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.
4-16 * * * * *