Bill not drafted by TLC or Senate E&E.

      Line and page numbers may not match official copy.

         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 person

1-12     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

 2-1     authorized under federal or state law to review or approve the

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

 2-3     ensure the protection of the rights and welfare of human research

 2-4     subjects.

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

 2-6     parent or legal guardian if the patient is a minor, a legal

 2-7     guardian if the patient has been adjudicated incapacitated

 2-8     [incompetent] to manage the patient's personal affairs, an agent of

 2-9     the patient authorized under a durable power of attorney for health

2-10     care, an attorney ad litem appointed for the patient, a guardian ad

2-11     litem appointed for the patient, a personal representative or

2-12     statutory beneficiary if the patient is deceased, [or] an attorney

2-13     retained by the patient or by the patient's legally authorized

2-14     representative, or an attorney-in-fact of the patient.

2-15           SECTION 2.  Section 241.152(a), Health and Safety Code, is

2-16     amended to read as follows:

2-17           (a)  Except as authorized by Section 241.153, a hospital or

2-18     an agent or employee of a hospital may not disclose health care

2-19     information about a patient to any person other than the patient or

2-20     the patient's legally authorized representative without the written

2-21     authorization of the patient or the patient's legally authorized

2-22     representative.

2-23           SECTION 3.  Section 241.153, Health and Safety Code, is

2-24     amended to read as follows:

2-25           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)  authorized by an applicable professional health

 3-7     care licensing act;

 3-8                 (3)  to a health care provider who is rendering health

 3-9     care to the patient when the request for the disclosure is made;

3-10                 (4)  to a transporting emergency medical services

3-11     provider for the sole purpose of determining the patient's

3-12     diagnosis and the outcome of the patient's hospital admission;

3-13                 (5)  made by a member of the clergy carrying out the

3-14     clergy member's pastoral duties;

3-15                 (6)  to a qualified organ or tissue procurement

3-16     organization as defined in Section 692.002 for the purpose of

3-17     making inquiries relating to donations according to the protocol

3-18     referred to in Section 692.013(d);

3-19                 (7)  to a prospective health care provider for the

3-20     purpose of securing the services of that health care provider as

3-21     part of the patient's continuum of care, as determined by the

3-22     patient's attending physician;

3-23                 (8)  to a person authorized to consent to medical

3-24     treatment under or exempted from Chapter 313 to facilitate the

3-25     adequate provision of treatment;

 4-1                 (9) [(2)]  to an employee or agent of the hospital who

 4-2     requires health care information for health care education, quality

 4-3     assurance, or peer review or for assisting the hospital in the

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

 4-5     accreditation, or certification requirements and if the hospital

 4-6     takes appropriate action to ensure that the employee or agent:

 4-7                       (A)  will not use or disclose the health care

 4-8     information for any other purpose; and

 4-9                       (B)  will take appropriate steps to protect the

4-10     health care information;

4-11                 (10) [(3)]  to a federal, state, or local government

4-12     agency or authority to the extent authorized or required by law;

4-13                 (11) [(4)]  to a hospital that is the successor in

4-14     interest to the hospital maintaining the health care information;

4-15                 (12)  to the American Red Cross for the specific

4-16     purpose of fulfilling the duties specified under its charter

4-17     granted as an instrumentality of the United States government;

4-18                 (13)  to a regional poison control center, as the term

4-19     is used in Chapter 777, to the extent necessary to enable the

4-20     center to provide information and education to health professionals

4-21     involved in the management of poison and overdose victims,

4-22     including information regarding appropriate therapeutic use of

4-23     medications, their compatibility and stability, and adverse drug

4-24     reactions and interactions;

4-25                 (14)  to a health care utilization review agent who

 5-1     requires the health care information for utilization review of

 5-2     health care under Article 21.58A, Insurance Code;

 5-3                 (15) [(5)]  for use in a research project authorized by

 5-4     an institutional review board under federal law;

 5-5                 (16) [(6)]  to health care personnel of a penal or

 5-6     other custodial institution in which the patient is detained if the

 5-7     disclosure is for the sole purpose of providing health care to the

 5-8     patient;

 5-9                 (17) [(7)]  to facilitate reimbursement [by a health

5-10     benefit plan] to a hospital, other health care provider, or the

5-11     patient for medical services or supplies;

5-12                 (18) [(8)]  to a health maintenance organization for

5-13     purposes of maintaining a statistical reporting system as required

5-14     by a rule adopted by a state agency or regulations adopted under

5-15     the federal Health Maintenance Organization Act of 1973, as amended

5-16     (42 U.S.C. Section 300 et seq.);

5-17                 (19) [(9)]  to satisfy a request for medical records of

5-18     a deceased or incompetent person pursuant to Section 4.01(e),

5-19     Medical Liability and Insurance Improvement Act of Texas (Article

5-20     4590i, Vernon's Texas Civil Statutes); [or]

5-21                 (20)  to comply with a court order except as provided

5-22     by Subdivision (21); or

5-23                 (21)  related to a judicial proceeding in which the

5-24     patient is a party and the disclosure is requested under a subpoena

5-25     issued under:

 6-1                       (A)  the Texas Rules of Civil Procedure or Code

 6-2     of Criminal Procedure; or

 6-3                       (B)  Chapter 121, Civil Practice and Remedies

 6-4     Code

 6-5                 [(10)  to a court pursuant to a court order or court

 6-6     subpoena].

 6-7           SECTION 4.  Section 241.154, Health and Safety Code, is

 6-8     amended to read as follows:

 6-9           Sec. 241.154.  Request.  (a)  On receipt of a written

6-10     authorization from a patient or legally authorized representative

6-11     to examine or copy all or part of the patient's recorded health

6-12     care information, or for disclosures under Section 241.153 not

6-13     requiring written authorization, a hospital or its agent, as

6-14     promptly as required under the circumstances but not later than the

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

6-16     Subsection (b) are [is] received, shall:

6-17                 (1)  make the information available for examination

6-18     during regular business hours and provide a copy to the requestor,

6-19     if requested; or

6-20                 (2)  inform the authorized requestor if the information

6-21     does not exist or cannot be found.

6-22           (b)  Except as provided by Subsection (d), the [The] hospital

6-23     or its agent may charge a reasonable fee for providing the health

6-24     care information and is not required to permit the examination,

6-25     [or] copying, or release of the information requested until the fee

 7-1     is paid unless there is a medical emergency.  The fee may not

 7-2     exceed the sum of:

 7-3                 (1)  a basic retrieval or processing fee, which must

 7-4     include the fee for providing the first 10 pages of the copies and

 7-5     which may not exceed $30; and

 7-6                       (A)  a charge for each page of:

 7-7                             (i)  $1 for the 11th through the 60th page

 7-8     of the provided copies;

 7-9                             (ii)  50 cents for the 61st through the

7-10     400th page of the provided copies; and

7-11                             (iii)  25 cents for any remaining pages of

7-12     the provided copies; and

7-13                       (B)  the actual cost of mailing, shipping, or

7-14     otherwise delivering the provided copies; or

7-15                 (2)  if the requested records are stored on any

7-16     microform or other electronic medium [microfiche], a retrieval or

7-17     processing fee, which must include the fee for providing the first

7-18     10 pages of the copies and which may not exceed $45; and

7-19                       (A)  $1 per page thereafter; and

7-20                       (B)  the actual cost of mailing, shipping, or

7-21     otherwise delivering the provided copies.

7-22           (c)  In addition, the hospital or its agent may charge a

7-23     reasonable fee for:

7-24                 (1)  certification of a document, not to exceed the

7-25     charge authorized by Section 22.004, Civil Practice and Remedies

 8-1     Code; and

 8-2                 (2)  written responses to a written set of questions,

 8-3     not to exceed $10 for a set.

 8-4           (d)  A hospital may not charge a fee for:

 8-5                 (1)  providing health care information under Subsection

 8-6     (b) to the extent the fee is prohibited under Subchapter M, Chapter

 8-7     161;

 8-8                 (2)  a patient to examine the patient's own health care

 8-9     information;

8-10                 (3)  an itemized statement of billed services, except

8-11     as provided under Section 311.002(e); or

8-12                 (4)  health care information relating to treatment or

8-13     hospitalization for which workers' compensation benefits are being

8-14     sought, except to the extent permitted under Chapter 408, Labor

8-15     Code.

8-16           (e) [(c)]  Effective September 1, 1996, and annually

8-17     thereafter, the fee for providing health care information as

8-18     specified in this section shall be adjusted accordingly based on

8-19     the most recent changes to the consumer price index as published by

8-20     the Bureau of Labor Statistics of the United States Department of

8-21     Labor that measures the average changes in prices of goods and

8-22     services purchased by urban wage earners and clerical workers'

8-23     families and single workers living alone.

8-24           SECTION 5.  Section 241.152(g), Health and Safety Code, is

8-25     repealed.

 9-1           SECTION 6.  The importance of this legislation and the

 9-2     crowded condition of the calendars in both houses create an

 9-3     emergency and an imperative public necessity that the

 9-4     constitutional rule requiring bills to be read on three several

 9-5     days in each house be suspended, and this rule is hereby suspended,

 9-6     and that this Act take effect and be in force from and after its

 9-7     passage, and it is so enacted.