorized representative is not
a resident of this state.
(c) Declares that a petition for injunctive relief under
Subsection (a)(1) takes precedence over all civil matters on
the court docket, except those matters to which equal
precedence on the docket is granted by law.
SECTION 2. Amends Section 1.03(a), Article 4495b, V.T.C.S., by
adding Subdivisions (17) and (18), to define "legally authorized
representative" and "medical records."
SECTION 3. Amends Sections 5.08(g) and (h), Article 4495b,
V.T.C.S., as follows:
(g) Declares that exceptions to confidentiality or privilege
in court or administrative proceedings exist when the
patient's physical or mental condition is relevant to the
execution of a will, when the information is relevant to a
proceeding under Subsection (l) of this section, to satisfy a
request for medical records of a deceased or incompetent
person under Section 4.01(e), Article 4590i, V.T.C.S., or to
a court or a party to an action pursuant to a court order or
court subpoena.
(h) Declares that exceptions to the privilege of
confidentiality, in other than court or administrative
proceedings, allowing disclosure of confidential information
by a physician, exist to health care personnel of a penal or
other custodial institution in which the patient is detained
if the disclosure os for the sole purpose of providing health
care to the patient.
SECTION 4. Amends Section 5.08(j)(2), Article 4495b, V.T.C.S., by
prohibiting a patient from maintaining an action against a
physician for disclosure made in good-faith, if the physician did
not have written notice that the authorization was revoked.
SECTION 5. Amends Section 5.08(k), Article 4495b, V.T.C.S., to
require a physician to furnish copies of medical records requested,
including records received from a physician or other health care
provider involved in the care or treatment of the patient, pursuant
to a written request under Subsection (j) of this section.
Authorizes the physician to delete confidential information about
another patient or family member of the patient who has not
consented to the release. Deletes a provision regarding fees for
the provision of information. Deletes the definition of "medical
records."
SECTION 6. Amends Section 5.08, Article 4495b, V.T.C.S., by adding
Subsections (o) and (p), as follows:
(o) Authorizes the physician to charge a reasonable fee for
copying records. Provides that the physician is not required
to permit access to the records until payment of the fee,
unless there is a medical emergency. Requires the Texas State
Board of Medical Examiners, by rule, to prescribe what
constitute reasonable fees.
(p) Prohibits a physician from charging a fee for copying
medical records under Subsection (o) to the extent that the
fee is prohibited under Chapter 161M, Health and Safety Code.
SECTION 7. Amends Section 611.004, Health and Safety Code, as
follows:
Sec. 611.004. New heading: AUTHORIZES DISCLOSURE OF
CONFIDENTIAL INFORMATION OTHER THAN IN JUDICIAL OR
ADMINISTRATIVE PROCEEDING. Authorizes a professional to
disclose confidential information to health care personnel of
a penal or other custodial institution in which the patient is
detained if the disclosure is for the sole purpose of
providing health care to the patient, to an employee or agent
of the professional who required mental health care
information to provide mental health care services or in
complying with statutory, licensing, or accreditation
requirements under certain circumstances; or to satisfy a
request for medical records of a deceased or incompetent
person pursuant to Section 4.01(e), Article 4690i, V.T.C.S.
SECTION 8. Amends Chapter 611, Health and Safety Code, by adding
Sections 611.006-611.008, as follows:
Sec. 611.006. AUTHORIZED DISCLOSURE OF CONFIDENTIAL
INFORMATION IN JUDICIAL OR ADMINISTRATIVE PROCEEDING. (a)
Sets forth conditions under which a professional is authorized
to disclose confidential information in a judicial or
administrative proceeding.
(b) Requires the court, on granting an order, to impose
appropriate safeguards against unauthorized disclosure.
Sec. 611.007. REVOCATION OF CONSENT. (a) Authorizes a
patient or authorized representative to revoke a disclosure
consent at any time, except as provided by Subsection (b).
Provides that a revocation is valid only if it is written,
dated, and signed by the patient or representative.
(b) Prohibits a patient from revoking a disclosure that is
required for making payment for services provided to the
patient.
(c) Prohibits a patient from maintaining an action against
a professional for a disclosure made in good faith, if the
professional did not have written notice of the revocation.
Sec. 611.008. REQUEST BY PATIENT. (a) Requires a
professional, not later than the 15th day after receiving a
request from a patient to examine the patient's records, to
make the information available and provide a copy, if
requested, and inform the patient if the information does not
exist or cannot be found.
(b) Authorizes a professional to charge a reasonable fee for
copying information. Provides that the professional is not
required to permit access to information until payment of
the fee, unless there is a medical emergency.
(c) Prohibits a professional from charging a fee for copying
mental health care information under Subsection (c) to the
extent the fee is prohibited under Chapter 161M.
SECTION 9. Provides that Sections 241.152(g) and 611.008(c), Health
and Safety Code, and Section 5.08(p), Article 4495b, V.T.C.S., take
effect only if S.B. 133, 74th Legislature, Regular Session, is
enacted and becomes law. Provides that if S.B. 133 does not become
law, this Act has no effect.
SECTION 10. Makes application of this Act prospective beginning
January 1, 1996.
SECTION 11. Effective date: September 1, 1995.
SECTION 12. Emergency clause.