By: Cook, Eckhardt S.B. No. 2768

A BILL TO BE ENTITLED

AN ACT

relating to certain health care services, increasing access to health care, and repealing or replacing medically unnecessary and outdated health care restrictions.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

ARTICLE 1. GENERAL PROVISIONS

SECTION 1.01. This Act may be cited as the Health Freedom for Texans Act.

SECTION 1.02. The legislature finds that:

(1) comprehensive reproductive health care, including safe abortion care and health care services for transgender and gender-nonconforming persons, is a vital component of a person's overall health and of their social and economic equality;

(2) abortion is one of the safest medical procedures in the United States, as demonstrated by available data, including from the Centers for Disease Control and Prevention, showing abortion has a more than 99 percent safety record;

(3) any regulation of medical care must have a legitimate and verifiable purpose and advance the goals of improving the quality of care and increasing access to care;

(4) according to the American College of Obstetricians and Gynecologists, American Medical Association, American Academy of Family Physicians, and American Osteopathic Association, "access to high-quality, evidence-based abortion care should not be limited by laws enacted under the guise of patient safety but that, in fact, [cause] harm"; and

(5) the almost complete abortion ban and the onerous restrictions enacted in this state based on pretextual reasons are a systematic attempt to eliminate access to safe and necessary medical care.

ARTICLE 2. INCREASING ACCESS TO HEALTH CARE

SECTION 2.01. Section 32.003, Family Code, is amended by amending Subsection (a) and adding Subsection (g) to read as follows:

(a) A child may consent to medical, dental, psychological, and surgical treatment for the child by a licensed physician or dentist if the child:

(1) is on active duty with the armed services of the United States of America;

(2) is:

(A) 16 years of age or older and resides separate and apart from the child's parents, managing conservator, or guardian, with or without the consent of the parents, managing conservator, or guardian and regardless of the duration of the residence; and

(B) managing the child's own financial affairs, regardless of the source of the income;

(3) consents to the diagnosis and treatment of an infectious, contagious, or communicable disease that is required by law or a rule to be reported by the licensed physician or dentist to a local health officer or the [Texas] Department of State Health Services, including all diseases within the scope of Section 81.041, Health and Safety Code;

(4) is unmarried and pregnant and consents to hospital, medical, or surgical treatment[, other than abortion,] related to the pregnancy;

(5) consents to examination and treatment for drug or chemical addiction, drug or chemical dependency, or any other condition directly related to drug or chemical use;

(6) is unmarried, is the parent of a child, and has actual custody of the [his or her] child and consents to medical, dental, psychological, or surgical treatment for the child; [or]

(7) is serving a term of confinement in a facility operated by or under contract with the Texas Department of Criminal Justice; or

(8) consents to a contraception-related examination or medical treatment[, unless the treatment would constitute a prohibited practice under Section 164.052(a)(19), Occupations Code].

(g) In this section, "contraception" means any reversible method of preventing pregnancy that is approved by the United States Food and Drug Administration.

SECTION 2.02. Section 501.065, Government Code, is amended to read as follows:

Sec. 501.065. CONSENT TO MEDICAL, DENTAL, PSYCHOLOGICAL, AND SURGICAL TREATMENT. An inmate who is younger than 18 years of age and is confined in a facility operated by or under contract with the department may, in accordance with procedures established by the department, consent to medical, dental, psychological, and surgical treatment for the inmate by a licensed health care practitioner, or a person under the direction of a licensed health care practitioner[, unless the treatment would constitute a prohibited practice under Section 164.052(a)(19), Occupations Code].

SECTION 2.03. Section 62.151, Health and Safety Code, is amended by amending Subsection (c) and adding Subsections (h) and (i) to read as follows:

(c) In modifying the plan, the executive commissioner shall ensure that primary and preventive health benefits [do not] include reproductive services, such as contraception, abortion services, [other than] prenatal care, and care related to diseases, illnesses, or abnormalities related to the reproductive system.

(h) Subject to Subsection (i), the child health plan must provide as covered benefits prescription contraceptive drugs or devices approved by the United States Food and Drug Administration.

(i) The child health plan shall provide as covered benefits prescription contraceptive drugs or devices for an enrolled child 17 years of age or younger for the purpose of primary and preventive reproductive health care if the prescribing health care provider receives written consent for the prescription from:

(1) the enrolled child's parent, guardian, or managing conservator; or

(2) the enrolled child or other adult if authorized under Section 32.001 or 32.003, Family Code, for the prescription or dispensing of the contraceptive drug or device.

SECTION 2.04. Section 171.002(1), Health and Safety Code, is amended to read as follows:

(1) "Abortion" means an act or procedure performed after pregnancy has been medically verified and with the intent to cause the termination of a pregnancy other than for the purpose of either the birth of a live fetus or the removal of a dead fetus. The term does not include birth control devices or oral contraceptives [has the meaning assigned by Section 245.002].

SECTION 2.05. Subtitle H, Title 2, Health and Safety Code, is amended by adding Chapter 174 to read as follows:

CHAPTER 174. REPRODUCTIVE AUTONOMY

Sec. 174.001. INTERNET WEBSITE ON REPRODUCTIVE RIGHTS AND RELATED RESOURCES. (a) The commission shall develop and maintain a web page on the commission's Internet website with information on the rights of an individual in this state to:

(1) obtain an abortion or related health care services in this state;

(2) receive treatment for a miscarriage or an ectopic pregnancy;

(3) access telemedicine medical services or telehealth services for an abortion; and

(4) self-manage an abortion.

(b) The information required under Subsection (a) must be printed in each of the five most spoken languages in this state.

SECTION 2.06. Section 32.024, Human Resources Code, is amended by amending Subsections (e) and (l-1) to read as follows:

(e) Except as provided by Section 32.03118, the [The] commission may not authorize the provision of any service to any person under the program unless federal matching funds are available to pay the cost of the service.

(l-1) The commission shall continue to provide medical assistance to an individual [a woman] who is eligible for medical assistance for pregnant individuals [women] for a period of not less than 24[:

[(1) six months following the date the woman delivers or experiences an involuntary miscarriage; and

[(2) 12] months that begins on the last day of the individual's [woman's] pregnancy and ends on the last day of the month in which the 24-month [12-month] period ends [in accordance with Section 1902(e)(16), Social Security Act (42 U.S.C. Section 1396a(e)(16))].

SECTION 2.07. Subchapter B, Chapter 32, Human Resources Code, is amended by adding Section 32.03118 to read as follows:

Sec. 32.03118. REIMBURSEMENT FOR CERTAIN REPRODUCTIVE HEALTH SERVICES. (a) Regardless of whether federal matching funds are available to pay the cost of the services, the commission shall ensure that medical assistance reimbursement is provided for the provision of the following services to medical assistance recipients:

(1) abortion services;

(2) forms of contraception approved by the United States Food and Drug Administration, including the insertion and removal of devices; and

(3) voluntary sterilization, including vasectomies.

(b) The commission shall ensure that abortion, contraception, and sterilization services are provided in accordance with applicable state and federal law.

(c) Notwithstanding any other law, abortion, contraception, and sterilization services provided under the medical assistance program may not be subject to:

(1) a cost-sharing requirement, including a deductible or coinsurance;

(2) utilization review;

(3) a prior authorization or step-therapy requirement; or

(4) any restrictions on or delays in coverage.

SECTION 2.08. Chapter 32, Human Resources Code, is amended by adding Subchapter H to read as follows:

SUBCHAPTER H. EXPANSION OF ELIGIBILITY FOR MEDICAL ASSISTANCE

Sec. 32.351. EXPANDED ELIGIBILITY FOR MEDICAL ASSISTANCE UNDER PATIENT PROTECTION AND AFFORDABLE CARE ACT. (a) Notwithstanding any other law, the commission shall provide medical assistance to all individuals who apply for that assistance and for whom federal matching funds are available under the Patient Protection and Affordable Care Act (Pub. L. No. 111-148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. No. 111-152), to provide that assistance.

(b) The executive commissioner shall adopt rules regarding the provision of medical assistance as required by this section.

Sec. 32.352. ANNUAL REPORT ON EXPANDED ELIGIBILITY FOR MEDICAL ASSISTANCE. Not later than December 1 of each year, the commission shall report to the governor, the lieutenant governor, the speaker of the house of representatives, and the standing committees of the senate and the house of representatives having primary jurisdiction over the medical assistance program on the effects of expanding eligibility for medical assistance under Section 32.351, including the effects on:

(1) the number of individuals in this state who do not have health benefits coverage;

(2) state health care costs, including costs relating to programs funded with money appropriated out of the general revenue fund;

(3) local health care costs; and

(4) charity care and uncompensated care costs for hospitals.

SECTION 2.09. The heading to Chapter 1218, Insurance Code, is amended to read as follows:

CHAPTER 1218. COVERAGE FOR REPRODUCTIVE HEALTH SERVICES

[ELECTIVE ABORTION; PROHIBITIONS AND REQUIREMENTS]

SECTION 2.10. Sections 1218.001 and 1218.004, Insurance Code, are amended to read as follows:

Sec. 1218.001. DEFINITIONS [DEFINITION]. In this chapter:

(1) "Abortion" has the meaning assigned[, "elective abortion" means an abortion, as defined] by Section [245.002, Health and Safety Code, other than an abortion performed due to a medical emergency as defined by Section] 171.002, Health and Safety Code.

(2) "Effective pain and anxiety management" means evidence-based pain and anxiety management, including prescription antianxiety medication, local anesthesia, topical anesthetic, paracervical block, and minimal and moderate sedation.

Sec. 1218.004. COVERAGE REQUIRED [BY HEALTH BENEFIT PLAN]. (a) A health benefit plan shall [may] provide coverage for abortion services, all forms of contraception approved by the United States Food and Drug Administration including the insertion and removal of devices and counseling on and provision of effective pain and anxiety management for the insertion or removal of devices, and voluntary sterilization including vasectomies, in accordance with applicable state and federal law.

(b) Coverage required under this section is not subject to [elective abortion only if]:

(1) a cost-sharing requirement, including a deductible or coinsurance [the coverage is provided to an enrollee separately from other health benefit plan coverage offered by the health benefit plan issuer];

(2) utilization review [the enrollee pays the premium for coverage for elective abortion separately from, and in addition to, the premium for other health benefit plan coverage, if any]; [and]

(3) a prior authorization or step-therapy requirement; or

(4) any restrictions on or delays in coverage [the enrollee provides a signature for coverage for elective abortion, separately and distinct from the signature required for other health benefit plan coverage, if any, provided to the enrollee by the health benefit plan issuer].

(c) This section controls over Subchapter C, Chapter 1369, to the extent of any conflict.

SECTION 2.11. Section 1369.1031(c), Insurance Code, is amended to read as follows:

(c) A health benefit plan that provides benefits for a prescription contraceptive drug must provide for an enrollee to obtain up to[:

[(1) a three-month supply of the covered prescription contraceptive drug at one time the first time the enrollee obtains the drug; and

[(2)] a 12-month supply of the covered prescription contraceptive drug at one time each [subsequent] time the enrollee obtains the [same] drug, regardless of whether the enrollee was enrolled in the health benefit plan the first time the enrollee obtained the drug.

SECTION 2.12. Section 164.052(a), Occupations Code, is amended to read as follows:

(a) A physician or an applicant for a license to practice medicine commits a prohibited practice if that person:

(1) submits to the board a false or misleading statement, document, or certificate in an application for a license;

(2) presents to the board a license, certificate, or diploma that was illegally or fraudulently obtained;

(3) commits fraud or deception in taking or passing an examination;

(4) uses alcohol or drugs in an intemperate manner that, in the board's opinion, could endanger a patient's life;

(5) commits unprofessional or dishonorable conduct that is likely to deceive or defraud the public, as provided by Section 164.053, or injure the public;

(6) uses an advertising statement that is false, misleading, or deceptive;

(7) advertises professional superiority or the performance of professional service in a superior manner if that advertising is not readily subject to verification;

(8) purchases, sells, barters, or uses, or offers to purchase, sell, barter, or use, a medical degree, license, certificate, or diploma, or a transcript of a license, certificate, or diploma in or incident to an application to the board for a license to practice medicine;

(9) alters, with fraudulent intent, a medical license, certificate, or diploma, or a transcript of a medical license, certificate, or diploma;

(10) uses a medical license, certificate, or diploma, or a transcript of a medical license, certificate, or diploma that has been:

(A) fraudulently purchased or issued;

(B) counterfeited; or

(C) materially altered;

(11) impersonates or acts as proxy for another person in an examination required by this subtitle for a medical license;

(12) engages in conduct that subverts or attempts to subvert an examination process required by this subtitle for a medical license;

(13) impersonates a physician or permits another to use the person's license or certificate to practice medicine in this state;

(14) directly or indirectly employs a person whose license to practice medicine has been suspended, canceled, or revoked;

(15) associates in the practice of medicine with a person:

(A) whose license to practice medicine has been suspended, canceled, or revoked; or

(B) who has been convicted of the unlawful practice of medicine in this state or elsewhere;

(16) [performs or procures a criminal abortion, aids or abets in the procuring of a criminal abortion, attempts to perform or procure a criminal abortion, or attempts to aid or abet the performance or procurement of a criminal abortion;

[(17)] directly or indirectly aids or abets the practice of medicine by a person, partnership, association, or corporation that is not licensed to practice medicine by the board;

(17) [(18) performs an abortion on a woman who is pregnant with a viable unborn child during the third trimester of the pregnancy unless:

[(A) the abortion is necessary to prevent the death of the woman;

[(B) the viable unborn child has a severe, irreversible brain impairment; or

[(C) the woman is diagnosed with a significant likelihood of suffering imminent severe, irreversible brain damage or imminent severe, irreversible paralysis;

[(19) performs an abortion on an unemancipated minor without the written consent of the child's parent, managing conservator, or legal guardian or without a court order, as provided by Section 33.003 or 33.004, Family Code, unless the abortion is necessary due to a medical emergency, as defined by Section 171.002, Health and Safety Code;

[(20) otherwise performs an abortion on an unemancipated minor in violation of Chapter 33, Family Code;

[(21) performs or induces or attempts to perform or induce an abortion in violation of Subchapter C, F, or G, Chapter 171, Health and Safety Code;

[(22)] in complying with the procedures outlined in Sections 166.045 and 166.046, Health and Safety Code, wilfully fails to make a reasonable effort to transfer a patient to a physician who is willing to comply with a directive; or

(18) [(23)] performs or delegates to another individual the performance of a pelvic examination on an anesthetized or unconscious patient in violation of Section 167A.002, Health and Safety Code[; or

[(24) performs a gender transitioning or gender reassignment procedure or treatment in violation of Section 161.702, Health and Safety Code].

ARTICLE 3. CONFORMING AMENDMENTS

SECTION 3.01. Section 161.006(b), Family Code, is amended to read as follows:

(b) In this code, "abortion" has the meaning assigned by Section 171.002 [245.002], Health and Safety Code.

SECTION 3.02. Section 266.010(a), Family Code, is amended to read as follows:

(a) A foster child who is at least 16 years of age may consent to the provision of medical care[, except as provided by Chapter 33,] if the court with continuing jurisdiction determines that the child has the capacity to consent to medical care. If the child provides consent by signing a consent form, the form must be written in language the child can understand.

SECTION 3.03. Section 419.909(c), Government Code, is amended to read as follows:

(c) This section does not apply to state agency personnel who conduct a life safety code survey of a building or facility in connection with determining whether to issue or renew a license under Chapter 142, 241, 242, 243, 244, [245,] 247, 248, 251, 252, 464, 466, or 577, Health and Safety Code, or Chapter 103, Human Resources Code.

SECTION 3.04. Section 32.046(e), Health and Safety Code, is amended to read as follows:

(e) For purposes of this section, "postpartum depression" means a disorder in which an individual [a woman] experiences moderate to severe depression following a pregnancy, regardless of whether the pregnancy resulted in birth, or an abortion [act] defined by Section 171.002 [245.002(1)].

SECTION 3.05. Section 170.001(1), Health and Safety Code, is amended to read as follows:

(1) "Abortion" has the meaning assigned by Section 171.002 [245.002].

SECTION 3.06. Section 241.011, Health and Safety Code, is amended to read as follows:

Sec. 241.011. HUMAN TRAFFICKING SIGNS REQUIRED. (a) An emergency department of a hospital shall display separate signs, in English and Spanish, side by side in accordance with this section in each restroom and patient consulting room. The signs must include the following information:

(1) no person, including an individual's parents, may force any individual to have an abortion;

(2) it is illegal for a person to force an individual to engage in sexual acts;

(3) an individual who needs help may call or text a state or national organization that assists victims of human trafficking and forced abortions; and

(4) the toll-free number of an organization described by Subdivision (3) [that comply with Section 245.025 as if the hospital is an abortion facility].

(b) In addition to the information required under Subsection (a), the sign must include the contact information for reporting suspicious activity to the Department of Public Safety.

(c) Signs required under this section must be at least 8-1/2 by 11 inches in size and displayed in a conspicuous manner clearly visible to the public and employees of a hospital. The notice must cover at least four-fifths of the sign.

(d) The executive commissioner shall adopt rules as necessary to implement and enforce this section.

SECTION 3.07. Section 248.003, Health and Safety Code, is amended to read as follows:

Sec. 248.003. EXEMPTIONS. This chapter does not apply to:

(1) a home and community support services agency required to be licensed under Chapter 142;

(2) a person required to be licensed under Chapter 241 (Texas Hospital Licensing Law);

(3) an institution required to be licensed under Chapter 242;

(4) an ambulatory surgical center required to be licensed under Chapter 243 (Texas Ambulatory Surgical Center Licensing Act);

(5) a birthing center required to be licensed under Chapter 244 (Texas Birthing Center Licensing Act);

(6) [a facility required to be licensed under Chapter 245 (Texas Abortion Facility Reporting and Licensing Act);

[(7)] a general residential operation, foster group home, foster home, and child-placing agency, for children in foster care or other residential care who are under the conservatorship of the Department of Family and Protective Services; or

(7) [(8)] a person providing medical or nursing care or services under a license or permit issued under other state law.

ARTICLE 4. REPEALER; TRANSITIONS; CONFLICTS; EFFECTIVE DATE

SECTION 4.01. The following provisions are repealed:

(1) Section 30.022, Civil Practice and Remedies Code;

(2) Subchapter L, Chapter 74, Civil Practice and Remedies Code;

(3) Section 38.063(e-1), Education Code;

(4) Chapter 33, Family Code;

(5) Section 151.002, Family Code;

(6) Section 311.036, Government Code;

(7) Chapter 2273, Government Code;

(8) Section 32.005, Health and Safety Code;

(9) Chapter 54, Health and Safety Code, as added by Chapter 1033 (S.B. 24), Acts of the 88th Legislature, Regular Session, 2023;

(10) Section 62.151(g), Health and Safety Code;

(11) Subchapter X, Chapter 161, Health and Safety Code, as added by Chapter 335 (S.B. 14), Acts of the 88th Legislature, Regular Session, 2023;

(12) Chapter 170A, Health and Safety Code;

(13) Sections 171.002(2), (3), and (4), Health and Safety Code;

(14) Section 171.0031, Health and Safety Code;

(15) Section 171.004, Health and Safety Code;

(16) Section 171.005, Health and Safety Code;

(17) Section 171.006, Health and Safety Code, as added by Chapter 4 (H.B. 13), Acts of the 85th Legislature, First Called Session, 2017;

(18) Section 171.006, Health and Safety Code, as added by Chapter 9 (H.B. 215), Acts of the 85th Legislature, First Called Session, 2017;

(19) Section 171.008, Health and Safety Code;

(20) Section 171.012, Health and Safety Code;

(21) Section 171.0121, Health and Safety Code;

(22) Section 171.0122, Health and Safety Code;

(23) Section 171.0123, Health and Safety Code;

(24) Section 171.0124, Health and Safety Code;

(25) Section 171.013, Health and Safety Code;

(26) Section 171.014, Health and Safety Code;

(27) Section 171.015, Health and Safety Code;

(28) Section 171.016, Health and Safety Code;

(29) Section 171.017, Health and Safety Code;

(30) Section 171.018, Health and Safety Code;

(31) Subchapters C, D, E, F, G, and H, Chapter 171, Health and Safety Code;

(32) Section 241.007, Health and Safety Code;

(33) Section 243.017, Health and Safety Code;

(34) Chapter 245, Health and Safety Code;

(35) Section 285.202, Health and Safety Code;

(36) Chapter 697, Health and Safety Code;

(37) Section 32.024(c-1), Human Resources Code;

(38) Section 32.024(pp), Human Resources Code, as added by Chapter 335 (S.B. 14), Acts of the 88th Legislature, Regular Session, 2023;

(39) Section 1218.003, Insurance Code;

(40) Section 1218.005, Insurance Code;

(41) Section 1218.006, Insurance Code;

(42) Subtitle M, Title 8, Insurance Code;

(43) Chapter 103, Occupations Code;

(44) Section 111.005(c), Occupations Code;

(45) Section 164.055, Occupations Code;

(46) Section 164.0551, Occupations Code;

(47) Section 164.0552, Occupations Code;

(48) Section 9.35, Penal Code; and

(49) Chapter 6-1/2, Title 71, Revised Statutes.

SECTION 4.02. 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 4.03. (a) Section 32.351, Human Resources Code, as added by this Act, applies only to an initial determination or recertification of eligibility of an individual for medical assistance under Chapter 32, Human Resources Code, made on or after the date the section is implemented, regardless of the date the individual applied for that assistance.

(b) As soon as possible after the effective date of this Act, the executive commissioner of the Health and Human Services Commission shall take all necessary actions to expand eligibility for medical assistance under Chapter 32, Human Resources Code, in accordance with Section 32.351, Human Resources Code, as added by this Act, including notifying appropriate federal agencies of that expanded eligibility.

SECTION 4.04. Chapter 1218, Insurance Code, as amended by this Act, applies only to a health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2026. A health benefit plan delivered, issued for delivery, or renewed before January 1, 2026, is governed by the law as it existed immediately before the effective date of this Act, and that law is continued in effect for that purpose.

SECTION 4.05. The changes in law made by this Act apply only to health care services provided on or after the effective date of this Act. Health care services provided before the effective date of this Act are governed by the law applicable to those services immediately before the effective date of this Act, and that law is continued in effect for that purpose.

SECTION 4.06. To the extent of any conflict, this Act prevails over another Act of the 89th Legislature, Regular Session, 2025, relating to nonsubstantive additions to and corrections in enacted codes.

SECTION 4.07. This Act takes effect September 1, 2025.