H.B. No. 4855 seeks to improve patient access to health records and enhance the exchange of health benefit plan information by introducing new provisions to the Business & Commerce Code and Health and Safety Code. The bill specifically addresses "information blocking," making it unlawful for individuals to intentionally violate federal laws regarding this issue. It requires covered entities to comply with the Health Insurance Portability and Accountability Act and federal regulations on information blocking. Patients or their authorized representatives are granted the right to request copies of health records, which must be provided promptly, and the bill outlines the conditions under which fees may be charged for these records. Additionally, civil penalties for violations related to patient access are established, with specific amounts for negligent and intentional violations.

The bill also mandates that health benefit plan issuers create application programming interfaces to facilitate electronic access and exchange of health benefit plan information for patients and healthcare providers. It requires the commissioner to adopt rules that align with standards set by the Centers for Medicare and Medicaid Services (CMS), including compliance with enforcement delays and suspensions. A severability clause is included to ensure that if any part of the Act is invalidated, the remaining provisions remain enforceable. The changes will apply only to violations occurring on or after the effective date of the Act, September 1, 2025, and new provisions in the Insurance Code will apply to health benefit plans delivered or renewed on or after January 1, 2026.

Statutes affected:
Introduced: Commerce Code 15.05, Health and Safety Code 181.001, Health and Safety Code 181.004, Health and Safety Code 181.102, Health and Safety Code 181.201, Health and Safety Code 241.154 (Health and Safety Code 241, Commerce Code 15, Health and Safety Code 181)