88R12593 JCG-F
By: Guerra H.B. No. 4867
A BILL TO BE ENTITLED
AN ACT
relating to health care transparency, including advertising,
identification, and notice requirements for certain health
facilities and health professionals; authorizing administrative
and civil penalties.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. 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. IDENTIFICATION AND NOTICE REQUIREMENTS FOR HEALTH
FACILITIES AND HEALTH PROFESSIONALS
Sec. 185.001. DEFINITIONS. In this chapter:
(1) "Advertisement" means:
(A) any printed, electronic, or oral statement,
with respect to the provision of health care services by a health
care professional:
(i) that is communicated or disseminated to
the public;
(ii) that:
(a) is intended to encourage a person
to use the professional's services; or
(b) for a commercial purpose, names
the professional in connection with the practice, profession, or
institution in which the professional provides health care
services; and
(iii) the preparation, communication, or
dissemination of which is controlled by the professional or a group
to which the professional is affiliated; and
(B) any communication or statement not described
by Paragraph (A) but that is used in the regular course of the
professional's business for the purpose of promoting the
professional's services to the public, including:
(i) business cards;
(ii) letterhead;
(iii) signs;
(iv) pamphlets;
(v) brochures;
(vi) e-mails and any other communication or
statement transmitted through the Internet; or
(vii) audio or video communications,
including television or radio advertisements.
(2) "Commission" means the Health and Human Services
Commission.
(3) "Health facility" means:
(A) a solo or group medical practice; or
(B) an urgent care facility.
(4) "Health professional" and "professional" mean an
individual licensed under Title 3, Occupations Code.
(5) "Urgent care facility" means a facility providing
health care that:
(A) provides episodic ambulatory health care to
individuals outside of a hospital emergency room setting;
(B) does not require an individual to make an
appointment;
(C) provides some services typically provided in
a primary care physician's office or emergency room; and
(D) treats individuals requiring treatment of an
illness or injury that requires immediate care but is not
life-threatening.
Sec. 185.002. PHOTO IDENTIFICATION BADGE REQUIRED. (a) A
health facility shall adopt a policy requiring a health
professional providing direct patient care at the facility to wear
a photo identification badge during all patient encounters, unless
wearing the badge is precluded by isolation or sterilization
protocols adopted by the facility. The badge must be of sufficient
size, be prominently worn and clearly visible, and include:
(1) the professional's first and last name;
(2) the facility department with which the
professional is associated;
(3) the type of license held by the professional under
Title 3, Occupations Code, and no other title; and
(4) if applicable, the professional's status as a
student, intern, or trainee, or resident, but only if the
professional is registered with the Texas Medical Board.
(b) For purposes of Subsection (a)(3), the identification
badge of a health professional licensed under Title 3, Occupations
Code, must clearly state:
(1) "physician," if the professional holds a license
under Subtitle B of that title;
(2) "acupuncturist," "chiropractor," "midwife,"
"physician assistant," "podiatrist," or "surgical assistant," as
applicable, if the professional holds a license under Subtitle C of
that title;
(3) "dental hygienist" or "dentist," as applicable, if
the professional holds a license under Subtitle D of that title;
(4) "advanced practice registered nurse," "licensed
vocational nurse," "registered nurse," "nurse practitioner,"
"nurse midwife," "nurse anesthetist," or "clinical nurse
specialist," as applicable, if the professional holds a license
under Subtitle E of that title;
(5) "optometrist" or "therapeutic optometrist," as
applicable, if the professional holds a license under Subtitle F of
that title;
(6) "audiologist" or "speech-language pathologist,"
as applicable, if the professional holds a license under Subtitle G
of that title;
(7) "athletic trainer," "massage therapist,"
"occupational therapist," "occupational therapy assistant,"
"physical therapist," or "physical therapist assistant," as
applicable, if the professional holds a license under Subtitle H of
that title;
(8) "pharmacist," if the professional holds a license
under Subtitle J of that title;
(9) "medical physicist," "medical radiologic
technologist," "orthotist," "orthotist assistant,"
"perfusionist," "prosthetist," "prosthetist assistant," or
"respiratory care practitioner," as applicable, if the
professional holds a license under Subtitle K of that title; or
(10) "dietitian," if the professional holds a license
under Subtitle M of that title.
Sec. 185.003. NOTICE OF HEALTH PROFESSIONAL LICENSE. A
health facility shall post in a conspicuous location in each office
where a health professional provides health care services a written
notice stating the type of license the professional holds. The
notice must be printed using an easily readable font and type size.
Sec. 185.004. HEALTH CARE SERVICES PROVIDED BY NONPHYSICIAN
HEALTH PROFESSIONAL. (a) If a nonphysician health professional
provides health care services in a health facility under the
supervision of a physician, the facility shall post in a
conspicuous location in each office where the professional provides
health care services a written notice stating:
(1) the name of the supervising physician;
(2) the supervising physician's medical license
number;
(3) any board certification or specialty in which the
physician is certified;
(4) the physician's practice contact information,
including the telephone number and address of the practice;
(5) either:
(A) the hours the physician is scheduled to be
present at the practice location; or
(B) if the physician is not scheduled to be
present at the practice location, the statement: "No physician on
site"; and
(6) the statement: "Any patient may request treatment
by a physician. Notify a staff member at this location if you want
to request this option."
(b) A patient may choose to be treated by the supervising
physician of a nonphysician health professional. If the patient
requests treatment by the supervising physician, the physician must
see the patient not later than the 30th day after the date the
patient makes the request. The physician may see the patient in
person or through an acceptable telemedicine medical services
platform.
Sec. 185.005. PROHIBITED CONDUCT. A health professional
may not:
(1) knowingly aid, abet, permit, advise, or solicit a
person who is not licensed to practice the health profession in
which the professional is licensed to engage in an act contrary to
that professional licensure; or
(2) delegate to or contract with another health
professional to provide health care services if the professional
knows, or has reason to know, that the other professional is not
authorized for delegation of or to contract for those services
under the professional's license.
Sec. 185.006. ADMINISTRATIVE PENALTY. (a) The commission
or the regulatory agency for a health professional, including the
Texas Medical Board, the Texas Physician Assistant Board, and the
Texas Board of Nursing, may impose an administrative penalty
against a health facility or professional regulated by the
commission or agency who violates this chapter or a rule adopted
under this chapter.
(b) The amount of the penalty imposed may not exceed $1,000
for each violation, and each day a violation continues or occurs is
a separate violation for the purpose of imposing a penalty. The
amount shall be based on:
(1) the seriousness of the violation, including the
nature, circumstances, extent, and gravity of the violation;
(2) the history of previous violations;
(3) the amount necessary to deter a future violation;
(4) the efforts to correct the violation; and
(5) any other matter that justice may require.
(c) The enforcement of the penalty may be stayed during the
time the order is under judicial review if the health facility or
professional pays the penalty to the clerk of the court or files a
supersedeas bond with the court in the amount of the penalty. A
facility or professional that cannot afford to pay the penalty or
file the bond may stay the enforcement by filing an affidavit in the
manner required by the Texas Rules of Civil Procedure for a party
who cannot afford to file security for costs, subject to the right
of the commission or regulatory agency to contest the affidavit as
provided by those rules.
(d) The attorney general may sue to collect the penalty.
The attorney general may recover reasonable expenses incurred in
obtaining relief under this subsection, including court costs,
reasonable attorney's fees, investigation costs, witness fees, and
deposition expenses.
(e) A proceeding to impose the penalty is considered to be a
contested case under Chapter 2001, Government Code.
Sec. 185.007. CIVIL PENALTY. (a) A health facility that
violates this chapter is liable to the state for a civil penalty of
not more than $1,000 for each violation. Each day of a continuing
violation constitutes a separate ground for recovery.
(b) The attorney general may sue to collect a civil penalty
under this section. The attorney general may recover reasonable
expenses incurred in obtaining relief under this section, including
court costs, reasonable attorney's fees, investigation costs,
witness fees, and deposition expenses.
SECTION 2. The heading to Subchapter E, Chapter 101,
Occupations Code, is amended to read as follows:
SUBCHAPTER E. CERTAIN PRACTICES RELATED TO ADVERTISING AND BILLING
PROHIBITED [GROUNDS FOR LICENSE REVOCATION OR DENIAL]
SECTION 3. Section 101.201, Occupations Code, is amended by
amending Subsection (b) and adding Subsections (c) and (d) to read
as follows:
(b) False, misleading, or deceptive advertising or
advertising not readily subject to verification includes
advertising that:
(1) makes a material misrepresentation of fact or
omits a fact necessary to make the statement as a whole not
materially misleading;
(2) makes a representation likely to create an
unjustified expectation about the results of a health care service
or procedure;
(3) compares a health care professional's services
with another health care professional's services unless the
comparison can be factually substantiated;
(4) contains a testimonial;
(5) causes confusion or misunderstanding as to the
credentials, education, or licensing of a health care professional,
including using a title, term, or other words that misstate,
falsely describe, falsely hold out, or falsely detail the health
care professional's:
(A) professional skills;
(B) training;
(C) expertise;
(D) educational degree;
(E) specialty certification; or
(F) licensure;
(6) represents that health care insurance deductibles
or copayments may be waived or are not applicable to health care
services to be provided if the deductibles or copayments are
required;
(7) represents that the benefits of a health benefit
plan will be accepted as full payment when deductibles or
copayments are required;
(8) makes a representation that is designed to take
advantage of the fears or emotions of a particularly susceptible
type of patient; or
(9) represents in the use of a professional name a
title or professional identification that is associated with
another profession and the health care professional is not licensed
or otherwise authorized to practice that profession [expressly or
commonly reserved to or used by another profession or
professional].
(c) For purposes of this section, advertising that does not
include the name of the health care professional and the
professional identification required by Section 104.003 is
considered false, misleading, deceptive, or not readily subject to
verification.
(d) In this section, "advertising" includes:
(1) any printed, electronic, or oral statement, with
respect to the provision of health care services by a health care
professional:
(A) that is communicated or disseminated to the
public;
(B) that:
(i) is intended to encourage a person to use
the professional's services; or
(ii) for a commercial purpose, names the
professional in connection with the practice, profession, or
institution in which the professional provides health care
services; and
(C) the preparation, communication, or
dissemination of which is controlled by the professional or a group
to which the professional is affiliated; and
(2) any communication or statement not described by
Subdivision (1) but that is used in the regular course of the
professional's business for the purpose of promoting the
professional's services to the public, including:
(A) business cards;
(B) letterhead;
(C) signs;
(D) pamphlets;
(E) brochures;
(F) e-mails and any other communication or
statement transmitted through the Internet; or
(G) audio or video communications, including
television or radio advertisements.
SECTION 4. Subchapter E, Chapter 101, Occupations Code, is
amended by adding Section 101.205 to read as follows:
Sec. 101.205. ADMINISTRATIVE PENALTY. (a) A health
licensing agency that issues a license, certificate, or other
authorization under this title, may impose an administrative
penalty on a person who:
(1) holds a license, certificate, or other
authorization issued by the health licensing agency; and
(2) violates Section 101.201.
(b) The amount of an administrative penalty may not exceed
$1,000 for each violation. Each day a violation continues or occurs
is a separate violation for purposes of imposing a penalty.
(c) A proceeding to impose an administrative penalty under
this section is subject to Chapter 2001, Government Code.
SECTION 5. Section 104.003, Occupations Code, is amended by
amending Subsections (b) and (c) and adding Subsection (h) to read
as follows:
(b) A person who is licensed by the Texas Medical [State]
Board [of Medical Examiners] and holds a doctor of medicine degree
shall use:
(1) physician or surgeon, M.D.;
(2) doctor, M.D.; [or]
(3) doctor of medicine, M.D.; or
(4) a designation indicating that the person is
certified or eligible for certification, as applicable, by a
certifying board of the American Board of Medical Specialties, the
American Board of Oral and Maxillofacial Surgery, the National
Board of Physicians and Surgeons, or a successor organization to
those organizations.
(c) A person who is licensed by the Texas Medical [State]
Board [of Medical Examiners] and holds a doctor of osteopathy
degree shall use:
(1) physician or surgeon, D.O.;
(2) osteopathic physician or surgeon;
(3) doctor, D.O.;
(4) doctor of osteopathy;
(5) doctor of osteopathic medicine;
(6) osteopath; [or]
(7) D.O.; or
(8) a designation indicating that the person is
certified or eligible for certification, as applicable, by a
certifying board of the American Osteopathic Association, the
American Board of Oral and Maxillofacial Surgery, the National
Board of Physicians and Surgeons, or a successor organization to
those organizations.
(h) A person licensed under this title and not described by
Subsection (b), (c), (d), (e), (f), or (g) may only use a title
authorized by the law under which the person is licensed.
SECTION 6. Chapter 104, Occupations Code, is amended by
adding Section 104.0035 to read as follows:
Sec. 104.0035. FALSE AND DECEPTIVE ADVERTISING. A healing
art practitioner may not use advertising that is false, misleading,
or deceptive, or not readily subject to verification as provided by
Section 101.201.
SECTION 7. Chapter 104, Occupations Code, is amended by
adding Section 104.008 to read as follows:
Sec. 104.008. ADMINISTRATIVE PENALTY. (a) A healing art
licensing board that issues a license, certificate, or other
authorization described by Section 104.003, may impose an
administrative penalty on a person who:
(1) holds a license, certificate, or other
authorization issued by the healing art licensing board; and
(2) violates this chapter.
(b) The amount of an administrative penalty may not exceed
$1,000 for each violation. Each day a violation continues or occurs
is a separate violation for purposes of imposing a penalty.
(c) A proceeding to impose an administrative penalty under
this section is subject to Chapter 2001, Government Code.
SECTION 8. Section 165.156, Occupations Code, is amended to
read as follows:
Sec. 165.156. MISREPRESENTATION REGARDING ENTITLEMENT TO
PRACTICE MEDICINE. A person, partnership, trust, association, or
corporation commits an offense if the person, partnership, trust,
association, or corporation, through the use of any title,
abbreviation, description of services, designation, letters,
words, or terms, alone or in combination with any other title,
affixed on stationery or on advertisements, or in any other manner,
including oral or written communications, indicates or induces
another to believe that the person, partnership, trust,
association, or corporation is entitled to practice medicine if the
person, partnership, trust, association, or corporation is not
licensed to do so.
SECTION 9. Subchapter D, Chapter 165, Occupations Code, is
amended by adding Section 165.1565 to read as follows:
Sec. 165.1565. USE OF TITLE. (a) In this section, "medical
or medical specialty title" means:
(1) "doctor of medicine" or "M.D.";
(2) "doctor of osteopathy" or "D.O.";
(3) "physician";
(4) "surgeon";
(5) "osteopathic physician";
(6) "osteopathic surgeon";
(7) "doctor";
(8) "aesthetic surgeon";
(9) "age management medicine physician";
(10) "allergist";
(11) "anesthesiologist";
(12) "associate physician";
(13) "cosmetic surgeon";
(14) "dermatologist";
(15) "emergency medicine doctor";
(16) "emergency medicine physician";
(17) "endocrinologist";
(18) "environmental medicine physician";
(19) "family medicine doctor";
(20) "family medicine physician";
(21) "family practice doctor";
(22) "family practice physician";
(23) "functional medicine doctor";
(24) "functional medicine physician";
(25) "gastroenterologist";
(26) "general practitioner";
(27) "geriatrician";
(28) "graduate physician";
(29) "gynecologist";
(30) "hematologist";
(31) "hepatologist";
(32) "hospitalist";
(33) "house officer";
(34) "intensivist";
(35) "internal medicine physician";
(36) "intern";
(37) "internist";
(38) "laryngologist";
(39) "neonatologist";
(40) "nephrologist";
(41) "neurologist";
(42) "nocturnist";
(43) "obstetrician";
(44) "occupational health physician";
(45) "occupational medicine doctor";
(46) "occupational medicine physician";
(47) "oncologist";
(48) "ophthalmologist";
(49) "orthopedic surgeon";
(50) "orthopedist";
(51) "osteopath";
(52) "otolaryngologist";
(53) "otologist";
(54) "otorhinolaryngologist";
(55) "pathologist";
(56) "pediatrician";
(57) "physiatrist";
(58) "physical medicine and rehabilitation
physician";
(59) "physician associate";
(60) "physician graduate";
(61) "plastic surgeon";
(62) "primary care doctor";
(63) "primary care physician";
(64) "proctologist";
(65) "psychiatrist";
(66) "radiologist";
(67) "resident";
(68) "rheumatologist";
(69) "rhinologist";
(70) "urogynecologist";
(71) "urologist"; or
(72) another title specified by board rule.
(b) Except as provided by Section 104.004, a person who is
not licensed to practice medicine by the board may not:
(1) use or publicly display a medical or medical
specialty title in connection with the person's name either alone
or in combination with another word or title; or
(2) indicate or induce another to believe that the
person is an attending doctor or attending physician or practices
medicine.
(c) In a clinical setting, the terms "fellowship" and
"residency" are reserved for postgraduate medical, dental,
podiatric, and pharmacologic education and training. The terms may
not be used to describe nursing or any nonmedical postgraduate
training.
(d) In a clinical setting, the terms "attending,"
"attending doctor," and "attending physician" are reserved for
physicians who are licensed to practice medicine and who have
completed a postgraduate medical residency training program.
(e) In a clinical setting, "physician associate,"
"associate physician," and "physician graduate" are reserved for
physicians licensed to practice medicine who:
(1) are graduates of a board-approved medical school
or osteopathic medical school; and
(2) have passed the second component of the United
States Medical Licensing Examination or the equivalent component of
another board-approved licensing examination.
SECTION 10. Section 204.203, Occupations Code, is amended
to read as follows:
Sec. 204.203. IDENTIFICATION REQUIREMENTS. A physician
assistant shall:
(1) keep the physician assistant's license available
for inspection at the physician assistant's primary place of
business; and
(2) when engaged in the physician assistant's
professional activities, wear a name tag identifying the license
holder as a physician assistant by title or the initials "P.A.".
SECTION 11. Subchapter E, Chapter 204, Occupations Code, is
amended by adding Section 204.2035 to read as follows:
Sec. 204.2035. FALSE AND DECEPTIVE ADVERTISING. A
physician assistant may not use advertising that is false,
misleading, deceptive, or not readily subject to verification as
provided by Section 101.201.
SECTION 12. Sections 301.351(a), (b), and (c), Occupations
Code, are amended to read as follows:
(a) A person who holds a license [as a registered nurse]
under this chapter[:
[(1)] is referred to as:
(1) a registered nurse or[; and
[(2) may use the abbreviation] "R.N.";
(2) a licensed vocational nurse or "L.V.N.";
(3) an advanced practice registered nurse or
"A.P.R.N.";
(4) a nurse practitioner or "N.P.";
(5) a nurse midwife;
(6) a certified registered nurse anesthetist or
"C.R.N.A."; or
(7) a clinical nurse specialist or "C.N.S.".
(b) Except as provided by Section 104.004, a [A] person who
holds a license [as a vocational nurse] under this chapter may not
use the title "doctor" unless the person also holds a license issued
by the Texas Medical Board under Subtitle B, as provided by Section
165.1565.[:
[(1) is referred to as a licensed vocational nurse or
vocational nurse; and
[(2) may use the abbreviation "L.V.N." or "V.N."]
(c) While interacting with the public in a nursing role,
each nurse shall wear a clearly legible insignia identifying the
nurse in accordance with Subsection (a) [as a registered or
vocational nurse]. The insignia may not contain information other
than:
(1) the appropriate [registered or vocational nurse]
designation;
(2) the nurse's name, certifications, academic
degrees, or practice position;
(3) the name of the employing facility or agency, or
other employer;
(4) a picture of the nurse; or
(5) any other information authorized by the board.
SECTION 13. Subchapter H, Chapter 301, Occupations Code, is
amended by adding Section 301.3515 to read as follows:
Sec. 301.3515. FALSE AND DECEPTIVE ADVERTISING. A nurse
may not use advertising that is false, misleading, deceptive, or
not readily subject to verification as provided by Section 101.201.
SECTION 14. Section 104.007, Occupations Code, is repealed.
SECTION 15. Each state regulatory agency that issues a
license to a health professional or health facility, including the
Texas Medical Board, Texas Physician Assistant Board, Texas Board
of Nursing, and Health and Human Services Commission, shall adopt
rules necessary to implement Chapter 185, Health and Safety Code,
as added by this Act, and Chapters 101 and 104, Occupations Code, as
amended by this Act, not later than January 1, 2024.
SECTION 16. 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 17. The changes in law made by this Act apply only
to conduct that occurs on or after the effective date of this Act.
Conduct that occurs before that date is governed by the law in
effect on the date the conduct occurred, and the former law is
continued in effect for that purpose.
SECTION 18. This Act takes effect September 1, 2023.