S.B. No. 1188
 
 
 
 
AN ACT
  relating to electronic health record requirements; authorizing a
  civil penalty.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle I, Title 2, Health and Safety Code, is
  amended by adding Chapter 183 to read as follows:
  CHAPTER 183.  ELECTRONIC HEALTH RECORDS
         Sec. 183.001.  DEFINITIONS.  In this chapter:
               (1)  "Biological sex" means the biological trait that
  determines whether a sexually reproducing organism produces male or
  female gametes.
               (2)  "Covered entity" has the meaning assigned by
  Section 181.001.  The term includes a health care practitioner.  The
  term does not include:
                     (A)  a home and community support services agency
  licensed under Chapter 142;
                     (B)  a nursing facility licensed under Chapter
  242;
                     (C)  a continuing care facility regulated under
  Chapter 246;
                     (D)  an assisted living facility licensed under
  Chapter 247;
                     (E)  an intermediate care facility licensed under
  Chapter 252;
                     (F)  a day activity and health services facility
  licensed under Chapter 103, Human Resources Code; or
                     (G)  a provider under the Texas home living
  (TxHmL) or home and community-based services (HCS) waiver program.
               (3)  "Female" means an individual whose reproductive
  system is developed to produce ova.
               (4)  "Health care practitioner" means an individual who
  is licensed, certified, or otherwise authorized to provide health
  care services in this state.
               (5)  "Male" means an individual whose reproductive
  system is developed to produce sperm.
               (6)  "Sexual development disorder" means a congenital
  condition associated with atypical development of internal or
  external genital structures.  The term includes a chromosomal,
  gonadal, or anatomic abnormality.
         Sec. 183.002.  REQUIREMENTS FOR ELECTRONIC HEALTH RECORD
  STORAGE.  (a)  A covered entity shall ensure that electronic health
  records under the control of the entity that contain patient
  information are physically maintained in the United States or a
  territory of the United States.  This subsection applies to:
               (1)  electronic health records that are stored by a
  third-party or subcontracted computing facility or an entity that
  provides cloud computing services; and
               (2)  electronic health records that are stored using a
  technology through which patient information may be electronically
  retrieved, accessed, or transmitted.
         (b)  A covered entity shall ensure that the electronic health
  record information of this state's residents, other than open data,
  is accessible only to individuals who require the information to
  perform duties within the scope of the individual's employment
  related to treatment, payment, or health care operations.
         (c)  Each covered entity shall implement reasonable and
  appropriate administrative, physical, and technical safeguards to
  protect the confidentiality, integrity, and availability of
  electronic health record information.
         Sec. 183.003.  REQUIRED MEDICAL HISTORY INFORMATION IN
  ELECTRONIC HEALTH RECORD. A covered entity shall ensure each
  electronic health record maintained for an individual includes the
  option for a health care practitioner to collect and record
  communications between two or more covered entities related to the
  individual's metabolic health and diet in the treatment of a
  chronic disease or illness.
         Sec. 183.004.  INFORMATION RESTRICTIONS IN ELECTRONIC
  HEALTH RECORD. A covered entity may not collect, store, or share
  any information regarding an individual's credit score or voter
  registration status in the individual's electronic health record. 
         Sec. 183.005.  ARTIFICIAL INTELLIGENCE IN ELECTRONIC HEALTH
  RECORD. (a)  A health care practitioner may use artificial
  intelligence for diagnostic purposes, including the use of
  artificial intelligence for recommendations on a diagnosis or
  course of treatment based on a patient's medical record, if:
               (1)  the practitioner is acting within the scope of the
  practitioner's license, certification, or other authorization to
  provide health care services in this state, regardless of the use of
  artificial intelligence;
               (2)  the particular use of artificial intelligence is
  not otherwise restricted or prohibited by state or federal law; and
               (3)  the practitioner reviews all records created with
  artificial intelligence in a manner that is consistent with medical
  records standards developed by the Texas Medical Board.
         (b)  A health care practitioner who uses artificial
  intelligence for diagnostic purposes as described by Subsection (a)
  must disclose the practitioner's use of that technology to the
  practitioner's patients.
         Sec. 183.006.  ACCESS TO ELECTRONIC HEALTH RECORD OF MINOR.
  (a)  In this section, "minor" means an individual 17 years of age or
  younger who has not had the disabilities of minority removed for
  general purposes. 
         (b)  A covered entity shall ensure each electronic health
  record system the entity uses to store electronic health records of
  minors allows a minor's parent or, if applicable, the minor's
  managing conservator or guardian to obtain complete and
  unrestricted access to the minor's electronic health record
  immediately, unless access to all or part of the record is
  restricted under state or federal law or by a court order.
         Sec. 183.007.  ELECTRONIC HEALTH RECORD REQUIREMENTS
  REGARDING BIOLOGICAL SEX.  (a)  Notwithstanding any other law, the
  commission, the Texas Medical Board, and the Texas Department of
  Insurance shall jointly ensure that:
               (1)  each electronic health record prepared or
  maintained by a covered entity in this state includes a separate
  space for the entity to document:
                     (A)  an individual's biological sex as either male
  or female based on the individual's observed biological sex
  recorded by a health care practitioner at birth; and
                     (B)  information on any sexual development
  disorder of the individual, whether identified at birth or later in
  the individual's life; and
               (2)  any algorithm or decision assistance tool included
  in an electronic health record to assist a health care practitioner
  in making medical treatment decisions includes an individual's
  biological sex as recorded in the space described by Subdivision
  (1)(A).
         (b)  This section does not prohibit an electronic health
  record from including spaces for recording other information
  related to an individual's biological sex or gender identity.
         Sec. 183.008.  AMENDING CERTAIN BIOLOGICAL SEX INFORMATION
  IN ELECTRONIC HEALTH RECORDS.  (a)  A covered entity may amend on an
  electronic health record an individual's biological sex as recorded
  in the space described by Section 183.007(a)(1)(A) only if:
               (1)  the amendment is to correct a clerical error; or
               (2)  the individual is diagnosed with a sexual
  development disorder and the amendment changes the individual's
  listed biological sex to the opposite biological sex.
         (b)  If an individual's biological sex is amended under
  Subsection (a)(2), the covered entity shall include in the
  individual's electronic health record information on the
  individual's sexual development disorder in the space described by
  Section 183.007(a)(1)(B).
         Sec. 183.009.  INVESTIGATION BY COMMISSION OR REGULATORY
  AGENCY. The commission or the appropriate regulatory agency shall
  conduct an investigation of any credible allegation of a violation
  of this chapter by a covered entity.  The commission or agency shall
  ensure the investigation is conducted in compliance with all
  applicable state and federal laws, including the Health Insurance
  Portability and Accountability Act of 1996 (Pub. L. No. 104-191).
         Sec. 183.010.  DISCIPLINARY ACTION BY REGULATORY AGENCY.  
  The appropriate regulatory agency may take disciplinary action
  against a covered entity that violates this chapter three or more
  times in the same manner as if the covered entity violated an
  applicable licensing or regulatory law.  The disciplinary action
  may include license, registration, or certification suspension or
  revocation for a period the agency determines appropriate.
         Sec. 183.011.  INJUNCTIVE RELIEF; CIVIL PENALTY.  (a)  The
  attorney general may institute an action for injunctive relief to
  restrain a violation of this chapter.
         (b)  In addition to the injunctive relief provided by
  Subsection (a), the attorney general may institute an action for
  civil penalties against a covered entity for a violation of this
  chapter.  A civil penalty assessed under this section may not
  exceed:
               (1)  $5,000 for each violation that is committed
  negligently and that occurs in a single year, regardless of how long
  the violation continues during that year;
               (2)  $25,000 for each violation that is committed
  knowingly or intentionally and that occurs in a single year,
  regardless of how long the violation continues during that year; or
               (3)  $250,000 for each violation in which the covered
  entity knowingly or intentionally used protected health
  information for financial gain.
         Sec. 183.012.  MEMORANDUM OF UNDERSTANDING; RULES. The
  executive commissioner, the Texas Medical Board, the Texas
  Department of Licensing and Regulation, the Texas Department of
  Insurance, and each regulatory agency subject to this chapter shall
  enter into a memorandum of understanding and, as necessary, adopt
  rules to implement this chapter.
         SECTION 2.  (a)  Except as provided by Subsection (b) of this
  section, Chapter 183, Health and Safety Code, as added by this Act,
  applies only to an electronic health record prepared on or after the
  effective date of this Act.
         (b)  Section 183.002, Health and Safety Code, as added by
  this Act, applies to the storage of an electronic health record on
  or after January 1, 2026, regardless of the date on which the
  electronic health record was prepared.
         SECTION 3.  If before implementing any provision of this Act
  a state agency determines that a waiver or authorization from a
  federal agency is necessary for implementation of that provision,
  the agency affected by the provision shall request the waiver or
  authorization and may delay implementing that provision until the
  waiver or authorization is granted.
         SECTION 4.  This Act takes effect September 1, 2025.
 
 
 
 
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
         I hereby certify that S.B. No. 1188 passed the Senate on
  April 7, 2025, by the following vote: Yeas 23, Nays 7; and that
  the Senate concurred in House amendment on May 28, 2025, by the
  following vote: Yeas 23, Nays 8.
 
 
  ______________________________
  Secretary of the Senate    
 
         I hereby certify that S.B. No. 1188 passed the House, with
  amendment, on May 23, 2025, by the following vote: Yeas 86,
  Nays 49, three present not voting.
 
 
  ______________________________
  Chief Clerk of the House   
 
 
 
  Approved:
 
  ______________________________ 
              Date
 
 
  ______________________________ 
            Governor