1-1 By: Smith (Senate Sponsor - Nelson) H.B. No. 398
1-2 (In the Senate - Received from the House May 7, 2001;
1-3 May 7, 2001, read first time and referred to Committee on Health
1-4 and Human Services; May 11, 2001, reported favorably by the
1-5 following vote: Yeas 7, Nays 0; May 11, 2001, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to disclosure of medical billing records regarding a
1-9 patient.
1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-11 SECTION 1. Section 159.001, Occupations Code, is amended to
1-12 read as follows:
1-13 Sec. 159.001. DEFINITIONS [DEFINITION]. In this chapter:
1-14 (1) "Billing record" means a record that describes
1-15 charges for services provided to a patient by a physician.
1-16 (2) "Medical record" does not include a billing
1-17 record.
1-18 (3) "Patient" [, "patient"] means a person who, to
1-19 receive medical care, consults with or is seen by a physician.
1-20 SECTION 2. Section 159.003(a), Occupations Code, is amended
1-21 to read as follows:
1-22 (a) An exception to the privilege of confidentiality in a
1-23 court or administrative proceeding exists:
1-24 (1) in a proceeding brought by a patient against a
1-25 physician, including:
1-26 (A) a malpractice proceeding; or
1-27 (B) a criminal proceeding or license revocation
1-28 proceeding in which the patient is a complaining witness and
1-29 disclosure is relevant to a claim or defense of the physician;
1-30 (2) if the patient or a person authorized to act on
1-31 the patient's behalf submits a written consent to the release of
1-32 confidential information as provided by Section 159.005;
1-33 (3) in a proceeding to substantiate and collect on a
1-34 claim for medical services provided to the patient;
1-35 (4) in a civil action or administrative proceeding, if
1-36 relevant, brought by the patient or a person on the patient's
1-37 behalf, if the patient or person is attempting to recover monetary
1-38 damages for a physical or mental condition including the patient's
1-39 death;
1-40 (5) in a disciplinary investigation or proceeding
1-41 conducted under this subtitle, if the board protects the identity
1-42 of any patient whose billing or medical records are examined other
1-43 than a patient:
1-44 (A) for whom an exception exists under
1-45 Subdivision (1); or
1-46 (B) who has submitted written consent to the
1-47 release of the billing or medical records as provided by Section
1-48 159.005;
1-49 (6) in a criminal investigation of a physician in
1-50 which the board is participating, or assisting in the investigation
1-51 or proceeding by providing certain billing or medical records
1-52 obtained from the physician, if the board protects the identity of
1-53 a patient whose billing or medical records are provided in the
1-54 investigation or proceeding other than a patient:
1-55 (A) for whom an exception exists under
1-56 Subdivision (1); or
1-57 (B) who has submitted written consent to the
1-58 release of the billing or medical records as provided by Section
1-59 159.005;
1-60 (7) in an involuntary civil commitment proceeding,
1-61 proceeding for court-ordered treatment, or probable cause hearing
1-62 under Chapter 462, 574, or 593, Health and Safety Code;
1-63 (8) if the patient's physical or mental condition is
1-64 relevant to the execution of a will;
2-1 (9) if the information is relevant to a proceeding
2-2 brought under Section 159.009;
2-3 (10) in a criminal prosecution in which the patient is
2-4 a victim, witness, or defendant;
2-5 (11) to satisfy a request for billing or medical
2-6 records of a deceased or incompetent person under Section 4.01(e),
2-7 Medical Liability and Insurance Improvement Act of Texas (Article
2-8 4590i, Vernon's Texas Civil Statutes); or
2-9 (12) to a court or a party to an action under a court
2-10 order or court subpoena.
2-11 SECTION 3. Section 159.004, Occupations Code, is amended to
2-12 read as follows:
2-13 Sec. 159.004. EXCEPTIONS TO CONFIDENTIALITY IN OTHER
2-14 SITUATIONS. An exception to the privilege of confidentiality in a
2-15 situation other than a court or administrative proceeding, allowing
2-16 disclosure of confidential information by a physician, exists only
2-17 with respect to the following:
2-18 (1) a governmental agency, if the disclosure is
2-19 required or authorized by law;
2-20 (2) medical or law enforcement personnel, if the
2-21 physician determines that there is a probability of:
2-22 (A) imminent physical injury to the patient, the
2-23 physician, or another person; or
2-24 (B) immediate mental or emotional injury to the
2-25 patient;
2-26 (3) qualified personnel for research or for a
2-27 management audit, financial audit, or program evaluation, but the
2-28 personnel may not directly or indirectly identify a patient in any
2-29 report of the research, audit, or evaluation or otherwise disclose
2-30 identity in any manner;
2-31 (4) those parts of the medical records reflecting
2-32 [charges and] specific services provided if necessary in the
2-33 collection of fees for medical services provided by a physician,
2-34 professional association, or other entity qualified to provide or
2-35 arrange for medical services;
2-36 (5) a person who has [the written] consent [of the
2-37 patient or other person authorized to act on the patient's behalf
2-38 for the release of confidential information], as provided by
2-39 Section 159.005;
2-40 (6) a person, corporation, or governmental agency
2-41 involved in the payment or collection of fees for medical services
2-42 provided by a physician;
2-43 (7) another physician or other personnel acting under
2-44 the direction of the physician who participate in the diagnosis,
2-45 evaluation, or treatment of the patient;
2-46 (8) an official legislative inquiry regarding state
2-47 hospitals or state schools, if:
2-48 (A) information or a record that identifies a
2-49 patient or client is not released for any purpose unless proper
2-50 consent to the release is given by the patient; and
2-51 (B) only records created by the state hospital
2-52 or school or its employees are included; or
2-53 (9) health care personnel of a penal or other
2-54 custodial institution in which the patient is detained if the
2-55 disclosure is for the sole purpose of providing health care to the
2-56 patient.
2-57 SECTION 4. Section 159.005(b), Occupations Code, is amended
2-58 to read as follows:
2-59 (b) The written consent must specify:
2-60 (1) the billing records, [information or] medical
2-61 records, or other information to be covered by the release;
2-62 (2) the reasons or purposes for the release; and
2-63 (3) the person to whom the information is to be
2-64 released.
2-65 SECTION 5. Section 159.006, Occupations Code, is amended to
2-66 read as follows:
2-67 Sec. 159.006. INFORMATION FURNISHED BY PHYSICIAN. (a)
2-68 Unless the physician determines that access to the information
2-69 would be harmful to the physical, mental, or emotional health of
3-1 the patient, a physician who receives a written consent for release
3-2 of information as provided by Section 159.005 shall furnish copies
3-3 of the requested billing or medical records, or a summary or
3-4 narrative of the records, including records received from a
3-5 physician or other health care provider involved in the care or
3-6 treatment of the patient.
3-7 (b) The physician may delete confidential information about
3-8 another patient or a family member of the patient who has not
3-9 consented to the release.
3-10 (c) In accordance with Section 159.005, on receipt of a
3-11 written request by a subsequent or consulting physician of a
3-12 patient of the requested physician, the requested physician shall
3-13 furnish a copy of the complete billing or medical records of the
3-14 patient to the subsequent or consulting physician. The duty to
3-15 provide billing or medical records to a subsequent or consulting
3-16 physician may not be nullified by contract.
3-17 (d) A physician shall provide the information requested
3-18 under this section not later than the 15th business day after the
3-19 date of receipt of the written consent for release under Subsection
3-20 (a) or the written request under Subsection (c).
3-21 (e) If the physician denies the request, in whole or in
3-22 part, the physician shall:
3-23 (1) furnish the patient with a written statement,
3-24 signed and dated, providing the reason for the denial; and
3-25 (2) place a copy of the statement denying the request
3-26 in the patient's:
3-27 (A) billing records, if the request was for
3-28 billing records; or
3-29 (B) medical records, if the request was for
3-30 medical records.
3-31 SECTION 6. Chapter 159, Occupations Code, is amended by
3-32 adding Section 159.0061 to conform to Section 1, Chapter 636, Acts
3-33 of the 76th Legislature, Regular Session, 1999, and by amending
3-34 that section to read as follows:
3-35 Sec. 159.0061. APPOINTMENT OF CUSTODIAN OF PHYSICIAN'S
3-36 RECORDS. (a) The board by rule shall establish conditions under
3-37 which the board may temporarily or permanently appoint a person as
3-38 a custodian of a physician's billing or medical records. In
3-39 adopting rules under this section, the board shall consider the
3-40 death of a physician, the mental or physical incapacitation of a
3-41 physician, and the abandonment of billing or medical records by a
3-42 physician.
3-43 (b) The rules adopted under this section must provide for:
3-44 (1) the release of the billing or medical records by
3-45 an appointed custodian in compliance with this chapter; and
3-46 (2) a fee charged by the appointed custodian that is
3-47 in addition to the copying fee governed by Section 159.008.
3-48 SECTION 7. Section 159.008, Occupations Code, is amended to
3-49 read as follows:
3-50 Sec. 159.008. PHYSICIAN FEES FOR INFORMATION. (a) Except
3-51 as provided by Subsection (b), a physician:
3-52 (1) may charge a reasonable fee, as prescribed by
3-53 board rule, for copying billing or medical records; and
3-54 (2) is not required to permit examination or copying
3-55 of the records until the fee is paid unless there is a medical
3-56 emergency.
3-57 (b) A physician may not charge a fee for copying billing or
3-58 medical records under Subsection (a) to the extent the fee is
3-59 prohibited under Subchapter M, Chapter 161, Health and Safety Code.
3-60 SECTION 8. (a) In accordance with Section 311.031(c),
3-61 Government Code, which gives effect to a substantive amendment
3-62 enacted by the same legislature that codifies the amended statute,
3-63 the text of Section 159.006, Occupations Code, as set out in
3-64 Section 5 of this Act, gives effect to changes made by Chapter 636,
3-65 Acts of the 76th Legislature, Regular Session, 1999.
3-66 (b) To the extent of any conflict, this Act prevails over
3-67 another Act of the 77th Legislature, Regular Session, 2001,
3-68 relating to nonsubstantive additions and corrections in enacted
3-69 codes.
4-1 SECTION 9. This Act takes effect immediately if it receives
4-2 a vote of two-thirds of all the members elected to each house, as
4-3 provided by Section 39, Article III, Texas Constitution. If this
4-4 Act does not receive the vote necessary for immediate effect, this
4-5 Act takes effect September 1, 2001.
4-6 * * * * *