AI Healthcare Regulations in Texas: 2025–2026 Guide

Texas HB 149, the Texas Responsible Artificial Intelligence Governance Act (TRAIGA), takes effect January 1, 2026. The law provides for civil penalties and involves the Texas Attorney General. Health care providers using AI systems should consult the bill text to determine specific obligations related to discrimination, biometric data, and staff training. Federal laws like HIPAA and FDA regulations continue to apply.

Quick Answer: What Texas AI Healthcare Rules Apply Right Now?

No comprehensive Texas statute governing AI in health care is in force today. This changes on January 1, 2026, when HB 149 (89th Regular Session), the Texas Responsible Artificial Intelligence Governance Act (TRAIGA), becomes effective.

Until then, obligations for Texas health care providers stem from federal law. These include FDA oversight of AI as a medical device, HIPAA privacy and security rules under 45 C.F.R. Parts 160 and 164, FTC Act Section 5 (15 U.S.C. § 45), and the HHS Section 1557 rule on non-discrimination (45 C.F.R. Part 92). These federal rules will continue to apply after TRAIGA takes effect.

What HB 149 adds starting January 1, 2026: The bill addresses several key areas of AI governance. Providers must consult the final text for specific requirements. Based on the legislative record, these areas include:

• Governance of AI systems that may produce discriminatory outcomes (HB 149, 89R, subject: DISCRIMINATION).
• Rules concerning the use of biometric identifiers and voiceprints (HB 149, 89R, subject: BIOMETRIC IDENTIFIERS & VOICEPRINTS).
• Requirements for staff development and training on AI systems (HB 149, 89R, subject: STAFF DEVELOPMENT & TRAINING).
• The establishment of the Texas Artificial Intelligence Council to provide ongoing oversight (HB 149, 89R, subject: ARTIFICIAL INTELLIGENCE COUNCIL, TEXAS).
• Civil penalties for violations, with enforcement involving the Texas Attorney General (HB 149, 89R, title, subject: ATTORNEY GENERAL).

Providers should begin compliance assessments well before the 2026 effective date.

What HB 149 (TRAIGA) Requires: Key Provisions for Health Care Providers

Scope: What Counts as an "AI System"

Consult the bill text for the specific definition of an "AI system." Clinical decision-support tools, diagnostic algorithms, and patient-triage chatbots are likely to fall within the scope. If software recommends a diagnosis, flags a high-risk patient, or routes a patient to a care pathway based on data inference, assume it is covered. Consult health care regulatory counsel to confirm.

For interpretive guidance on specific use cases, consult the Texas Attorney General's consumer protection division.

Transparency and Disclosure Obligations

Providers deploying AI in health care settings should consult the bill text to determine their disclosure obligations to patients. These state-level requirements may intersect with existing informed-consent standards under the Texas Health and Safety Code. Organizations should plan to update consent forms, patient portal language, and intake materials before January 1, 2026.

Non-Discrimination Requirements

HB 149 addresses discriminatory outcomes from AI systems (HB 149, 89R, subject: DISCRIMINATION). Providers must consult the bill text to understand their obligations for preventing and mitigating disparate outcomes based on protected classes. This may require implementing a bias audit methodology.

The HHS Section 1557 final rule (45 C.F.R. Part 92) also requires covered health programs to address discrimination through automated systems. Both state and federal obligations apply. Verify the current litigation status of the Section 1557 rule with counsel.

Biometric Identifier and Voiceprint Restrictions

HB 149 contains provisions related to biometric identifiers and voiceprints (HB 149, 89R, subject: BIOMETRIC IDENTIFIERS & VOICEPRINTS). Texas also has the Capture or Use of Biometric Identifier Act (CUBI), Tex. Bus. & Com. Code Ch. 503. If your AI tools capture voice or other biometric data, both statutes may apply. Consult counsel to map the overlapping requirements.

Vendor and Provider Obligations

Health care providers deploying AI systems should consult the bill text to understand how compliance obligations are allocated between the provider and the AI vendor. Review vendor contracts to ensure they account for any specific duties or representations required under HB 149.

Civil Penalties and Enforcement

HB 149 provides for civil penalties and involves the Texas Attorney General in enforcement (HB 149, 89R, title, subject: ATTORNEY GENERAL). Consult the enrolled bill text for the specific penalty structure and amounts. For information on enforcement priorities, consult the Texas Attorney General's Office.

Exemptions for Small or Rural Providers

The provided source material does not confirm any explicit safe harbors for small or rural providers. Consult the enrolled bill text or the Texas Attorney General's consumer protection division to determine if any tiered requirements or exemptions apply based on an organization's size or setting.

What HB 149 (TRAIGA) Requires: Key Provisions for Health Care Providers

Scope: What Counts as an "AI System"

Consult the bill text for the specific definition of an "AI system." Clinical decision-support tools, diagnostic algorithms, and patient-triage chatbots are likely to fall within the scope. If software recommends a diagnosis, flags a high-risk patient, or routes a patient to a care pathway based on data inference, assume it is covered. Consult health care regulatory counsel to confirm.

For interpretive guidance on specific use cases, consult the Texas Attorney General's consumer protection division.

Transparency and Disclosure Obligations

Providers deploying AI in health care settings should consult the bill text to determine their disclosure obligations to patients. These state-level requirements may intersect with existing informed-consent standards under the Texas Health and Safety Code. Organizations should plan to update consent forms, patient portal language, and intake materials before January 1, 2026.

Non-Discrimination Requirements

HB 149 addresses discriminatory outcomes from AI systems (HB 149, 89R, subject: DISCRIMINATION). Providers must consult the bill text to understand their obligations for preventing and mitigating disparate outcomes based on protected classes. This may require implementing a bias audit methodology.

The HHS Section 1557 final rule (45 C.F.R. Part 92) also requires covered health programs to address discrimination through automated systems. Both state and federal obligations apply. Verify the current litigation status of the Section 1557 rule with counsel.

Biometric Identifier and Voiceprint Restrictions

HB 149 contains provisions related to biometric identifiers and voiceprints (HB 149, 89R, subject: BIOMETRIC IDENTIFIERS & VOICEPRINTS). Texas also has the Capture or Use of Biometric Identifier Act (CUBI), Tex. Bus. & Com. Code Ch. 503. If your AI tools capture voice or other biometric data, both statutes may apply. Consult counsel to map the overlapping requirements.

Vendor and Provider Obligations

Health care providers deploying AI systems should consult the bill text to understand how compliance obligations are allocated between the provider and the AI vendor. Review vendor contracts to ensure they account for any specific duties or representations required under HB 149.

Civil Penalties and Enforcement

HB 149 provides for civil penalties and involves the Texas Attorney General in enforcement (HB 149, 89R, title, subject: ATTORNEY GENERAL). Consult the enrolled bill text for the specific penalty structure and amounts. For information on enforcement priorities, consult the Texas Attorney General's Office.

Exemptions for Small or Rural Providers

The provided source material does not confirm any explicit safe harbors for small or rural providers. Consult the enrolled bill text or the Texas Attorney General's consumer protection division to determine if any tiered requirements or exemptions apply based on an organization's size or setting.

What Changed Recently: 2024–2025 Texas AI Regulatory Activity

HB 149 Legislative Timeline

HB 149 was passed during the 89th Regular Session of the Texas Legislature and signed by the Governor. Its effective date is January 1, 2026 (HB 149, 89R, latest action confirmed June 25, 2025).

Texas Artificial Intelligence Council

HB 149 establishes the Texas Artificial Intelligence Council (HB 149, 89R, subject: ARTIFICIAL INTELLIGENCE COUNCIL, TEXAS). Consult the bill text for the Council's composition, authority, and duties. Monitor the Council's designated state agency home for meeting schedules and guidance publications.

Texas Department of Information Resources (DIR)

DIR is an agency associated with HB 149 (HB 149, 89R, subject: INFORMATION RESOURCES, DEPARTMENT OF). While DIR has published AI governance resources for state agencies, providers should verify any health-sector-specific guidance at the DIR website (dir.texas.gov).

Texas Medical Board and HHSC

As of mid-2025, the Texas Medical Board and the Texas Health and Human Services Commission had not issued separate AI-specific rulemaking. Monitor both agencies for any guidance that could supplement the obligations under HB 149.

Federal Context

Federal oversight remains in effect. This includes the FDA's framework for AI/ML-Based Software as a Medical Device (SaMD), FTC enforcement against deceptive AI health claims under Section 5 (15 U.S.C. § 45), and the HHS Section 1557 non-discrimination rule (45 C.F.R. Part 92). TRAIGA does not supersede these federal laws.

Compliance Requirements by Provider Type: Comparison Table

Analysis is directional. Engage legal counsel for organization-specific advice. Consult enrolled HB 149 text for definitive requirements.

HIPAA Note: An AI vendor processing protected health information for a covered entity is a business associate under 45 C.F.R. Parts 160 and 164. Business Associate Agreements (BAAs) should be reviewed and updated to reflect any new state-law obligations.

Staff Training: HB 149 identifies staff development and training as a compliance area (HB 149, 89R, subject: STAFF DEVELOPMENT & TRAINING). Organizations should document their training programs.

Intersection with Federal AI and Health Data Law

FDA: AI/ML as Software as a Medical Device

If an AI tool meets the FDA's definition of a medical device, it may require federal clearance or authorization under 21 C.F.R. Part 880, independent of HB 149. An FDA-cleared device deployed in Texas must still comply with TRAIGA.

HIPAA and AI: OCR Guidance

Using patient data to train AI models raises compliance questions under the HIPAA Privacy Rule's minimum necessary standard (45 C.F.R. Parts 160 and 164). Data must be properly de-identified before being used for purposes other than those permitted by HIPAA. TRAIGA does not alter these requirements.

FTC Act Section 5

The FTC uses its authority under 15 U.S.C. § 45 to police unfair or deceptive claims about AI health tools. Marketing an AI tool with unsubstantiated claims about its accuracy or failing to disclose AI involvement in a health recommendation creates FTC enforcement risk.

ACA Section 1557 Non-Discrimination Rule

The 2024 HHS final rule under Section 1557 of the ACA (45 C.F.R. Part 92) requires covered health programs to address discrimination in automated decision-making systems. Where the Section 1557 rule and TRAIGA overlap, the stricter standard applies. As of mid-2025, verify the rule's current legal status with counsel.

State vs. Federal Law

TRAIGA may establish requirements that differ from federal law. A preemption analysis is necessary for FDA-regulated devices and HIPAA-covered functions. Consult health care regulatory counsel for a provision-by-provision analysis.

Private Right of Action

Consult the enrolled bill text and guidance from the Texas Attorney General to confirm whether HB 149 allows for a private right of action. Patients may have other avenues for relief under federal statutes. The absence of a private right of action under TRAIGA does not eliminate litigation risk from other sources.

Practical Compliance Checklist for Texas Health Care Organizations

Step 1: AI System Inventory (Complete by Q3 2025) Catalog every AI tool used in clinical, administrative, and patient-facing workflows, including tools embedded in EHRs and other third-party platforms.

Step 2: Vendor Contract Review (Complete by Q3 2025) Review all AI vendor contracts. Confirm HIPAA BAA coverage (45 C.F.R. Parts 160 and 164) and add addenda to address any specific obligations or representations required by HB 149.

Step 3: Assess Non-Discrimination Requirements (Complete by Q4 2025) Review HB 149's provisions on discrimination (HB 149, 89R, subject: DISCRIMINATION). Develop a process to assess AI tools for compliance with these state requirements, in addition to federal obligations under rules like ACA Section 1557.

Step 4: Review Disclosure Requirements (Complete by Q4 2025) Analyze HB 149's disclosure provisions. Update consent forms, patient portal language, and intake materials as needed to comply.

Step 5: Review Biometric Data Policies (Complete by Q4 2025) Identify all AI tools that capture biometric data. Review compliance with HB 149's biometric provisions (HB 149, 89R, subject: BIOMETRIC IDENTIFIERS & VOICEPRINTS) and the Texas CUBI statute (Tex. Bus. & Com. Code Ch. 503).

Step 6: Develop Staff Training Program (Deploy by Q4 2025) Develop and deliver training on AI governance policies to comply with HB 149's staff development obligations (HB 149, 89R, subject: STAFF DEVELOPMENT & TRAINING). Maintain completion logs.

Step 7: Update Incident Response Plan (Complete by Q4 2025) Update plans to include processes for identifying, escalating, and remediating harmful or non-compliant AI outputs. Map these processes to existing HIPAA breach response procedures.

Next Steps and Who to Contact in Texas

Texas Attorney General's Office Handles HB 149 enforcement (HB 149, 89R, subject: ATTORNEY GENERAL). Submit compliance questions through the AG's official portal at texasattorneygeneral.gov.

Texas Artificial Intelligence Council Established by HB 149, the Council is expected to issue guidance. Monitor the Council's meeting schedule and publications via its designated state agency home.

Texas Department of Information Resources (DIR) DIR has AI governance resources that may be relevant (HB 149, 89R, subject: INFORMATION RESOURCES, DEPARTMENT OF). Check for current publications at dir.texas.gov.

Texas Medical Board For physician-specific questions on AI in clinical practice and professional standards, contact the Texas Medical Board at tmb.state.tx.us.

Texas Health and Human Services Commission (HHSC) For Medicaid and state-funded health programs using AI, contact HHSC for program-specific guidance at hhs.texas.gov.

Industry Resources The Texas Hospital Association and Texas Medical Association may publish member resources and model compliance templates as the January 1, 2026 deadline approaches.

Recommended immediate action: Engage health care regulatory counsel with experience in both Texas law and federal health regulations to analyze how HB 149 applies to your organization's specific use of AI.