BILL ANALYSIS

H.B. 173

By: Klick

Public Health

Committee Report (Unamended)

BACKGROUND AND PURPOSE

It has been noted that Texas has no uniform standards for the practice or training of genetic counselors, which puts patients in physical and financial risk. A genetic counselor is a health care professional with specialized training in medical genetics and counseling. As members of a health care team, genetic counselors provide risk assessments, education, and support to individuals and families at risk for, or diagnosed with, a variety of inherited conditions. Genetic counselors also interpret genetic testing results, provide support counseling, and serve as patient advocates. H.B. 173 seeks to ensure accountability and access to quality care while protecting patients from physical, psychological, and financial harm by providing for licensing requirements for and regulation of the practice of genetic counseling and by establishing an advisory board to provide advice and recommendations to the Texas Department of Licensing and Regulation on technical matters relevant to the administration of genetic counseling.

CRIMINAL JUSTICE IMPACT

It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.

RULEMAKING AUTHORITY

It is the committee's opinion that rulemaking authority is expressly granted to the Texas Commission of Licensing and Regulation in SECTION 2 of this bill.

ANALYSIS

H.B. 173 amends the Occupations Code to establish licensing requirements for the practice of genetic counseling and to establish the Licensed Genetic Counselor Advisory Board. The  practice of genetic counseling consists of the following:

· obtaining and evaluating individual, family, and medical histories to determine the risk for a genetic or medical condition or disease in a patient, the patient's offspring, or other family members of the patient;

· discussing the features, natural history, means of diagnosis, genetic and environmental factors, and management of risk for a genetic or medical condition or disease;

· identifying, coordinating, ordering, and explaining the results of genetic laboratory tests and other diagnostic studies as appropriate for genetic assessment;

· integrating the results of laboratory tests and other diagnostic studies with medical histories to assess and communicate risk factors for a genetic or medical condition or disease;

· evaluating a patient's or family member's response to a genetic or medical condition or disease, including the risk of recurrence, and providing patient-centered counseling and anticipatory guidance;

· identifying and using community resources that provide medical, educational, financial, and psychosocial support and advocacy; and

· providing written documentation of medical, genetic, and counseling information for a patient's family members and health care providers.

The bill defines "practice of genetic counseling" as providing these professional services for compensation to communicate genetic information to an individual, family, group, or other entity by a patient's self-referral or on the documented referral by a physician licensed in Texas, a physician assistant licensed in Texas, an advanced practice registered nurse licensed in Texas, or a person acting under authority delegated by a physician. The practice of genetic counseling does not include the diagnosis of disorders.

Licensing Requirements

H.B. 173 requires a person to hold a genetic counselor license in order to act as a genetic counselor, engage in the practice of genetic counseling, or take certain actions to represent or imply that the person is a licensed genetic counselor in Texas. That licensing requirement takes effect September 1, 2024, and may not be construed to prohibit a physician or an employee or other person acting under a physician's delegated authority from representing to a patient or the public that the physician, employee, or person provides genetic counseling.

H.B. 173 sets out license application requirements. To be eligible for a genetic counselor license, a license applicant must present evidence to the Texas Department of Licensing and Regulation (TDLR) that the applicant meets the following criteria:

· has passed an examination by a certifying entity or an equivalent examination in genetic counseling approved by TDLR;

· is currently certified by a certifying entity in genetic counseling or medical genetics;

· has met the educational requirements of a certifying entity, which must include a master's degree in genetic counseling or medical genetics or an equivalent educational standard adopted by the certifying entity;

· is in compliance with all professional, ethical, and disciplinary standards established by the certifying entity; and

· is not subject to any disciplinary action by the certifying entity.

The bill sets the license expiration as the second anniversary of the date of issuance and provides for license renewal. The genetic counseling license does not authorize the practice of medicine as defined by state law. The bill defines "certifying entity" as the American Board of Medical Genetics and Genomics, the American Board of Genetic Counseling, or another entity that is nationally accredited to issue credentials in the practice of genetic counseling and is approved by TDLR.

H.B. 173 exempts from its provisions a physician licensed in Texas who is not a licensed genetic counselor. The bill authorizes the following persons to engage in the practice of genetic counseling without holding a license:

· a person who is licensed, certified, or registered to practice in Texas in a health care‑related occupation, acts within the occupation's scope of practice, and does not use the title "genetic counselor" or represent or imply the person is licensed as a genetic counselor;

· a student or intern who is pursuing a course of study or engaged in an applicable occupational or graduate-level training program and acting within the scope of the occupation or training program; and

· a certified genetic counselor who is not a Texas resident, performs an activity or provides a service in Texas for not more than 30 days during any year, and meets any other requirement established by Texas Commission of Licensing and Regulation (TCLR) rule.

For such purposes, a student or intern includes a trained genetic counselor or doctoral medical geneticist who has applied to take the certification examination and has not failed that examination more than twice.

Administration and Enforcement

H.B. 173 requires TCLR to adopt rules for the administration and enforcement of the bill's provisions, set fees in amounts reasonable and necessary to cover the costs of that administration, and adopt rules that establish standards of ethical practice. The bill requires TDLR to do the following:

· administer and enforce the bill's provisions;

· evaluate license applicants' qualifications;

· provide for the examination of license applicants;

· issue a license to a compliant applicant who pays the required fees and meets any additional requirements established by TCLR rule;

· provide reasonable assistance to a person who wishes to file a complaint regarding a person or activity regulated under the license requirement;

· issue subpoenas, examine witnesses, and administer oaths under state law in connection with a hearing under the bill's provisions; and

· investigate persons engaging in practices that violate the bill's provisions.

The bill establishes the confidentiality of complaint and investigation information and materials under state public information law and under provisions governing TDLR. However, the bill provides for certain authorized disclosures to specified individuals and entities, including the disclosure of notices of alleged violations and final disciplinary actions. The bill specifies that, notwithstanding any other law, the requirements of the TDLR governing statutes related to the confidentiality of complaint and investigation information for a health-related program are applicable to complaint and investigation under the bill's provisions governing genetic counselors.

H.B. 173 authorizes TCLR or TDLR's executive director to deny, revoke, or suspend a license, refuse to renew a license, place on probation a person whose license has been suspended, or reprimand a license holder for a violation of the bill's licensing requirements, related rules, or an order of TCLR or TDLR's executive director. The bill authorizes TCLR, TDLR, or TDLR's executive director, effective September 1, 2023, to enforce the licensing requirements, rules, or orders by imposing an administrative or other penalty and taking enforcement actions authorized by law.

H.B. 173 requires TCLR, not later than May 1, 2024, to adopt the rules, procedures, and fees necessary to administer the bill's provisions.

Licensed Genetic Counselor Advisory Board

H.B. 173 creates the Licensed Genetic Counselor Advisory Board to provide advice and recommendations to TDLR on technical matters relevant to the administration of genetic counselor licensing. The bill does the following with respect to the board:

· sets out the composition of the nine-member board, appointed by TCLR's presiding officer with the approval of TCLR, as follows:

o six licensed genetic counselors, each of whom has at least two years of experience practicing genetic counseling as a genetic counselor and is licensed under the bill's provisions or is certified by a certifying entity;

o one physician who has experience with genetic counseling; and

o two members who represent the public;

· provides for the designation of the presiding officer, conduct of the board, grounds for removal, reimbursement of members' expenses, and the process to fill a board vacancy;

· limits board members to two consecutive six-year terms;

· authorizes the appointment of a person who meets the license eligibility requirements as an initial licensed genetic counselor member of the board regardless of whether the person holds a license; and

· requires TCLR's presiding officer to appoint the initial nine members as soon as practicable after the bill's effective date and, in making those appointments, to designate three members for terms expiring February 1, 2025, three members for terms expiring February 1, 2027, and three members for terms expiring February 1, 2029.

The bill includes genetic counselors among the health-related professions to which certain requirements relating to the role of advisory boards in TCLR rulemaking apply.

EFFECTIVE DATE

Except as otherwise provided, September 1, 2023.