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.