Texas 2025 - 89th Regular

Texas Senate Bill SB1188 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		By: Kolkhorst S.B. No. 1188
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3		-
	2	+	(In the Senate - Filed February 7, 2025; February 28, 2025,
	3	+	read first time and referred to Committee on Health & Human
	4	+	Services; March 31, 2025, reported adversely, with favorable
	5	+	Committee Substitute by the following vote: Yeas 8, Nays 1;
	6	+	March 31, 2025, sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR S.B. No. 1188 By: Hancock
4	9
5	10
6	11		A BILL TO BE ENTITLED
7	12		AN ACT
8	13		relating to electronic health record requirements; authorizing a
9	14		civil penalty.
10	15		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	16		SECTION 1. Subtitle I, Title 2, Health and Safety Code, is
12	17		amended by adding Chapter 183 to read as follows:
13	18		CHAPTER 183. ELECTRONIC HEALTH RECORDS
14	19		Sec. 183.001. DEFINITIONS. In this chapter:
15	20		(1) "Biological sex" means the biological trait that
16	21		determines whether a sexually reproducing organism produces male or
17	22		female gametes.
18	23		(2) "Covered entity" has the meaning assigned by
19		-	Section 181.001. The term includes a health care practitioner. The
20		-	term does not include:
21		-	(A) a home and community support services agency
22		-	licensed under Chapter 142;
23		-	(B) a nursing facility licensed under Chapter
24		-	242;
25		-	(C) a continuing care facility regulated under
26		-	Chapter 246;
27		-	(D) an assisted living facility licensed under
28		-	Chapter 247;
29		-	(E) an intermediate care facility licensed under
30		-	Chapter 252;
31		-	(F) a day activity and health services facility
32		-	licensed under Chapter 103, Human Resources Code; or
33		-	(G) a provider under the Texas home living
34		-	(TxHmL) or home and community-based services (HCS) waiver program.
	24	+	Section 181.001. The term includes a health care practitioner.
35	25		(3) "Female" means an individual whose reproductive
36	26		system is developed to produce ova.
37	27		(4) "Health care practitioner" means an individual who
38	28		is licensed, certified, or otherwise authorized to provide health
39	29		care services in this state.
40	30		(5) "Male" means an individual whose reproductive
41	31		system is developed to produce sperm.
42	32		(6) "Sexual development disorder" means a congenital
43	33		condition associated with atypical development of internal or
44	34		external genital structures. The term includes a chromosomal,
45	35		gonadal, and anatomic abnormality.
46	36		Sec. 183.002. REQUIREMENTS FOR ELECTRONIC HEALTH RECORD
47	37		STORAGE. (a) A covered entity shall ensure that electronic health
48	38		records under the control of the entity that contain patient
49	39		information are physically maintained in the United States or a
50	40		territory of the United States. This subsection applies to:
51	41		(1) electronic health records that are stored by a
52	42		third-party or subcontracted computing facility or an entity that
53	43		provides cloud computing services; and
54	44		(2) electronic health records that are stored using a
55	45		technology through which patient information may be electronically
56	46		retrieved, accessed, or transmitted.
57	47		(b) A covered entity shall ensure that the electronic health
58	48		record information of this state's residents, other than open data,
59	49		is accessible only to individuals who require the information to
60	50		perform duties within the scope of the individual's employment
61	51		related to treatment, payment, or health care operations.
62	52		(c) Each covered entity shall implement reasonable and
63	53		appropriate administrative, physical, and technical safeguards to
64	54		protect the confidentiality, integrity, and availability of
65	55		electronic health record information.
66	56		Sec. 183.003. REQUIRED MEDICAL HISTORY INFORMATION IN
67	57		ELECTRONIC HEALTH RECORD. A covered entity shall ensure each
68	58		electronic health record maintained for an individual includes the
69	59		option for a health care practitioner to collect and record
70	60		communications between two or more covered entities related to the
71	61		individual's metabolic health and diet in the treatment of a
72	62		chronic disease or illness.
73	63		Sec. 183.004. INFORMATION RESTRICTIONS IN ELECTRONIC
74	64		HEALTH RECORD. A covered entity may not collect, store, or share
75	65		any information regarding an individual's credit score or voter
76	66		registration status in the individual's electronic health record.
77	67		Sec. 183.005. ARTIFICIAL INTELLIGENCE IN ELECTRONIC HEALTH
78	68		RECORD. (a) A health care practitioner who uses artificial
79	69		intelligence for diagnostic purposes, including the use of
80	70		artificial intelligence for recommendations on a diagnosis or
81	71		course of treatment based on a patient's medical record, shall
82	72		review all records created with artificial intelligence to ensure
83	73		that the data is accurate and properly managed.
84	74		(b) A health care practitioner who uses artificial
85	75		intelligence for diagnostic purposes as described by Subsection (a)
86	76		must disclose the practitioner's use of that technology to the
87	77		practitioner's patients.
88	78		Sec. 183.006. ACCESS TO ELECTRONIC HEALTH RECORD OF MINOR.
89	79		(a) In this section, "minor" means an individual 17 years of age or
90	80		younger who has not had the disabilities of minority removed for
91	81		general purposes.
92	82		(b) A covered entity shall ensure each electronic health
93	83		record system the entity uses to store electronic health records of
94	84		minors allows a minor's parent or, if applicable, the minor's
95	85		managing conservator or guardian to obtain complete and
96	86		unrestricted access to the minor's electronic health record
97	87		immediately upon request, unless access to all or part of the record
98	88		is restricted under state or federal law or by a court order.
99	89		Sec. 183.007. ELECTRONIC HEALTH RECORD REQUIREMENTS
100	90		REGARDING BIOLOGICAL SEX. (a) Notwithstanding any other law, the
101	91		commission, the Texas Medical Board, and the Texas Department of
102	92		Insurance shall jointly ensure that:
103	93		(1) each electronic health record prepared or
104	94		maintained by a covered entity in this state includes a separate
105	95		space for the entity to document:
106	96		(A) an individual's biological sex as either male
107	97		or female based on the individual's observed biological sex
108	98		recorded by a health care practitioner at birth; and
109	99		(B) information on any sexual development
110	100		disorder of the individual, whether identified at birth or later in
111	101		the individual's life; and
112	102		(2) any algorithm or decision assistance tool included
113	103		in an electronic health record to assist a health care practitioner
114	104		in making medical treatment decisions includes an individual's
115	105		biological sex as recorded in the space described by Subdivision
116	106		(1)(A).
117	107		(b) This section does not prohibit an electronic health
118	108		record from including spaces for recording other information
119	109		related to an individual's biological sex or gender identity.
120	110		Sec. 183.008. AMENDING CERTAIN BIOLOGICAL SEX INFORMATION
121	111		IN ELECTRONIC HEALTH RECORDS. (a) A covered entity may amend on an
122	112		electronic health record an individual's biological sex as recorded
123	113		in the space described by Section 183.007(a)(1)(A) only if:
124	114		(1) the amendment is to correct a clerical error; or
125	115		(2) the individual is diagnosed with a sexual
126	116		development disorder and the amendment changes the individual's
127	117		listed biological sex to the opposite biological sex.
128	118		(b) If an individual's biological sex is amended under
129	119		Subsection (a)(2), the covered entity shall include in the
130	120		individual's electronic health record information on the
131	121		individual's sexual development disorder in the space described by
132	122		Section 183.007(a)(1)(B).
133		-	Sec. 183.009. INVESTIGATION BY COMMISSION OR REGULATORY
	123	+	Sec. 183.009. PROHIBITION ON COVERED ENTITY PARTICIPATION
	124	+	UNDER MEDICAID AND CHILD HEALTH PLAN PROGRAM. (a) In this section,
	125	+	"child health plan program" and "Medicaid" have the meanings
	126	+	assigned by Section 521.0001, Government Code.
	127	+	(b) The executive commissioner by rule shall prohibit a
	128	+	covered entity that violates this chapter from participating as a
	129	+	health care provider under Medicaid or the child health plan
	130	+	program for a period that is reasonably proportionate to the
	131	+	seriousness and frequency of the violation, as the executive
	132	+	commissioner determines. In adopting rules under this section, the
	133	+	executive commissioner shall ensure that the period during which a
	134	+	covered entity is prohibited from participating as a provider under
	135	+	Medicaid or the child health plan program runs concurrently with
	136	+	the period during which the covered entity's license, registration,
	137	+	certification, or other regulatory authorization is suspended or
	138	+	revoked by a regulatory agency under Section 183.011, as
	139	+	applicable.
	140	+	Sec. 183.010. INVESTIGATION BY COMMISSION OR REGULATORY
134	141		AGENCY. The commission or the appropriate regulatory agency shall
135	142		conduct an investigation of any credible allegation of a violation
136	143		of this chapter by a covered entity. The commission or agency shall
137	144		ensure the investigation is conducted in compliance with all
138	145		applicable state and federal laws, including the Health Insurance
139	146		Portability and Accountability Act of 1996 (Pub. L. No. 104-191).
140		-	Sec. 183.~~010~~. DISCIPLINARY ACTION BY REGULATORY AGENCY.
	147	+	Sec. 183.011. DISCIPLINARY ACTION BY REGULATORY AGENCY.
141	148		The appropriate regulatory agency may take disciplinary action
142	149		against a covered entity that violates this chapter three or more
143	150		times in the same manner as if the covered entity violated an
144	151		applicable licensing or regulatory law. The disciplinary action
145	152		may include license, registration, or certification suspension or
146	153		revocation for a period the agency determines appropriate.
147		-	Sec. 183.~~011~~. INJUNCTIVE RELIEF; CIVIL PENALTY. (a) The
	154	+	Sec. 183.012. INJUNCTIVE RELIEF; CIVIL PENALTY. (a) The
148	155		attorney general may institute an action for injunctive relief to
149	156		restrain a violation of this chapter.
150	157		(b) In addition to the injunctive relief provided by
151	158		Subsection (a), the attorney general may institute an action for
152	159		civil penalties against a covered entity for a violation of this
153	160		chapter. A civil penalty assessed under this section may not
154	161		exceed:
155	162		(1) $5,000 for each violation that is committed
156	163		negligently and that occurs in a single year, regardless of how long
157	164		the violation continues during that year;
158	165		(2) $25,000 for each violation that is committed
159	166		knowingly or intentionally and that occurs in a single year,
160	167		regardless of how long the violation continues during that year; or
161	168		(3) $250,000 for each violation in which the covered
162	169		entity knowingly or intentionally used protected health
163	170		information for financial gain.
164		-	Sec. 183.~~012~~. MEMORANDUM OF UNDERSTANDING; RULES. The
	171	+	Sec. 183.013. MEMORANDUM OF UNDERSTANDING; RULES. The
165	172		executive commissioner, the Texas Medical Board, the Texas
166	173		Department of Licensing and Regulation, the Texas Department of
167	174		Insurance, and each regulatory agency subject to this chapter shall
168	175		enter into a memorandum of understanding and, as necessary, adopt
169	176		rules to implement this chapter.
170	177		SECTION 2. (a) Except as provided by Subsection (b) of this
171	178		section, Chapter 183, Health and Safety Code, as added by this Act,
172	179		applies only to an electronic health record prepared on or after the
173	180		effective date of this Act.
174	181		(b) Section 183.002, Health and Safety Code, as added by
175	182		this Act, applies to the storage of an electronic health record on
176	183		or after January 1, 2026, regardless of the date on which the
177	184		electronic health record was prepared.
178	185		SECTION 3. If before implementing any provision of this Act
179	186		a state agency determines that a waiver or authorization from a
180	187		federal agency is necessary for implementation of that provision,
181	188		the agency affected by the provision shall request the waiver or
182	189		authorization and may delay implementing that provision until the
183	190		waiver or authorization is granted.
184	191		SECTION 4. This Act takes effect September 1, 2025.
	192	+	* * * * *