HB 4855 — Relating to a patient's access to health records and access to and exchange of certain health benefit plan information; authorizing a civil penalty; authorizing fees.

Summary

Relating to a patient's access to health records and access to and exchange of certain health benefit plan information; authorizing a civil penalty; authorizing fees.

Bill Text

Compared against the Texas statutes as published AI-generated reading aid — verify against the official bill.

This bill amends 7 section(s) of the Texas statutes: Section 15.05, Commerce Code, Section 181.001(b), Health and Safety Code, Section 181.004(a), Health and Safety Code, Section 181.102, Health and Safety Code, Section 181.105, Section 181.201, Health and Safety Code.

• Section 15.05, Commerce Code

  (a-1) It is unlawful for a person to place a restraint on trade or commerce by intentionally violating federal laws regulating information blocking, as that term is defined by 45 C.F.R. Section 171.103.

  amended

• Section 181.001(b), Health and Safety Code

  (3-a) "Information blocking" has the meaning assigned by 45 C.F.R. Section 171.103.

  amended

• Section 181.004(a), Health and Safety Code

  : (1) ; and (2) federal laws regulating information blocking

  amended

• Section 181.102, Health and Safety Code

  ELECTRONIC (b) (b) (c) Subsection (a) → Subject to the payment of fees required under this section, a patient or the patient's legally authorized representative on request is entitled to copies of the patient's physical or electronic health records. (b) (d) as soon as practicable but (c) Except as provided by Subsection (d) and Section 181.105, a health care provider's violation of federal laws regulating information blocking constitutes a violation of this section. (d) (e) this section (f) A covered entity that receives a request from a patient or the patient's legally authorized representative for a copy of the patient's health records may charge a fee to produce those records in an amount consistent with the requirements under 45 C.F.R. Section 164.524, except a covered entity may not charge an aggregate amount that exceeds $100 to produce the records if: (1) the patient is a Medicaid recipient; or (2) the patient's household income is at or below 200 percent of the federal poverty level. (g) A covered entity shall post in a conspicuous location for patients requesting health records notice of the option to obtain a copy of the patient's health records under Subsection (f). (h) A covered entity may require a patient or the patient's legally authorized representative to submit a written or electronic request for copies of the patient's health records but may not require a patient or the patient's legally authorized representative to submit a request by facsimile. (i) Unless explicitly authorized by state or federal law, a covered entity may not enter into a contract with terms restricting a patient or the patient's legally authorized representative from accessing the patient's health records. Any contract clause or provision that restricts a patient or the patient's legally authorized representative from accessing the patient's health records is unenforceable.

  amended

• Section 181.105

  Sec. 181.105. DISCLOSURE OF SENSITIVE TEST RESULT. (a) In this section, "sensitive test result" means a: (1) pathology or radiology report reasonably likely to show a malignancy; (2) test result revealing a genetic marker; (3) positive test for the human immunodeficiency virus if the patient has not been previously informed of a positive test result for the virus; or (4) result showing a presence of antigens indicating a hepatitis infection. (b) A health care provider may not electronically disclose a sensitive test result to a patient before the third day after the date the results are finalized unless the provider directs the release of the results before that date.

  added

• Section 181.201, Health and Safety Code

  Subsection and → , other than a violation of Section 181.102 Subsections and (g) or information blocking ; (7) the size and geographic location of the covered entity; and (8) the financial impact of the penalty on the covered entity's financial viability and ability to adequately serve an underserved community or population (g) 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 Section 181.102. A civil penalty assessed under this subsection may not exceed: (1) $10,000 for each negligent violation, regardless of the time the violation continues during any year; or (2) $250,000 for each intentional violation committed for the purpose of financial gain, regardless of the time the violation continues during any year. (h) If the court in a pending action under Subsection (g) finds the violations occurred with a frequency constituting a pattern or practice, the court may assess additional civil penalties for each violation.

  amended

• Section 241.154(b), Health and Safety Code

  sum of: (1) a basic retrieval or processing fee, which must include the fee for providing the first 10 pages of the copies and which may not exceed $30; and (A) a charge for each page of: (i) $1 for the 11th through the 60th page of the provided copies; (ii) 50 cents for the 61st through the 400th page of the provided copies; and (iii) 25 cents for any remaining pages of the provided copies; and (B) the actual cost of mailing, shipping, or otherwise delivering the provided copies; (2) if the requested records are stored on microform, a retrieval or processing fee, which must include the fee for providing the first 10 pages of the copies and which may not exceed $45; and (A) $1 per page thereafter; and (B) the actual cost of mailing, shipping, or otherwise delivering the provided copies; or (3) if the requested records are provided on a digital or other electronic medium and the requesting party requests delivery in a digital or electronic medium, including electronic mail: (A) a retrieval or processing fee, which may not exceed $75; and (B) → aggregate amount specified under Section 181.102(f) and

  amended

• CHAPTER 1212. ELECTRONIC ACCESS TO AND EXCHANGE OF CERTAIN HEALTH BENEFIT PLAN INFORMATION Sec. 1212.001. APPLICABILITY OF CHAPTER. (a) This chapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is issued by: (1) an insurance company; (2) a group hospital service corporation operating under Chapter 842; (3) a health maintenance organization operating under Chapter 843; (4) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; (5) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; (6) a stipulated premium company operating under Chapter 884; (7) a fraternal benefit society operating under Chapter 885; (8) a Lloyd's plan operating under Chapter 941; or (9) an exchange operating under Chapter 942. (b) Notwithstanding any other law, this chapter applies to: (1) a basic coverage plan under Chapter 1551; (2) a basic plan under Chapter 1575; (3) a primary care coverage plan under Chapter 1579; and (4) a plan providing basic coverage under Chapter 1601. Sec. 1212.002. CONSTRUCTION OF CHAPTER. This chapter may not be construed to limit the requirements of Chapter 181, Health and Safety Code. Sec. 1212.003. RULEMAKING. The commissioner may adopt rules necessary to implement this chapter. Sec. 1212.004. REQUIRED APPLICATION PROGRAMMING INTERFACES. (a) To facilitate patient and health care provider access to health information, a health benefit plan issuer shall establish and maintain the following application programming interfaces for the benefit of all enrollees and contracted health care providers, as applicable, as if the issuer were a Medicare advantage organization: (1) a patient access interface described by 42 C.F.R. Sections 422.119(a)-(e); (2) a provider directory interface described by 42 C.F.R. Section 422.120; and (3) a payer-to-payer data exchange interface described by 42 C.F.R. Section 422.121(b). (b) In addition to the application programming interfaces described by Subsection (a) and subject to Subsection (c), the commissioner by rule may require a health benefit plan issuer to establish and maintain the following application programming interfaces after the date final rules associated with the interfaces are published by the federal Centers for Medicare and Medicaid Services: (1) a provider access interface; and (2) a prior authorization support interface. (c) In implementing the requirements described by Subsection (b), the commissioner shall adopt rules that conform to: (1) any associated standard published in a final rule issued by the Centers for Medicare and Medicaid Services; and (2) federal effective dates, including enforcement delays and suspension, issued by the Centers for Medicare and Medicaid Services.

  amended

Action History

1. April 03, 2025

   Referred to Public Health

2. April 03, 2025

   Read first time

3. March 13, 2025

   Filed

Sponsors

• Dade Phelan · Primary

Subjects