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