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.