By:  Madla                                             S.B. No. 975

                                A BILL TO BE ENTITLED

                                       AN ACT

 1-1     relating to the disclosure of health care information by certain

 1-2     health care providers.

 1-3           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

 1-4           SECTION 1.  Section 241.151, Health and Safety Code, is

 1-5     amended to read as follows:

 1-6           Sec. 241.151.  DEFINITIONS.  In this subchapter:

 1-7                 (1)  "Directory information" means information

 1-8     disclosing the presence of a person who is receiving inpatient,

 1-9     outpatient, or emergency services from a licensed hospital, the

1-10     nature of the person's injury, the person's municipality of

1-11     residence, sex, and age, and the general health status of the

1-12     person as described in terms of "critical," "poor," "fair," "good,"

1-13     "excellent," or similar terms.

1-14                 (2)  "Health care information" means information

1-15     recorded in any form or medium that identifies a patient and

1-16     relates to the history, diagnosis, treatment, or prognosis of a

1-17     patient.

1-18                 (3) [(2)]  "Health care provider" means a person who is

1-19     licensed, certified, or otherwise authorized by the laws of this

1-20     state to provide health care in the ordinary course of business or

1-21     practice of a profession.

1-22                 (4) [(3)]  "Institutional review board" means a board,

1-23     committee, or other group formally designated by an institution or

1-24     authorized under federal or state law to review or approve the

 2-1     initiation of or conduct periodic review of research programs to

 2-2     ensure the protection of the rights and welfare of human research

 2-3     subjects.

 2-4                 (5) [(4)]  "Legally authorized representative" means a

 2-5     parent or legal guardian if the patient is a minor, a legal

 2-6     guardian if the patient has been adjudicated incapacitated

 2-7     [incompetent] to manage the patient's personal affairs, an agent of

 2-8     the patient authorized under a durable power of attorney for health

 2-9     care, an attorney ad litem appointed for the patient, a guardian ad

2-10     litem appointed for the patient, a personal representative or

2-11     statutory beneficiary if the patient is deceased, [or] an attorney

2-12     retained by the patient or by the patient's legally authorized

2-13     representative, or an attorney-in-fact of the patient.

2-14           SECTION 2.  Subsections (a) and (c), Section 241.152, Health

2-15     and Safety Code, are amended to read as follows:

2-16           (a)  Except as authorized by Section 241.153, a hospital or

2-17     an agent or employee of a hospital may not disclose health care

2-18     information about a patient to any person other than the patient or

2-19     the patient's legally authorized representative without the written

2-20     authorization of the patient or the patient's legally authorized

2-21     representative.

2-22           (c)  A disclosure authorization is valid until the 180th

2-23     [90th] day after the date it is signed unless it provides otherwise

2-24     or unless it is revoked.

2-25           SECTION 3.  Section 241.153, Health and Safety Code, is

2-26     amended to read as follows:

2-27           Sec. 241.153.  DISCLOSURE WITHOUT WRITTEN AUTHORIZATION.  A

 3-1     patient's health care information may be disclosed without the

 3-2     patient's authorization if the disclosure is:

 3-3                 (1)  directory information, unless the patient has

 3-4     instructed the hospital not to make the disclosure or the directory

 3-5     information is otherwise protected by state or federal law;

 3-6                 (2)  to a health care provider who is rendering health

 3-7     care to the patient when the request for the disclosure is made;

 3-8                 (3)  to a transporting emergency medical services

 3-9     provider for the sole purpose of determining the patient's

3-10     diagnosis and the outcome of the patient's hospital admission;

3-11                 (4)  to a member of the clergy specifically designated

3-12     by the patient;

3-13                 (5)  to a qualified organ or tissue procurement

3-14     organization as defined in Section 692.002 for the purpose of

3-15     making inquiries relating to donations according to the protocol

3-16     referred to in Section 692.013(d);

3-17                 (6)  to a prospective health care provider for the

3-18     purpose of securing the services of that health care provider as

3-19     part of the patient's continuum of care, as determined by the

3-20     patient's attending physician;

3-21                 (7)  to a person authorized to consent to medical

3-22     treatment under Chapter 313 or to a person in a circumstance

3-23     exempted from Chapter 313 to facilitate the adequate provision of

3-24     treatment;

3-25                 (8) [(2)]  to an employee or agent of the hospital who

3-26     requires health care information for health care education, quality

3-27     assurance, or peer review or for assisting the hospital in the

 4-1     delivery of health care or in complying with statutory, licensing,

 4-2     accreditation, or certification requirements and if the hospital

 4-3     takes appropriate action to ensure that the employee or agent:

 4-4                       (A)  will not use or disclose the health care

 4-5     information for any other purpose; and

 4-6                       (B)  will take appropriate steps to protect the

 4-7     health care information;

 4-8                 (9) [(3)]  to a federal, state, or local government

 4-9     agency or authority to the extent authorized or required by law;

4-10                 (10) [(4)]  to a hospital that is the successor in

4-11     interest to the hospital maintaining the health care information;

4-12                 (11)  to the American Red Cross for the specific

4-13     purpose of fulfilling the duties specified under its charter

4-14     granted as an instrumentality of the United States government;

4-15                 (12)  to a regional poison control center, as the term

4-16     is used in Chapter 777, to the extent necessary to enable the

4-17     center to provide information and education to health professionals

4-18     involved in the management of poison and overdose victims,

4-19     including information regarding appropriate therapeutic use of

4-20     medications, their compatibility and stability, and adverse drug

4-21     reactions and interactions;

4-22                 (13)  to a health care utilization review agent who

4-23     requires the health care information for utilization review of

4-24     health care under Article 21.58A, Insurance Code;

4-25                 (14) [(5)]  for use in a research project authorized by

4-26     an institutional review board under federal law;

4-27                 (15) [(6)]  to health care personnel of a penal or

 5-1     other custodial institution in which the patient is detained if the

 5-2     disclosure is for the sole purpose of providing health care to the

 5-3     patient;

 5-4                 (16) [(7)]  to facilitate reimbursement [by a health

 5-5     benefit plan] to a hospital, other health care provider, or the

 5-6     patient for medical services or supplies;

 5-7                 (17) [(8)]  to a health maintenance organization for

 5-8     purposes of maintaining a statistical reporting system as required

 5-9     by a rule adopted by a state agency or regulations adopted under

5-10     the federal Health Maintenance Organization Act of 1973, as amended

5-11     (42 U.S.C. Section 300 et seq.);

5-12                 (18) [(9)]  to satisfy a request for medical records of

5-13     a deceased or incompetent person pursuant to Section 4.01(e),

5-14     Medical Liability and Insurance Improvement Act of Texas (Article

5-15     4590i, Vernon's Texas Civil Statutes); [or]

5-16                 (19)  to comply with a court order except as provided

5-17     by Subdivision (20); or

5-18                 (20)  related to a judicial proceeding in which the

5-19     patient is a party and the disclosure is requested under a subpoena

5-20     issued under:

5-21                       (A)  the Texas Rules of Civil Procedure or Code

5-22     of Criminal Procedure; or

5-23                       (B)  Chapter 121, Civil Practice and Remedies

5-24     Code

5-25                 [(10)  to a court pursuant to a court order or court

5-26     subpoena].

5-27           SECTION 4.  Section 241.154, Health and Safety Code, is

 6-1     amended to read as follows:

 6-2           Sec. 241.154.  REQUEST.  (a)  On receipt of a written

 6-3     authorization from a patient or legally authorized representative

 6-4     to examine or copy all or part of the patient's recorded health

 6-5     care information, or for disclosures under Section 241.153 not

 6-6     requiring written authorization, a hospital or its agent, as

 6-7     promptly as required under the circumstances but not later than the

 6-8     15th day after the date the request and payment authorized under

 6-9     Subsection (b) are [is] received, shall:

6-10                 (1)  make the information available for examination

6-11     during regular business hours and provide a copy to the requestor,

6-12     if requested; or

6-13                 (2)  inform the authorized requestor if the information

6-14     does not exist or cannot be found.

6-15           (b)  Except as provided by Subsection (d), the [The] hospital

6-16     or its agent may charge a reasonable fee for providing the health

6-17     care information and is not required to permit the examination,

6-18     [or] copying, or release of the information requested until the fee

6-19     is paid unless there is a medical emergency.  The fee may not

6-20     exceed the sum of:

6-21                 (1)  a basic retrieval or processing fee, which must

6-22     include the fee for providing the first 10 pages of the copies and

6-23     which may not exceed $30; and

6-24                       (A)  a charge for each page of:

6-25                             (i)  $1 for the 11th through the 60th page

6-26     of the provided copies;

6-27                             (ii)  50 cents for the 61st through the

 7-1     400th page of the provided copies; and

 7-2                             (iii)  25 cents for any remaining pages of

 7-3     the provided copies; and

 7-4                       (B)  the actual cost of mailing, shipping, or

 7-5     otherwise delivering the provided copies; or

 7-6                 (2)  if the requested records are stored on any

 7-7     microform or other electronic medium [microfiche], a retrieval or

 7-8     processing fee, which must include the fee for providing the first

 7-9     10 pages of the copies and which may not exceed $45; and

7-10                       (A)  $1 per page thereafter; and

7-11                       (B)  the actual cost of mailing, shipping, or

7-12     otherwise delivering the provided copies.

7-13           (c)  In addition, the hospital or its agent may charge a

7-14     reasonable fee for:

7-15                 (1)  execution of an affidavit or certification of a

7-16     document, not to exceed the charge authorized by Section 22.004,

7-17     Civil Practice and Remedies Code; and

7-18                 (2)  written responses to a written set of questions,

7-19     not to exceed $10 for a set.

7-20           (d)  A hospital may not charge a fee for:

7-21                 (1)  providing health care information under Subsection

7-22     (b) to the extent the fee is prohibited under Subchapter M, Chapter

7-23     161;

7-24                 (2)  a patient to examine the patient's own health care

7-25     information;

7-26                 (3)  providing an itemized statement of billed services

7-27     to a patient or third-party payor, except as provided under Section

 8-1     311.002(e); or

 8-2                 (4)  health care information relating to treatment or

 8-3     hospitalization for which workers' compensation benefits are being

 8-4     sought, except to the extent permitted under Chapter 408, Labor

 8-5     Code.

 8-6           (e)  Effective September 1, 1996, and annually thereafter,

 8-7     the fee for providing health care information as specified in this

 8-8     section shall be adjusted accordingly based on the most recent

 8-9     changes to the consumer price index as published by the Bureau of

8-10     Labor Statistics of the United States Department of Labor that

8-11     measures the average changes in prices of goods and services

8-12     purchased by urban wage earners and clerical workers' families and

8-13     single workers living alone.

8-14           SECTION 5.  Subsection (g), Section 241.152, Health and

8-15     Safety Code, is repealed.

8-16           SECTION 6.  The importance of this legislation and the

8-17     crowded condition of the calendars in both houses create an

8-18     emergency and an imperative public necessity that the

8-19     constitutional rule requiring bills to be read on three several

8-20     days in each house be suspended, and this rule is hereby suspended.