1-1     By:  Madla                                             S.B. No. 975

 1-2           (In the Senate - Filed March 6, 1997; March 10, 1997, read

 1-3     first time and referred to Committee on Health and Human Services;

 1-4     April 18, 1997, reported adversely, with favorable Committee

 1-5     Substitute by the following vote:  Yeas 10, Nays 0; April 18, 1997,

 1-6     sent to printer.)

 1-7     COMMITTEE SUBSTITUTE FOR S.B. No. 975                    By:  Madla

 1-8                            A BILL TO BE ENTITLED

 1-9                                   AN ACT

1-10     relating to the disclosure of health care information by certain

1-11     health care providers.

1-12           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

1-13           SECTION 1.  Section 241.151, Health and Safety Code, is

1-14     amended to read as follows:

1-15           Sec. 241.151.  DEFINITIONS.  In this subchapter:

1-16                 (1)  "Directory information" means information

1-17     disclosing the presence of a person who is receiving inpatient,

1-18     outpatient, or emergency services from a licensed hospital, the

1-19     nature of the person's injury, the person's municipality of

1-20     residence, sex, and age, and the general health status of the

1-21     person as described in terms of "critical," "poor," "fair," "good,"

1-22     "excellent," or similar terms.

1-23                 (2)  "Health care information" means information

1-24     recorded in any form or medium that identifies a patient and

1-25     relates to the history, diagnosis, treatment, or prognosis of a

1-26     patient.

1-27                 (3) [(2)]  "Health care provider" means a person who is

1-28     licensed, certified, or otherwise authorized by the laws of this

1-29     state to provide health care in the ordinary course of business or

1-30     practice of a profession.

1-31                 (4) [(3)]  "Institutional review board" means a board,

1-32     committee, or other group formally designated by an institution or

1-33     authorized under federal or state law to review or approve the

1-34     initiation of or conduct periodic review of research programs to

1-35     ensure the protection of the rights and welfare of human research

1-36     subjects.

1-37                 (5) [(4)]  "Legally authorized representative" means a

1-38     parent or legal guardian if the patient is a minor, a legal

1-39     guardian if the patient has been adjudicated incapacitated

1-40     [incompetent] to manage the patient's personal affairs, an agent of

1-41     the patient authorized under a durable power of attorney for health

1-42     care, an attorney ad litem appointed for the patient, a guardian ad

1-43     litem appointed for the patient, a personal representative or

1-44     statutory beneficiary if the patient is deceased, [or] an attorney

1-45     retained by the patient or by the patient's legally authorized

1-46     representative, or an attorney-in-fact of the patient.

1-47           SECTION 2.  Subsections (a) and (c), Section 241.152, Health

1-48     and Safety Code, are amended to read as follows:

1-49           (a)  Except as authorized by Section 241.153, a hospital or

1-50     an agent or employee of a hospital may not disclose health care

1-51     information about a patient to any person other than the patient or

1-52     the patient's legally authorized representative without the written

1-53     authorization of the patient or the patient's legally authorized

1-54     representative.

1-55           (c)  A disclosure authorization is valid until the 180th

1-56     [90th] day after the date it is signed unless it provides otherwise

1-57     or unless it is revoked.

1-58           SECTION 3.  Section 241.153, Health and Safety Code, is

1-59     amended to read as follows:

1-60           Sec. 241.153.  DISCLOSURE WITHOUT WRITTEN AUTHORIZATION.  A

1-61     patient's health care information may be disclosed without the

1-62     patient's authorization if the disclosure is:

1-63                 (1)  directory information, unless the patient has

1-64     instructed the hospital not to make the disclosure or the directory

 2-1     information is otherwise protected by state or federal law;

 2-2                 (2)  authorized by an applicable professional health

 2-3     care licensing act;

 2-4                 (3)  to a health care provider who is rendering health

 2-5     care to the patient when the request for the disclosure is made;

 2-6                 (4)  to a transporting emergency medical services

 2-7     provider for the sole purpose of determining the patient's

 2-8     diagnosis and the outcome of the patient's hospital admission;

 2-9                 (5)  to a member of the clergy specifically designated

2-10     by the patient;

2-11                 (6)  to a qualified organ or tissue procurement

2-12     organization as defined in Section 692.002 for the purpose of

2-13     making inquiries relating to donations according to the protocol

2-14     referred to in Section 692.013(d);

2-15                 (7)  to a prospective health care provider for the

2-16     purpose of securing the services of that health care provider as

2-17     part of the patient's continuum of care, as determined by the

2-18     patient's attending physician;

2-19                 (8)  to a person authorized to consent to medical

2-20     treatment under Chapter 313 or to a person in a circumstance

2-21     exempted from Chapter 313 to facilitate the adequate provision of

2-22     treatment;

2-23                 (9) [(2)]  to an employee or agent of the hospital who

2-24     requires health care information for health care education, quality

2-25     assurance, or peer review or for assisting the hospital in the

2-26     delivery of health care or in complying with statutory, licensing,

2-27     accreditation, or certification requirements and if the hospital

2-28     takes appropriate action to ensure that the employee or agent:

2-29                       (A)  will not use or disclose the health care

2-30     information for any other purpose; and

2-31                       (B)  will take appropriate steps to protect the

2-32     health care information;

2-33                 (10) [(3)]  to a federal, state, or local government

2-34     agency or authority to the extent authorized or required by law;

2-35                 (11) [(4)]  to a hospital that is the successor in

2-36     interest to the hospital maintaining the health care information;

2-37                 (12)  to the American Red Cross for the specific

2-38     purpose of fulfilling the duties specified under its charter

2-39     granted as an instrumentality of the United States government;

2-40                 (13)  to a regional poison control center, as the term

2-41     is used in Chapter 777, to the extent necessary to enable the

2-42     center to provide information and education to health professionals

2-43     involved in the management of poison and overdose victims,

2-44     including information regarding appropriate therapeutic use of

2-45     medications, their compatibility and stability, and adverse drug

2-46     reactions and interactions;

2-47                 (14)  to a health care utilization review agent who

2-48     requires the health care information for utilization review of

2-49     health care under Article 21.58A, Insurance Code;

2-50                 (15) [(5)]  for use in a research project authorized by

2-51     an institutional review board under federal law;

2-52                 (16) [(6)]  to health care personnel of a penal or

2-53     other custodial institution in which the patient is detained if the

2-54     disclosure is for the sole purpose of providing health care to the

2-55     patient;

2-56                 (17) [(7)]  to facilitate reimbursement [by a health

2-57     benefit plan] to a hospital, other health care provider, or the

2-58     patient for medical services or supplies;

2-59                 (18) [(8)]  to a health maintenance organization for

2-60     purposes of maintaining a statistical reporting system as required

2-61     by a rule adopted by a state agency or regulations adopted under

2-62     the federal Health Maintenance Organization Act of 1973, as amended

2-63     (42 U.S.C. Section 300 et seq.);

2-64                 (19) [(9)]  to satisfy a request for medical records of

2-65     a deceased or incompetent person pursuant to Section 4.01(e),

2-66     Medical Liability and Insurance Improvement Act of Texas (Article

2-67     4590i, Vernon's Texas Civil Statutes); [or]

2-68                 (20)  to comply with a court order except as provided

2-69     by Subdivision (21); or

 3-1                 (21)  related to a judicial proceeding in which the

 3-2     patient is a party and the disclosure is requested under a subpoena

 3-3     issued under:

 3-4                       (A)  the Texas Rules of Civil Procedure or Code

 3-5     of Criminal Procedure; or

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

 3-7     Code

 3-8                 [(10)  to a court pursuant to a court order or court

 3-9     subpoena].

3-10           SECTION 4.  Section 241.154, Health and Safety Code, is

3-11     amended to read as follows:

3-12           Sec. 241.154.  REQUEST.  (a)  On receipt of a written

3-13     authorization from a patient or legally authorized representative

3-14     to examine or copy all or part of the patient's recorded health

3-15     care information, or for disclosures under Section 241.153 not

3-16     requiring written authorization, a hospital or its agent, as

3-17     promptly as required under the circumstances but not later than the

3-18     15th day after the date the request and payment authorized under

3-19     Subsection (b) are [is] received, shall:

3-20                 (1)  make the information available for examination

3-21     during regular business hours and provide a copy to the requestor,

3-22     if requested; or

3-23                 (2)  inform the authorized requestor if the information

3-24     does not exist or cannot be found.

3-25           (b)  Except as provided by Subsection (d), the [The] hospital

3-26     or its agent may charge a reasonable fee for providing the health

3-27     care information and is not required to permit the examination,

3-28     [or] copying, or release of the information requested until the fee

3-29     is paid unless there is a medical emergency.  The fee may not

3-30     exceed the sum of:

3-31                 (1)  a basic retrieval or processing fee, which must

3-32     include the fee for providing the first 10 pages of the copies and

3-33     which may not exceed $30; and

3-34                       (A)  a charge for each page of:

3-35                             (i)  $1 for the 11th through the 60th page

3-36     of the provided copies;

3-37                             (ii)  50 cents for the 61st through the

3-38     400th page of the provided copies; and

3-39                             (iii)  25 cents for any remaining pages of

3-40     the provided copies; and

3-41                       (B)  the actual cost of mailing, shipping, or

3-42     otherwise delivering the provided copies; or

3-43                 (2)  if the requested records are stored on any

3-44     microform or other electronic medium [microfiche], a retrieval or

3-45     processing fee, which must include the fee for providing the first

3-46     10 pages of the copies and which may not exceed $45; and

3-47                       (A)  $1 per page thereafter; and

3-48                       (B)  the actual cost of mailing, shipping, or

3-49     otherwise delivering the provided copies.

3-50           (c)  In addition, the hospital or its agent may charge a

3-51     reasonable fee for:

3-52                 (1)  execution of an affidavit or certification of a

3-53     document, not to exceed the charge authorized by Section 22.004,

3-54     Civil Practice and Remedies Code; and

3-55                 (2)  written responses to a written set of questions,

3-56     not to exceed $10 for a set.

3-57           (d)  A hospital may not charge a fee for:

3-58                 (1)  providing health care information under Subsection

3-59     (b) to the extent the fee is prohibited under Subchapter M, Chapter

3-60     161;

3-61                 (2)  a patient to examine the patient's own health care

3-62     information;

3-63                 (3)  providing an itemized statement of billed services

3-64     to a patient or third-party payor, except as provided under Section

3-65     311.002(e); or

3-66                 (4)  health care information relating to treatment or

3-67     hospitalization for which workers' compensation benefits are being

3-68     sought, except to the extent permitted under Chapter 408, Labor

3-69     Code.

 4-1           (e)  Effective September 1, 1996, and annually thereafter,

 4-2     the fee for providing health care information as specified in this

 4-3     section shall be adjusted accordingly based on the most recent

 4-4     changes to the consumer price index as published by the Bureau of

 4-5     Labor Statistics of the United States Department of Labor that

 4-6     measures the average changes in prices of goods and services

 4-7     purchased by urban wage earners and clerical workers' families and

 4-8     single workers living alone.

 4-9           SECTION 5.  Subsection (g), Section 241.152, Health and

4-10     Safety Code, is repealed.

4-11           SECTION 6.  The importance of this legislation and the

4-12     crowded condition of the calendars in both houses create an

4-13     emergency and an imperative public necessity that the

4-14     constitutional rule requiring bills to be read on three several

4-15     days in each house be suspended, and this rule is hereby suspended.

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