By: Coleman	H.B. No. 3690

	A BILL TO BE ENTITLED
	AN ACT
	relating to advance directives.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Section 166.002, Health and Safety Code, is
	amended by amending Subdivisions (6) and (9) and adding Subdivision
	(16) to read as follows:
	(6)  "Ethics or medical committee" means a committee
	established under Sections 161.031-161.033 or a subcommittee of an
	ethics or medical committee.
	(9)  "Irreversible condition" means a condition,
	injury, or illness that:
	(A)  [that] may be treated but is never cured or
	eliminated;
	(B)  [that] leaves a person wholly and permanently
	unable to care for [or make decisions for the person's own] himself;
	[and]
	(C)  leaves a person permanently unable to make
	decisions for himself; and
	(D) [(C)]  [that] without life-sustaining
	treatment provided in accordance with the prevailing standard of
	medical care, is fatal.
	(16)  "Surrogate" means a legal guardian, agent under a
	medical power of attorney, or a person authorized under Section
	166.039 to make a health care decision or treatment decision for an
	incompetent patient under this chapter.
	SECTION 2.  Section 166.033, Health and Safety Code, is
	amended to read as follows:
	DIRECTIVE TO PHYSICIANS AND FAMILY OR SURROGATES
	Instructions for completing this document:
	This is an important legal document known as an Advance
	Directive. It is designed to help you communicate your wishes about
	medical treatment at some time in the future when you are unable to
	make your wishes known because of illness or injury. These wishes
	are usually based on personal values. In particular, you may want
	to consider what burdens or hardships of treatment you would be
	willing to accept for a particular amount of benefit obtained if you
	were seriously ill.
	You are encouraged to discuss your values and wishes with
	your family or chosen spokesperson, as well as your physician. Your
	physician, other health care provider, or medical institution may
	provide you with various resources to assist you in completing your
	advance directive. Brief definitions are listed below and may aid
	you in your discussions and advance planning. Initial the
	treatment choices that best reflect your personal preferences.
	Provide a copy of your directive to your physician, usual hospital,
	and family or spokesperson. Consider a periodic review of this
	document. By periodic review, you can best assure that the
	directive reflects your preferences.
	In addition to this advance directive, Texas law provides for
	two other types of directives that can be important during a serious
	illness. These are the Medical Power of Attorney and the
	Out-of-Hospital Do-Not-Resuscitate Order. You may wish to discuss
	these with your physician, family, hospital representative, or
	other advisers. You may also wish to complete a directive related
	to the donation of organs and tissues.
	DIRECTIVE
	I, __________, recognize that the best health care is based
	upon a partnership of trust and communication with my physician. My
	physician and I will make health care decisions together as long as
	I am of sound mind and able to make my wishes known. If there comes
	a time that I am unable to make medical decisions about myself
	because of illness or injury, I direct that the following treatment
	preferences be honored:
	If, in the judgment of my physician, I am suffering with a
	terminal condition from which I am expected to die within six
	months, even with available life-sustaining treatment provided in
	accordance with prevailing standards of medical care:
	__________  I request that all treatments other than those needed
	to keep me comfortable be discontinued or withheld and
	my physician allow me to die as gently as possible; OR
	__________  I request that I be kept alive in this terminal
	condition using available life-sustaining treatment.
	(THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
	If, in the judgment of my physician, I am suffering with an
	irreversible condition so that I cannot care for myself or make
	decisions for myself and am expected to die without life-sustaining
	treatment provided in accordance with prevailing standards of care:
	__________  I request that all treatments other than those needed
	to keep me comfortable be discontinued or withheld and
	my physician allow me to die as gently as possible; OR
	__________  I request that I be kept alive in this irreversible
	condition using available life-sustaining treatment.
	(THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
	Additional requests: (After discussion with your physician,
	you may wish to consider listing particular treatments in this
	space that you do or do not want in specific circumstances, such as
	artificial nutrition and fluids, intravenous antibiotics, etc. Be
	sure to state whether you do or do not want the particular
	treatment.)
	________________________________________________________________
	________________________________________________________________
	________________________________________________________________
	After signing this directive, if my representative or I elect
	hospice care, I understand and agree that only those treatments
	needed to keep me comfortable would be provided and I would not be
	given available life-sustaining treatments.
	If I do not have a Medical Power of Attorney, and I am unable
	to make my wishes known, I designate the following person(s) to make
	treatment decisions with my physician compatible with my personal
	values:
	1. __________
	2. __________
	(If a Medical Power of Attorney has been executed, then an
	agent already has been named and you should not list additional
	names in this document.)
	If the above persons are not available, or if I have not
	designated a spokesperson, I understand that a spokesperson will be
	chosen for me following standards specified in the laws of Texas.
	If, in the judgment of my physician, my death is imminent within
	minutes to hours, even with the use of all available medical
	treatment provided within the prevailing standard of care, I
	acknowledge that all treatments may be withheld or removed except
	those needed to maintain my comfort. I understand that under Texas
	law this directive has no effect if I have been diagnosed as
	pregnant. This directive will remain in effect until I revoke it.
	No other person may do so.
	Signed__________ Date__________ City, County, State of
	Residence __________
	Two competent adult witnesses must sign below, acknowledging
	the signature of the declarant. The witness designated as Witness 1
	may not be a person designated to make a treatment decision for the
	patient and may not be related to the patient by blood or marriage.
	This witness may not be entitled to any part of the estate and may
	not have a claim against the estate of the patient. This witness
	may not be the attending physician or an employee of the attending
	physician. If this witness is an employee of a health care facility
	in which the patient is being cared for, this witness may not be
	involved in providing direct patient care to the patient. This
	witness may not be an officer, director, partner, or business
	office employee of a health care facility in which the patient is
	being cared for or of any parent organization of the health care
	facility.
	Witness 1 __________ Witness 2 __________
	Definitions:
	"Artificial nutrition and hydration" means the provision of
	nutrients or fluids by a tube inserted in a vein, under the skin in
	the subcutaneous tissues, or in the stomach (gastrointestinal
	tract).
	"Irreversible condition" means a condition, injury, or
	illness that:
	(1)  [that] may be treated, but is never cured or
	eliminated;
	(2)  [that] leaves a person wholly and permanently
	unable to care for [or make decisions for the person's own] himself;
	[and]
	(3)  leaves a person permanently unable to make
	decisions for himself; and
	(4) [(3)]  [that] without life-sustaining treatment
	provided in accordance with the prevailing standard of medical
	care, is fatal.
	Explanation: Many serious illnesses such as cancer, failure
	of major organs (kidney, heart, liver, or lung), and serious brain
	disease such as Alzheimer's dementia may be considered irreversible
	early on. There is no cure, but the patient may be kept alive for
	prolonged periods of time if the patient receives life-sustaining
	treatments. Late in the course of the same illness, the disease may
	be considered terminal when, even with treatment, the patient is
	expected to die. You may wish to consider which burdens of
	treatment you would be willing to accept in an effort to achieve a
	particular outcome. This is a very personal decision that you may
	wish to discuss with your physician, family, or other important
	persons in your life.
	"Life-sustaining treatment" means treatment that, based on
	reasonable medical judgment, sustains the life of a patient and
	without which the patient will die. The term includes both
	life-sustaining medications and artificial life support such as
	mechanical breathing machines, kidney dialysis treatment, and
	artificial hydration and nutrition. The term does not include the
	administration of pain management medication, the performance of a
	medical procedure necessary to provide comfort care, or any other
	medical care provided to alleviate a patient's pain.
	"Terminal condition" means an incurable condition caused by
	injury, disease, or illness that according to reasonable medical
	judgment will produce death within six months, even with available
	life-sustaining treatment provided in accordance with the
	prevailing standard of medical care.
	Explanation: Many serious illnesses may be considered
	irreversible early in the course of the illness, but they may not be
	considered terminal until the disease is fairly advanced. In
	thinking about terminal illness and its treatment, you again may
	wish to consider the relative benefits and burdens of treatment and
	discuss your wishes with your physician, family, or other important
	persons in your life.
	SECTION 3.  Section 166.039(e), Health and Safety Code, is
	amended to read as follows:
	(e)  If the patient does not have a legal guardian or agent
	under a medical power of attorney and a person listed in Subsection
	(b) is not available, a treatment decision made under Subsection
	(b) must be concurred in by another physician who is not involved in
	the treatment of the patient or who is a representative of an ethics
	or medical committee of the health care facility in which the person
	is a patient.
	SECTION 4.  Section 166.046, Health and Safety Code, is
	amended to read as follows:
	Sec. 166.046.  PROCEDURE IF NOT EFFECTUATING A DIRECTIVE OR
	TREATMENT DECISION.  (a)  If an attending physician desires not
	[refuses] to follow [honor] an incompetent, qualified [a] patient's
	advance directive or disagrees with a health care or treatment
	decision made [by or] on behalf of an incompetent, qualified [a]
	patient, then the physician's request [refusal] shall be considered
	[reviewed] by an ethics or medical committee in a two-part process
	as described in this section. [The attending physician may not be a
	member of that committee.] The patient shall be given
	life-sustaining treatment during this two-part process [the
	review].
	(1)  An advisory consultation between the surrogate and a
	representative of an ethics or medical committee shall be held and
	documented in the medical record. The attending physician may not
	participate as a member of that committee.
	(2)  If a disagreement over a health care or treatment
	decision persists, then the attending physician may request a
	meeting with the ethics or medical committee with notice provided
	pursuant to Subsection (b).  The attending physician may not
	participate as a member of that committee.
	(b)  Upon request for a meeting with the ethics or medical
	committee described under Subsection (a)(2), the patient's
	surrogate shall be: [The patient or the person responsible for the
	health care decisions of the individual who has made the decision
	regarding the directive or treatment decision]:
	(1)  [may be] given a written description of the ethics
	or medical committee review process under Section 166.052(b) and
	may be given any other policies and procedures related to this
	section adopted by the health care facility;
	(2)  [shall be] informed of the committee review
	process not less than 60 [48] hours before the meeting with the
	ethics or medical committee is called to discuss the patient's
	directive or the surrogate's health care or treatment decision,
	unless the time period is waived by mutual agreement;
	(3)  informed that the surrogate on request is entitled
	to receive within 24 hours a copy of the patient's medical record of
	the patient's current admission to the facility;
	(3)  informed that the surrogate is entitled to receive
	the assistance of a patient liaison to assist the surrogate
	throughout the process described in this section;
	(4)  informed that the surrogate may bring one or more
	persons for support, subject to the ethics or medical committee's
	policy and ability to accomodate; and
	[(3)  at the time of being so informed, shall be
	provided:
	[(A)  a copy of the appropriate statement set
	forth in Section 166.052; and
	[(B)  a copy of the registry list of health care
	providers and referral groups that have volunteered their readiness
	to consider accepting transfer or to assist in locating a provider
	willing to accept transfer that is posted on the website maintained
	by the Texas Health Care Information Council under Section
	166.053.]
	(5) [(4)is] entitled to:
	(A)  attend the meeting and bring other persons
	for support as provided in Subsection (b)(4) above and;
	(B)  receive a written explanation of the decision
	reached during the review process.
	(c)  The written explanation required by Subsection
	(b)(5)(B) [(b)(2)(B)] must be included in the patient's medical
	record.
	(d)  If the attending physician or the surrogate[, the
	patient, or the person responsible for the health care decisions of
	the individual] does not agree with the decision reached during the
	review process under Subsection (b), the physician shall make a
	reasonable effort to transfer the patient to a physician who is
	willing to comply with the directive or the surrogate's health care
	or treatment decision. The [If the patient is a patient in a health
	care facility, the] facility's personnel shall assist the physician
	in arranging the patient's transfer to:
	(1)  another physician;
	(2)  an alternative care setting within that facility;
	or
	(3)  another facility.
	(e)  If the patient's directive [patient] or the surrogate
	[person responsible for the health care decisions of the patient]
	is requesting life-sustaining treatment that the attending
	physician has decided and the review process has affirmed is not
	appropriate [inappropriate] treatment, the patient shall be given
	[available] life-sustaining treatment of at least the same
	intensity as that provided at the time the meeting with the ethics
	or medical committee was held under Subsection (a)(2) while
	awaiting [pending] transfer under Subsection (d). The patient also
	shall be treated in a manner that will enhance pain relief and
	minimize suffering. The patient is responsible for any costs
	incurred in transferring the patient to another facility. The
	attending physician, any other physician responsible for the care
	of the patient, and the health care facility are not obligated to
	provide life-sustaining treatment after the 10th day after the
	written decision required under Subsection (b) is provided to the
	patient or the surrogate [person responsible for the health care
	decisions of the patient] unless ordered to do so under Subsection
	(g).
	(e-1)  If during a previous admission to a facility a
	patient's attending physician and the review process under
	Subsection (b) have determined that life-sustaining treatment is
	inappropriate, and the patient is readmitted to the same facility
	or another facility in the same health care system within six months
	from the date of the decision reached during the review process
	conducted upon the previous admission, Subsections (b) through (e)
	need not be followed if the patient's attending physician and a
	consulting physician who was not involved in the patient's care
	during the previous admission [is a member of the ethics or medical
	committee of the facility] document in the medical record on the
	patient's readmission that the patient's condition either has not
	improved or has deteriorated since the review process was
	conducted.
	(f)  Life-sustaining treatment under this section may not be
	entered in the patient's medical record as medically unnecessary
	treatment until the time period provided under Subsection (e) and
	Section 166.0465, if applicable, has expired.
	(g)  At the request of the patient or the surrogate [person
	responsible for the health care decisions of the patient], the
	appropriate district or county court shall extend the time period
	provided under Subsection (e) only if the court in a proceeding
	conducted under Section 166.0465 finds, by a preponderance of the
	evidence, that there is a reasonable expectation that a physician
	or health care facility that will honor the patient's directive
	will be found if the time extension is granted.
	(h)  This section may not be construed to impose an
	obligation on a facility or a home and community support services
	agency licensed under Chapter 142 or similar organization that is
	beyond the scope of the services or resources of the facility or
	agency. This section does not apply to hospice services provided by
	a home and community support services agency licensed under Chapter
	142.
	SECTION 5.  Subchapter B, Chapter 166, Health and Safety
	Code, is amended by adding Section 166.0465 to read as follows:
	Sec. 166.0465.  COURT ORDER FOR LIFE-SUSTAINING TREATMENT;
	APPEAL; FILING FEE AND COURT COSTS.  (a)  A patient or the patient's
	surrogate may submit a motion for extension of time to effect a
	patient transfer for relief under Section 166.046(g) in any county
	court at law, court having probate jurisdiction, or district court,
	including a family district court and immediately serve a copy on
	the health care facility.
	(b)  The court shall set a time for a hearing on a motion
	filed under Subsection (a) and shall keep a record of all testimony
	and other oral proceedings in the action.  The court shall rule on
	the motion and issue written findings of fact and conclusions of law
	not later than the fifth business day after the date the application
	is filed with the court.  The time for the hearing and the date by
	which the court must rule on the motion may be extended by
	stipulation of the parties, with the approval of the court.
	(c)  Any party may appeal the decision of the court under
	Subsection (b) to the court of appeals having jurisdiction over
	civil matters in the county in which the application was filed by
	filing a notice of appeal with the clerk of the court that ruled on
	the application not later than the first business day after the day
	on which the decision of the court was issued.
	(d)  On receipt of a notice of appeal under Subsection (c),
	the clerk of the court that ruled on the motion shall deliver a copy
	of the notice of appeal and record on appeal to the clerk of the
	court of appeals.  On receipt of the notice and record, the clerk of
	the court of appeals shall place the appeal on the docket of the
	court, and the court of appeals shall promptly issue an expedited
	briefing schedule and set a time for a hearing.
	(e)  The court of appeals shall rule on an appeal under
	Subsection (d) not later than the fifth business day after the date
	the notice of appeal is filed with the court that ruled on the
	application.  The times for the filing of briefs, the hearing, and
	the date by which the court of appeals must rule on the appeal may be
	extended by stipulation of the parties, with the approval of the
	court of appeals.
	(f)  Any party may file a petition for review of the decision
	of the court of appeals with the clerk of the supreme court not
	later than the third business day after the day on which the
	decision of the court of appeals was issued.  Other parties may file
	responses not later than the third business day after the day on
	which the petition for review was filed.  The supreme court shall
	grant the petition, deny it, refuse it, or dismiss it for want of
	jurisdiction, whether or not a reply to any response has been filed,
	not later than the third business day after the day on which the
	response was due.  If the supreme court grants the petition for
	review, it shall exercise its sound discretion in determining how
	expeditiously to hear and decide the case.
	(g)  If a motion is filed under Subsection (a),
	life–sustaining treatment shall be provided through midnight of the
	day by which a notice of appeal must be filed unless the court
	directs that it be provided for a longer period.  If a notice of
	appeal under Subsection (c) is filed, life-sustaining treatment
	shall be provided through midnight of the day by which a petition
	for review to the supreme court must be filed, unless the court of
	appeals directs that it be provided for a longer period.  If a
	petition for review to the supreme court is filed under Subsection
	(f), life-sustaining treatment shall be provided through midnight
	of the day on which the supreme court denies, refuses, or dismisses
	the petition or issues a ruling on the merits, unless the supreme
	court directs that it be provided for a longer period.
	(h)  A filing fee or court cost may not be assessed for any
	proceeding in a trial or appellate court under this section.
	SECTION 6.  Section 166.052(a), Health and Safety Code, is
	amended to read as follows:
	(a)  In cases in which the attending physician desires not
	[refuses] to follow [honor] an advance directive or treatment
	decision requesting the provision of life-sustaining treatment,
	the statement required by Section 166.046(b)(1) [166.046(b)(2)(A)]
	shall be in substantially the following form:
	When There Is A Disagreement About Medical Treatment: The
	Physician Recommends Against Life-Sustaining Treatment That You
	Wish To Continue
	You have been given this information because you have
	requested life-sustaining treatment on behalf of the patient,*
	which the attending physician believes is not appropriate. This
	information is being provided to help you understand state law,
	your rights, and the resources available to you in such
	circumstances. It outlines the process for resolving disagreements
	about treatment among patients, families, and physicians. It is
	based upon Section 166.046 of the Texas Advance Directives Act,
	codified in Chapter 166 of the Texas Health and Safety Code.
	When an attending physician desires not [refuses] to follow
	[comply with] an advance directive or other request for
	life-sustaining treatment because of the physician's judgment that
	the treatment would be inappropriate, the case will be reviewed by
	an ethics or medical committee. Life-sustaining treatment will be
	provided through the review.
	You will receive notification of this review at least 60 [48]
	hours before a meeting of the committee related to your case. You
	are entitled to attend the meeting. With your agreement, the
	meeting may be held sooner than 60 [48] hours, if possible.
	The committee will appoint a patient liaison to assist you
	through this process.  You are entitled to attend the meeting and to
	be accompanied by one or more persons to support you, subject to the
	committee's policy and ability to accommodate the persons
	authorized and wishing to attend.  You also are entitled to receive
	within 24 hours a copy of the patient's medical record of the
	patient's current admission to the facility.  You are entitled to
	receive a written explanation of the decision reached during the
	review process.
	If after this review process both the attending physician and
	the ethics or medical committee conclude that life-sustaining
	treatment is inappropriate and yet you continue to request such
	treatment, then the following procedure will occur:
	1.  The physician, with the help of the health care facility,
	will assist you in trying to find a physician and facility willing
	to provide the requested treatment.
	[2.  You are being given a list of health care providers and
	referral groups that have volunteered their readiness to consider
	accepting transfer, or to assist in locating a provider willing to
	accept transfer, maintained by the Texas Health Care Information
	Council. You may wish to contact providers or referral groups on
	the list or others of your choice to get help in arranging a
	transfer.]
	2. [3.]  The patient will continue to be given
	life-sustaining treatment and treatment to enhance pain management
	and reduce suffering until he or she can be transferred to a willing
	provider for up to 10 business days from the time you were given the
	committee's written decision that life-sustaining treatment is not
	appropriate.
	3. [4.]  If a transfer can be arranged, the patient will be
	responsible for the costs of the transfer.
	4. [5.]  If a provider cannot be found willing to give the
	requested treatment within 10 business days, life-sustaining
	treatment may be withdrawn unless a court of law has granted an
	extension.
	5. [6.]  You may ask the appropriate district or county court
	to extend the 10 business-day period if the court finds that there
	is a reasonable expectation that a physician or health care
	facility willing to provide life-sustaining treatment will be found
	if the extension is granted.
	*"Life-sustaining treatment" means treatment that, based on
	reasonable medical judgment, sustains the life of a patient and
	without which the patient will die. The term includes both
	life-sustaining medications and artificial life support, such as
	mechanical breathing machines, kidney dialysis treatment, and
	artificial nutrition and hydration. The term does not include the
	administration of pain management medication or the performance of
	a medical procedure considered to be necessary to provide comfort
	care, or any other medical care provided to alleviate a patient's
	pain.
	SECTION 7.  Subchapter B, Chapter 166, Health and Safety
	Code, is amended by adding Section 166.054 to read as follows:
	Sec. 166.054.  REPORTING REQUIREMENTS REGARDING ETHICS OR
	MEDICAL COMMITTEE PROCESSES OF DATA.  (a)  On submission of a health
	care facility's application to renew its license, a facility in
	which one or more meetings of an ethics or medical committee is held
	under Section 166.046 shall file a report with the department that
	contains aggregate information regarding the number of cases
	considered by an ethics or medical committee and the disposition of
	those cases by the facility.
	(b)  The report required by this section may not contain any
	data specific to an individual patient.
	SECTION 8.  Sections 166.082(a) and (c), Health and Safety
	Code, are amended to read as follows:
	(a)  A competent adult [person] may at any time execute a
	written out-of-hospital DNR order directing health care
	professionals acting in an out-of-hospital setting to withhold
	cardiopulmonary resuscitation and certain other life-sustaining
	treatment designated by the board.
	(c)  If the person is incompetent but previously executed or
	issued a directive to physicians in accordance with Subchapter B
	requesting that all treatment, other than treatment necessary for
	keeping the person comfortable, be discontinued or withheld, the
	physician may rely on the directive as the person's instructions to
	issue an out-of-hospital DNR order and shall place a copy of the
	directive in the person's medical record. The physician shall sign
	the order in lieu of the person signing under Subsection (b).
	SECTION 9.  Section 166.152(d), Health and Safety Code, is
	amended to read as follows:
	(d)  The principal's attending physician shall make
	reasonable efforts to inform the principal of any proposed
	treatment or of any proposal to withdraw or withhold treatment
	before implementing an agent's health care decision [advance
	directive].
	SECTION 10.  Chapter 166, Health and Safety Code, is amended
	by adding Subchapter E to read as follows:
	SUBCHAPTER E.  ADVANCE DIRECTIVE REGISTRY
	Sec. 166.201.  ADVANCE DIRECTIVE REGISTRY.  (a)  The
	department shall establish and maintain an advance directive
	registry that is accessible through an Internet website.
	(b)  The registry must be used to store advance directives
	made under this chapter that are filed with the department.
	(c)  The department shall ensure that the registry is
	maintained in a secure database that is designed to provide
	authorized health care providers with immediate access to the
	registry at all times but prevent unauthorized access to the
	registry.
	Sec. 166.202.  CONTRACT WITH PRIVATE ENTITY.  The department
	may contract with a public or private entity to develop and maintain
	the advance directive registry.
	Sec. 166.203.  FEES.  The department may not charge a fee to:
	(1)  register an advance directive in the registry; or
	(2)  access an advance directive maintained in the
	registry.
	Sec. 166.204.  EVIDENCE OF REGISTRATION.  The department
	shall provide a method by which a notation indicating that an
	individual has an advance directive registered with the department
	may be placed on the individual's driver's license or
	identification card.
	Sec. 166.205.  REMOVAL FROM REGISTRY.  If the department
	receives notice that an advance directive that is contained in the
	registry has been revoked or that the individual who is the subject
	of an advance directive contained in the registry is deceased, the
	department shall remove the advance directive from the registry.
	Sec. 166.206.  REGISTRATION NOT REQUIRED.  (a)  Failure to
	file an advance directive with the registry does not affect the
	validity of the advance directive.
	(b)  Failure to notify the department of a revocation of an
	advance directive does not affect the validity of the revocation.
	Sec. 166.207.  CONFIDENTIALITY.  Information obtained by the
	department for the advance directive registry is confidential and
	may be disclosed only with the written consent of the declarant of
	the advanced directive or a person authorized to make health care
	decisions on the declarant's behalf.
	Sec. 166.208.  GIFTS AND GRANTS.  The department may accept
	gifts, grants, donations, bequests, and other forms of voluntary
	contributions to support, promote, and maintain the advance
	directive registry.
	Sec. 166.209.  RULES.  (a)  The executive commissioner of the
	Health and Human Services Commission shall adopt rules to implement
	the creation and maintenance of the advance directive registry,
	including rules to:
	(1)  protect the confidentiality of individuals in
	accordance with Section 159.002, Occupations Code;
	(2)  inform the public about the registry;
	(3)  require the written consent of the declarant of
	the advance directive or a person authorized to make health care
	decisions on the declarant's behalf before any information relating
	to the declarant is included in the registry; and
	(4)  ensure the authenticity of an advance directive
	submitted to the department for inclusion in the advance directive
	registry.
	(b)  The rules governing use or disclosure of information in
	the registry must be at least as stringent as the Health Insurance
	Portability and Accountability Act and Privacy Standards, as
	defined by Section 181.001.
	SECTION 11.  Subchapter D, Chapter 166, Health and Safety
	Code, is amended by adding Section 166.1641 to read as follows:
	Sec. 166.1641.  AUTHORITY OF AN AGENT PRIOR TO A COMPETENCY
	DETERMINATION.  To ensure appropriate access to medical and health
	information under the federal Health Insurance Portability and
	Accountability Act of 1996 and its accompanying regulations, prior
	to a determination of competency under Health & Safety Code
	166.152, the person named as an agent in the Medical Power of
	Attorney is a personal representative for the purpose of reviewing
	and/or determining the patient's competency.
	SECTION 12.  (a)  Not later than November 1, 2007, the Texas
	Supreme Court shall issue the rules and prescribe the forms
	necessary for the process established by Section 166.0465, Health
	and Safety Code, as added by this Act.  The rules shall prescribe
	the method of service of the application under Section 166.0465 and
	may require filing and service of notices, petitions, and briefs
	electronically to the extent the Supreme Court considers
	appropriate.
	(b)  Not later than March 1, 2008, the executive commissioner
	of the Health and Human Services Commission shall adopt the rules
	necessary to implement the changes in law made by this Act to
	Chapter 166, Health and Safety Code.
	SECTION 13.  An advance directive form executed under
	Chapter 166, Health and Safety Code, before the effective date of
	this Act is valid and shall be honored as if the form were executed
	on or after the effective date of this Act.  If an attending
	physician refuses to honor a patient's advance directive or a
	health care or treatment decision made by or on behalf of a patient
	under an advance directive form executed before the effective date
	of this Act, the refusal is governed by Chapter 166, Health and
	Safety Code, as amended by this Act.
	SECTION 14.  This Act takes effect September 1, 2007.