89R6209 EAS-F     By: Kolkhorst S.B. No. 1188       A BILL TO BE ENTITLED   AN ACT   relating to electronic health record requirements.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subtitle I, Title 2, Health and Safety Code, is   amended by adding Chapter 183 to read as follows:   CHAPTER 183.  ELECTRONIC HEALTH RECORDS          Sec. 183.001.  DEFINITIONS.  In this chapter:                (1)  "Biological sex" means the biological trait that   determines whether a sexually reproducing organism produces male or   female gametes.                (2)  "Female" means an individual whose reproductive   system is developed to produce ova.                (3)  "Governmental entity" means this state, an agency   of the executive, legislative, or judicial branch of state   government, or a political subdivision of this state. The term   includes a local health department.                (4)  "Health care practitioner" means an individual who   is licensed, certified, or otherwise authorized to provide health   care services in this state.                (5)  "Male" means an individual whose reproductive   system is developed to produce sperm.                (6)  "Medical facility" means:                      (A)  a facility licensed or registered by a state   agency to provide medical care and other health care services; or                      (B)  a health care facility in this state that   provides medical care and other health care services and that   receives reimbursement under the state Medicaid program or receives   any other state funding, including pass-through federal money   provided to a state agency for grant awards.                (7)  "Sexual development disorder" means a congenital   condition associated with atypical development of internal or   external genital structures.  The term includes a chromosomal,   gonadal, and anatomic abnormality.          Sec. 183.002.  REQUIREMENTS FOR ELECTRONIC HEALTH RECORD   STORAGE.  (a)  Each medical facility, health care practitioner, and   governmental entity shall store all electronic health record   information of residents of this state only at a location in the   United States.          (b)  Each medical facility, health care practitioner, and   governmental entity shall ensure electronic health record   information of residents of this state, other than open data, is   inaccessible to any person located outside of the United States.          Sec. 183.003.  REQUIRED MEDICAL HISTORY INFORMATION IN   ELECTRONIC HEALTH RECORD. A medical facility, health care   practitioner, or governmental entity shall ensure each electronic   health record maintained for an individual includes the   individual's medical history and any communications between the   practitioner and a specialty health care practitioner related to   the individual's metabolic health and diet in the treatment of a   chronic disease or illness.          Sec. 183.004.  INFORMATION RESTRICTIONS IN ELECTRONIC   HEALTH RECORD. A medical facility, health care practitioner, or   governmental entity may not collect or store any information   regarding an individual's credit score or voter registration status   in the individual's electronic health record.           Sec. 183.005.  ARTIFICIAL INTELLIGENCE IN ELECTRONIC HEALTH   RECORD. A health care practitioner who uses artificial   intelligence for diagnostic or other purposes, including the use of   artificial intelligence for recommendations on a diagnosis or   course of treatment based on a patient's medical record, shall   review all information obtained through the artificial   intelligence process to ensure the accuracy of the information for   that patient before entering the information in the patient's   electronic health record.          Sec. 183.006.  ACCESS TO ELECTRONIC HEALTH RECORD OF MINOR.   (a)  In this section, "minor" means an individual under 18 years of   age who has not had the disabilities of minority removed for general   purposes.           (b)  A medical facility, health care practitioner, or   governmental entity shall ensure each electronic health record   system the facility, practitioner, or entity uses to store   electronic health records of minors automatically allows a minor's   parent, guardian, or conservator to fully access the minor's   electronic health record unless access to all or a portion of the   record is restricted under state or federal law or by a court order.          Sec. 183.007.  ELECTRONIC HEALTH RECORD REQUIREMENTS   REGARDING BIOLOGICAL SEX.  (a)  Notwithstanding any other law, the   commission, the Texas Medical Board, and the Texas Department of   Insurance shall jointly ensure that:                (1)  each electronic health record prepared or   maintained by a medical facility, health care practitioner, or   governmental entity in this state includes a separate space for the   health care practitioner to document:                      (A)  an individual's biological sex as either male   or female based on the individual's observed biological sex   recorded by a health care practitioner at birth; and                      (B)  information on any sexual development   disorder of the individual, whether identified at birth or later in   the individual's life; and                (2)  any algorithm or decision assistance tool included   in an electronic health record to assist a health care practitioner   in making medical treatment decisions is based on an individual's   biological sex as recorded in the space described by Subdivision   (1)(A).          (b)  This section does not prohibit an electronic health   record from including spaces for recording other information   related to an individual's biological sex or gender identity.          Sec. 183.008.  AMENDING CERTAIN BIOLOGICAL SEX INFORMATION   IN ELECTRONIC HEALTH RECORDS.  (a)  A medical facility, health care   practitioner, or governmental entity may amend on an electronic   health record an individual's biological sex as recorded in the   space described by Section 183.007(a)(1)(A) only if:                (1)  the amendment is to correct a clerical error; or                (2)  the individual is diagnosed with a sexual   development disorder and the amendment changes the individual's   listed biological sex to the opposite biological sex.          (b)  If an individual's biological sex is amended under   Subsection (a)(2), the medical facility, health care practitioner,   or governmental entity shall include in the individual's electronic   health record information on the individual's sexual development   disorder in the space described by Section 183.007(a)(1)(B).          Sec. 183.009.  DISCIPLINARY ACTION BY LICENSING AGENCY;   MEDICAID REIMBURSEMENT INELIGIBILITY.  (a)  The appropriate state   licensing agency may take disciplinary action against a medical   facility or health care practitioner that violates this chapter as   if the medical facility or health care practitioner violated an   applicable licensing law.          (b)  The commission may not provide Medicaid reimbursement   to a medical facility or health care practitioner that violates   this chapter and shall disenroll the medical facility or health   care practitioner from participation as a Medicaid provider.          Sec. 183.010.  RULES.  The commission, the Texas Medical   Board, and the Texas Department of Insurance shall adopt rules as   necessary to implement this chapter.          SECTION 2.  (a)  Except as provided by Subsection (b) of this   section, Chapter 183, Health and Safety Code, as added by this Act,   applies only to an electronic health record prepared on or after the   effective date of this Act.          (b)  Section 183.002, Health and Safety Code, as added by   this Act, applies to the storage of an electronic health record on   or after January 1, 2026, regardless of the date on which the   electronic health record was prepared.          SECTION 3.  This Act takes effect September 1, 2025.