88R1396 SCL-F
 
  By: Campos H.B. No. 1873
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to patients' rights, consumer protection, and directives
  for the provision of health care services; providing an
  administrative penalty.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter A, Chapter 166, Health and Safety
  Code, is amended by adding Section 166.012 to read as follows:
         Sec. 166.012.  DIRECTIVE FOR PHYSICIAN DIAGNOSIS AND
  TREATMENT. (a)  A competent adult may execute a written directive
  that:
               (1)  requires any diagnosis or treatment provided to
  the adult to be provided only by a physician; and
               (2)  provides that if the adult is incompetent or
  otherwise mentally or physically incapable of communication, only a
  physician may diagnose and treat the adult.
         (b)  Except as provided by Subsection (c), the declarant must
  sign the directive in the presence of two witnesses who qualify
  under Section 166.003, at least one of whom must be a witness who
  qualifies under Section 166.003(2).  The witnesses must sign the
  directive.
         (c)  The declarant, in lieu of signing in the presence of
  witnesses, may sign the directive and have the signature
  acknowledged before a notary public.
         (d)  A declarant shall notify the declarant's attending
  physician of the existence of the written directive.  If the
  declarant is incompetent or otherwise mentally or physically
  incapable of communication, another person may notify the attending
  physician of the existence of the directive.  The attending
  physician shall make the directive a part of the declarant's
  medical record.
         (e)  A directive described by Subsection (a) prevails over a
  conflicting directive unless the conflicting directive is later
  executed and states that the directive executed under this section
  is revoked.
         SECTION 2.  Title 2, Health and Safety Code, is amended by
  adding Subtitle J to read as follows:
  SUBTITLE J.  PROVISION OF HEALTH CARE SERVICES
  CHAPTER 185.  TEXAS PATIENTS' BILL OF RIGHTS
  SUBCHAPTER A.  GENERAL PROVISIONS
         Sec. 185.001.  DEFINITIONS. In this chapter:
               (1)  "Health care facility" means a facility licensed,
  certified, registered, or otherwise authorized to administer
  health care services, for profit or otherwise, to individuals in
  this state in the ordinary course of business or professional
  practice.
               (2)  "Health care practitioner" means an individual
  licensed, certified, registered, or otherwise authorized to
  administer health care services, for profit or otherwise, to
  individuals in this state in the ordinary course of business or
  practice.
               (3)  "Health care services" means services provided by
  a health care practitioner to prevent, alleviate, cure, or heal
  human illness or injury.
         Sec. 185.002.  PURPOSE. The purpose of this chapter is to
  provide the necessary information for patients to make informed
  decisions on health care services.
         Sec. 185.003.  APPLICABILITY. (a)  Except as provided by
  Subsection (b), this chapter applies to each health care facility
  in this state, including hospitals, freestanding emergency medical
  care facilities, hospital-owned outpatient clinics, urgent care
  centers, and ambulatory surgical centers, and each health care
  practitioner in this state.
         (b)  This chapter does not apply to a dentist, physical
  therapist, or chiropractor. 
         Sec. 185.004.  RULES. A state regulatory agency that issues
  a license, certification, registration, or other authorization to a
  health care facility or health care practitioner, including The
  Texas Medical Board, Texas Physician Assistant Board, Texas Board
  of Nursing, and executive commissioner, may adopt rules necessary
  to implement this chapter.
  SUBCHAPTER B.  PATIENT RIGHTS
         Sec. 185.051.  RIGHTS RELATED TO HEALTH CARE PRACTITIONERS.
  A patient in this state has the right to:
               (1)  be informed of the type of license a health care
  practitioner holds by viewing a photo identification worn by the
  practitioner in accordance with Section 185.102;
               (2)  be informed about whether a supervising physician
  is present at the health care facility at the time the patient
  receives health care services at the facility;
               (3)  decline health care services provided by a
  nonphysician health care practitioner and instead request that a
  physician provide the health care services within a reasonable
  time;
               (4)  be informed in advance of the patient's health care
  appointment of the health care practitioner scheduled to provide
  health care services to the patient;
               (5)  avoid any penalty for the patient's refusal to
  accept provision of health care services by a nonphysician health
  care practitioner;
               (6)  be provided an initial consultation only with a
  specialist who is a physician;
               (7)  be informed of the identity of the physician
  supervising each nonphysician health care practitioner involved in
  providing health care services to the patient; and
               (8)  be provided accurate health care information that
  is not misleading or deceptive in a manner prohibited under Section
  102.0015, Occupations Code.
         Sec. 185.052.  RIGHTS RELATED TO INFORMED CONSENT. (a)  A
  patient in this state has the right to:
               (1)  receive a clearly readable and intelligible copy
  of all consent to treat forms before the patient is asked to sign
  those forms;
               (2)  receive and execute a one-page document
  authorizing only a physician to diagnose and treat the patient;
               (3)  receive simplified paperwork that does not require
  the patient to enter duplicate information on multiple forms;
               (4)  execute an advance directive under Section 166.012
  requiring that only a physician diagnose and treat the patient,
  including when the patient is unable to communicate; and
               (5)  receive documentation with a clear explanation of
  each proposed health care service, including medications, and any
  practicable alternatives to each service.
         (b)  A reference on an electronic device to a consent to
  treat form or another document that the patient has not received
  does not satisfy the requirements of Subsection (a)(1).
         Sec. 185.053.  RIGHTS RELATED TO TREATMENT. A patient in
  this state has the right to:
               (1)  if practicable, have an advocate, including a
  family member or other individual, present with the patient during
  the provision of health care services;
               (2)  receive an easily understandable summary of the
  health care services provided to the patient;
               (3)  for hospitalized patients, have an accurate active
  medication list maintained at all times while the patient remains
  hospitalized; and
               (4)  as applicable, receive documentation stating that
  the patient's treatment is deviating from the standard of care
  because of cost, health benefit plan coverage, or hospital supply
  shortage. 
         Sec. 185.054.  RIGHTS RELATED TO BILLING. A patient in this
  state has the right to receive:
               (1)  if practicable, a written estimate of the cost of
  health care services, including the cost of directly paying the
  health care practitioner or health care facility that provides the
  services rather than paying through a health benefit plan;
               (2)  written notice on whether the patient's health
  benefit plan covers a health care service;
               (3)  a written disclosure on whether any health care
  practitioner who may provide health care services to the patient is
  an independent contractor who bills separately; and
               (4)  a reduced price for health care services provided
  by a nonphysician health care practitioner.
  SUBCHAPTER C.  REQUIREMENTS FOR HEALTH CARE FACILITIES AND
  PRACTITIONERS
         Sec. 185.101.  PROHIBITED ABRIDGEMENT OF RIGHTS OR VIOLATION
  OF RULES. A health care facility or health care practitioner may
  not abridge a right described by Subchapter B or violate a rule
  adopted under this chapter.
         Sec. 185.102.  PHOTO IDENTIFICATION REQUIREMENTS FOR HEALTH
  CARE PRACTITIONERS. (a)  While providing health care services to a
  patient, a health care practitioner shall wear a clearly visible
  photo identification that identifies the practitioner's
  occupational license, certification, registration, or other
  authorization issued under Title 3, Occupations Code, or the
  occupational license, certification, registration, or other
  authorization for which the practitioner is training under that
  title. 
         (b)  The photo identification must clearly state the health
  care practitioner's occupation and may not abbreviate the
  occupation.
         (c)  The photo identification for a health care practitioner
  who is training to hold a license, certification, registration, or
  other authorization under Title 3, Occupations Code, must identify
  the practitioner as a student, resident, or fellow.
         Sec. 185.103.  INFORMATION REGARDING NONPHYSICIAN HEALTH
  CARE PRACTITIONERS. A health care facility employing nonphysician
  health care practitioners at a facility location shall clearly post
  in each patient waiting area at the location and on all
  advertisements for health care services provided at the location
  that:
               (1)  health care services are provided by nonphysician
  health care practitioners; and
               (2)  the patient has the right to be informed of the
  identity of the supervising physician of any nonphysician health
  care provider who provides health care services to the patient.
         Sec. 185.104.  PROVISION OF TRAINING INFORMATION. A health
  care facility in this state shall post the differences in training
  requirements for the health care practitioners employed by the
  facility on the facility's Internet website and in each of the
  facility's patient waiting areas.
  SUBCHAPTER D.  ENFORCEMENT
         Sec. 185.151.  REPORT. A patient may report a violation of a
  right described by Subchapter B to:
               (1)  the state regulatory agency that issues a license,
  certification, registration, or other authorization to a health
  care practitioner, including:
                     (A)  the Texas Medical Board for physicians;
                     (B)  the Texas Physician Assistant Board for
  physician assistants; and
                     (C)  the Texas Board of Nursing for nurses; and 
               (2)  the state regulatory agency that issues a license,
  certification, registration, or other authorization to a health
  care facility, including the commission.
         Sec. 185.152.  ADMINISTRATIVE PENALTY. (a)  A state
  regulatory agency for a health care facility or health care
  practitioner, including the Texas Medical Board, the Texas
  Physician Assistant Board, the Texas Board of Nursing, and the
  commission, may impose an administrative penalty against a person
  regulated by the agency who violates this chapter or a rule adopted
  under this chapter.
         (b)  The assessed penalty may not be less than $100 or more
  than $10,000 for each violation. Each day of a violation that
  occurs before the day on which the person receives written notice of
  the violation does not constitute a separate violation and shall be
  considered one violation.  Each day of a continuing violation that
  occurs after the day on which the person receives written notice of
  the violation constitutes a separate violation.
         SECTION 3.  Subchapter A, Chapter 102, Occupations Code, is
  amended by adding Section 102.0015 to read as follows:
         Sec. 102.0015.  REQUIREMENTS AND PROHIBITED PRACTICES
  RELATED TO QUALIFICATIONS IN ADVERTISEMENTS. (a)  A person may not
  make a deceptive or misleading statement or engage in a deceptive or
  misleading act in advertising health care services that
  misrepresents:
               (1)  whether the person holds a license, certification,
  registration, or other authorization issued by this state to
  provide the services; or
               (2)  the person's education, training, or clinical
  expertise.
         (b)  A person who is advertising health care services
  provided by the person shall disclose in the advertisement the
  applicable license, certification, registration, or other
  authorization under which the person is authorized to provide the
  services.
         SECTION 4.  Section 102.008, Occupations Code, is amended to
  read as follows:
         Sec. 102.008.  DISCIPLINARY ACTION.  A violation of Section
  102.001, 102.0015, or 102.006 is grounds for disciplinary action by
  the regulatory agency that issued a license, certification, or
  registration to the person who committed the violation.
         SECTION 5.  Each state regulatory agency that issues a
  license, certification, registration, or other authorization to a
  health care practitioner or health care facility, including the
  Texas Medical Board, Texas Physician Assistant Board, Texas Board
  of Nursing, and executive commissioner of the Health and Human
  Services Commission, shall adopt rules necessary to implement
  Chapter 185, Health and Safety Code, as added by this Act, not later
  than January 1, 2024.
         SECTION 6.  Chapter 185, Health and Safety Code, as added by
  this Act, applies to the provision of health care services on or
  after January 1, 2024.
         SECTION 7.  This Act takes effect September 1, 2023.