LEGISLATIVE BUDGET BOARD
Austin, Texas
FISCAL NOTE, 77th Regular Session
April 25, 2001
TO: Honorable Patricia Gray, Chair, House Committee on Public
Health
FROM: John Keel, Director, Legislative Budget Board
IN RE: HB1221 by Maxey (Relating to protecting the privacy of
medical records; providing penalties.), As Introduced
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* Estimated Two-year Net Impact to General Revenue Related Funds for *
* HB1221, As Introduced: negative impact of $(33,371,687) through *
* the biennium ending August 31, 2003. *
* *
* The bill would make no appropriation but could provide the legal *
* basis for an appropriation of funds to implement the provisions of *
* the bill. *
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General Revenue-Related Funds, Five-Year Net Impact:
****************************************************
* Fiscal Year Probable Net Positive/(Negative) *
* Impact to General Revenue Related *
* Funds *
* 2002 $(18,326,032) *
* 2003 (15,045,655) *
* 2004 (8,838,869) *
* 2005 (8,867,765) *
* 2006 (8,879,107) *
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All Funds, Five-Year Impact:
***********************************************************************
*Fiscal Probable Probable Probable Probable Change in *
* Year Savings/ Savings/ Savings/ Savings/ Number of *
* (Cost) from (Cost) from (Cost) from (Cost) from State *
* General GR Match Federal Local Employees *
* Revenue for Funds - Institutio- from FY 2001 *
* Fund Medicaid Federal nal Funds *
* 0001 0758 0555 *
* 2002 $(2,500) $(24,855) 228.0 *
* $(18,323, $(13,622, *
* 532) 352) *
* 2003 (898) (1,046,499) 245.0 *
* (15,044,757) (10,755,035) *
* 2004 (8,838,117) (752) (940,729) (9,281,462) 246.1 *
* 2005 (8,867,010) (755) (956,700) (9,197,912) 246.3 *
* 2006 (8,878,350) (757) (972,995) (8,865,869) 246.3 *
***********************************************************************
*****************************************************
* Fiscal Year Probable Revenue Gain/(Loss) from *
* Local Institutional Funds *
* 2002 $(80,000) *
* 2003 (80,000) *
* 2004 (80,000) *
* 2005 (80,000) *
* 2006 (80,000) *
*****************************************************
Technology Impact
Estimated technology impact for FYs 2002-06 would be $33.8 million for
new or modified hardware, software, personal computers, printers, and
programming, $22.7 million of which would occur in the 2002-03 biennium.
Fiscal Analysis
The bill defines information that must be protected. The bill would
require covered entities, as defined in the bill, to meet various
requirements related to the privacy of medical records such as allow
patients to inspect or copy protected health information, allow patients
to amend or append health records upon written request, maintain an
"audit trail" system to track use and disclosure of protected medical
information, and provide written notice of the entity's practices with
respect to protected health information.
The bill would require the Attorney General to appoint a lawyer to serve
as the medical records privacy ombudsman, and lists eight specific
duties of the ombudsman including the issuance of advisory opinions to
governmental units about compliance with the chapter and the mediation of
disputes relating to the release of protected health information.
The bill would require the Ethics Commission to establish a privacy board
for health research projects to review the effect of research protocol
on patients' privacy rights. The bill also sets criteria and procedures
the privacy board would use to grant a waiver of consent for use of
protected health information. The privacy board would be required to
provide documentation of the board's findings in regard to a waiver of
consent on request to the Texas Ethics Commission, the Office of the
Attorney General, the ombudsman, and the patient.
The bill would also authorize the Office of Attorney General to seek
injunctive relief and civil penalties for certain violations and set
forth criminal penalties for each violation or a pattern or practice of
violations. The bill would add professional and facility licensing
sanctions for violations by covered entities subject to the provisions of
the bill and repeal sections of the Education Code authorizing school
officials to access student medical records.
The bill would take effect September 1, 2002.
Methodology
Entities indicating costs would be incurred through implementation of the
bill were Texas Tech University Health Sciences Center, the Health Care
Information Council, the Department of Health, the University of Texas
System, and Office of the Attorney General. According to these
agencies, 228 FTEs in FY 2002, and 245 FTEs in FY 2003 would be needed
to handle the additional workload that would be created by
implementation of the bill. Estimated salary and benefits for the
2002-03 biennium would be $23,210,885. Other expenses for the 2002-03
biennium include $850,023 in medical administrative costs for WIC, and
expenses for general startup and day-to-day operation.
Local Government Impact
No significant fiscal implication to units of local government is
anticipated.
Source Agencies: 364 Health Professions Council, 503 Texas State
Board of Medical Examiners, 356 Texas Ethics
Commission, 50B Texas Health Care Information
Council, 739 Texas Tech University Health Sciences
Center, 709 Texas A&M University System Health
Science Center, 720 The University of Texas
System, 763 UNT Health Science Center , 501
Texas Department of Health, 302 Office of the
Attorney General
LBB Staff: JK, HD, KF, RM