77R14403 E
By Green, Janek, Delisi H.B. No. 1702
Substitute the following for H.B. No. 1702:
By Delisi C.S.H.B. No. 1702
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to immunizations and the immunization registry.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. The legislature finds that vaccination represents
1-5 an important aspect of public health programs and has been shown to
1-6 be one of the most efficient tools available for suppressing
1-7 disease. Vaccinations protect individuals from certain disease
1-8 and, when combined with appropriate education, help the community
1-9 by reducing the spread of infectious agents. When implemented
1-10 effectively and responsibly, vaccination can provide an overall
1-11 protection for communities.
1-12 SECTION 2. Sections 161.001(b) and (c), Health and Safety
1-13 Code, are amended to read as follows:
1-14 (b) A person who administers or authorizes the
1-15 administration of a vaccine or immunizing agent is not liable or
1-16 responsible for the failure to immunize a child because of the
1-17 failure or refusal of a parent, managing conservator, or guardian
1-18 to consent to the vaccination or immunization required under this
1-19 chapter, including the failure or refusal to consent to the
1-20 immunization because immunization is declined for reasons of
1-21 personal belief or because of a religious belief. Consent to the
1-22 vaccination or immunization must be given in the manner authorized
1-23 by Chapter 32, Family Code.
1-24 (c) A parent, managing conservator, or guardian who fails or
2-1 refuses to consent to the vaccination or immunization required
2-2 under this chapter, including a parent, managing conservator, or
2-3 guardian who fails or refuses to consent to the immunization
2-4 because the immunization is declined for reasons of personal belief
2-5 or religious belief, may not bring a cause of action against any
2-6 person for the other person's failure to immunize the child. [A
2-7 person who fails to comply with Section 161.004 is not liable or
2-8 responsible for that failure, and that failure does not create a
2-9 cause of action.]
2-10 SECTION 3. Section 161.004(d), Health and Safety Code, is
2-11 amended to read as follows:
2-12 (d) A child is exempt from an immunization required by this
2-13 section if:
2-14 (1) [immunization conflicts with the tenets of an
2-15 organized religion to which] a parent, managing conservator, or
2-16 guardian of the child states that the immunization is being
2-17 declined for reasons of personal belief or because of a religious
2-18 belief [belongs]; or
2-19 (2) the immunization is medically contraindicated
2-20 based on an examination of the child by a physician licensed by any
2-21 state in the United States.
2-22 A personal exemption under Subdivision (1) will no longer be
2-23 available if the number of exemptions taken under this section
2-24 exceeds one percent of the total population of children eligible
2-25 for vaccines under the age of five.
2-26 SECTION 4. Section 161.004, Health and Safety Code, is
2-27 amended by adding Subsection (h) to read as follows:
3-1 (h) The department shall develop and implement an outreach
3-2 and education campaign to maximize the number of children who
3-3 receive immunizations required under this section.
3-4 SECTION 5. Subchapter A, Chapter 161, Health and Safety Code,
3-5 is amended by adding Section 161.0045 to read as follows:
3-6 Sec. 161.0045. IMMUNIZATION EXEMPTION AFFIDAVIT FORM. (a)
3-7 The department shall develop and provide an exemption affidavit
3-8 form to a person subject to exclusion from a school or facility
3-9 because the person declines a required immunization for reasons of
3-10 personal belief or because of a religious belief.
3-11 (b) The exemption affidavit form must:
3-12 (1) include a statement of the department's position
3-13 regarding the benefits of immunization;
3-14 (2) include educational information on immunizations
3-15 and a reference to an Internet website, phone number, and other
3-16 contact information for the department that provides additional
3-17 information on the benefits of immunizations and the risks of not
3-18 being immunized;
3-19 (3) include a statement indicating the applicant or,
3-20 if a minor, the applicant's parent, managing conservator, or
3-21 guardian understands the benefits and risks of immunizations and
3-22 the benefits and risks of not being immunized;
3-23 (4) include a statement indicating the applicant or,
3-24 if the applicant is a minor, the applicant's parent, managing
3-25 conservator, or guardian visited with a health care provider or
3-26 physician to discuss the risks and benefits of immunizations and
3-27 the risks and benefits of not being immunized; and
4-1 (5) include contact information for the department
4-2 that may be used to request that a child's name be included in the
4-3 registry and a statement that reads: "If you have chosen not to
4-4 immunize your child for medical reasons or personal or religious
4-5 beliefs, you may wish to have your child's name included in the
4-6 ImmTrac registry. In the event of an outbreak or epidemic, the
4-7 Texas Department of Health will notify you of the outbreak or
4-8 epidemic so that you may take proper precautions to protect your
4-9 child from exposure."
4-10 (c) The department shall make the exemption affidavit form
4-11 available in a printable format on the department's Internet
4-12 website and shall provide the form on request by facsimile
4-13 transmission, mail, or electronic mail.
4-14 SECTION 6. Section 161.007, Health and Safety Code, is
4-15 amended to read as follows:
4-16 Sec. 161.007. IMMUNIZATION REGISTRY; REPORTS TO DEPARTMENT.
4-17 (a) The department, for purposes of establishing and maintaining a
4-18 single repository of accurate, complete, and current immunization
4-19 records to be used in aiding, coordinating, and promoting efficient
4-20 and cost-effective childhood communicable disease prevention and
4-21 control efforts, shall establish and maintain a childhood
4-22 immunization registry. The department by rule shall develop
4-23 guidelines to:
4-24 (1) protect the confidentiality of patients [in
4-25 accordance with Section 5.08, Medical Practice Act (Article 4495b,
4-26 Vernon's Texas Civil Statutes)];
4-27 (2) inform a parent, managing conservator, or guardian
5-1 of each patient about the registry;
5-2 (3) permit [require the written consent of] a parent,
5-3 managing conservator, or guardian of a patient to choose to have
5-4 the patient excluded from [before any information relating to the
5-5 patient is included in] the registry; and
5-6 (4) encourage schools to apply for a Texas Department
5-7 of Health ImmTrac user number to enable an authorized school
5-8 employee to:
5-9 (A) track the immunization records of students
5-10 enrolled at the school and included in the registry; and
5-11 (B) verify whether a child has received the
5-12 required vaccinations [permit a parent, managing conservator, or
5-13 guardian to withdraw consent for the patient to be included in the
5-14 registry].
5-15 (b) Except as provided by Section 161.0071, the [The]
5-16 childhood immunization registry must contain information on the
5-17 immunization history that is obtained by the department under this
5-18 section of each person who is younger than 18 years of age [and for
5-19 whom consent has been obtained in accordance with guidelines
5-20 adopted under Subsection (a). The department shall remove from the
5-21 registry information for any person for whom consent has been
5-22 withdrawn].
5-23 (c) An insurance company, a health maintenance organization,
5-24 or another organization that pays or reimburses a claim for an
5-25 immunization of a person younger than 18 years of age shall provide
5-26 an immunization history to the department. The report shall
5-27 contain the elements prescribed by the department, which may
6-1 include submission in writing, by electronic format, or by voice.
6-2 An insurance company, health maintenance organization, or other
6-3 organization is not required to provide an immunization history to
6-4 the department under this subsection for a person excluded from the
6-5 registry. The department shall consult with entities required to
6-6 report under this section to determine the most efficient and
6-7 cost-effective manner of reporting immunization histories [for whom
6-8 consent has not been obtained in accordance with guidelines adopted
6-9 under Subsection (a) or for whom consent has been withdrawn].
6-10 (d) A health care provider who administers an immunization
6-11 to a person younger than 18 years of age shall provide an
6-12 immunization history to the department unless the immunization
6-13 history is submitted to an insurance company, a health maintenance
6-14 organization, or another organization that pays or reimburses a
6-15 claim for an immunization to a person younger than 18 years of age.
6-16 The report shall contain the elements [be in a format] prescribed
6-17 by the department, which may include submission in writing, by
6-18 electronic means, or by voice. A health care provider is not
6-19 required to provide an immunization history to the department under
6-20 this subsection for a person excluded from the registry. The
6-21 department shall consult with health care providers to determine
6-22 the most efficient and cost-effective manner of reporting
6-23 immunization histories [for whom consent has not been obtained in
6-24 accordance with guidelines adopted under Subsection (a) or for whom
6-25 consent has been withdrawn].
6-26 (e) The department may use the registry to provide notices
6-27 by mail, telephone, personal contact, or other means to a parent,
7-1 managing conservator, or guardian regarding his or her child or
7-2 ward who is due or overdue for a particular type of immunization
7-3 according to the department's immunization schedule. The notice
7-4 must contain instructions for the parent, managing conservator, or
7-5 guardian to request that future notices not be sent and to remove
7-6 the child's immunization record from the registry and any other
7-7 registry-related record that individually identifies the child.
7-8 The notice must describe the procedure to report a violation if a
7-9 child is included in the registry after requesting exclusion. The
7-10 department shall consult with health care providers to determine
7-11 the most efficient and cost-effective manner of using the registry
7-12 to provide those notices.
7-13 (f) Nothing in this subchapter [section] diminishes a
7-14 parent's, managing conservator's, or guardian's responsibility for
7-15 having a child immunized properly, subject to Section 161.004(d).
7-16 (g) A person, including a health care provider or an
7-17 insurance company, a health maintenance organization, or another
7-18 organization that pays or reimburses a claim for immunization, who
7-19 submits or obtains in good faith an immunization history or data to
7-20 or from the department in compliance with the provisions of this
7-21 subchapter [section] and any rules adopted under this subchapter
7-22 [section] is not liable for any civil damages.
7-23 (h) [Information obtained by the department for the
7-24 immunization registry is confidential and may be disclosed only
7-25 with the written consent of the child's parent, managing
7-26 conservator, or guardian.]
7-27 [(i)] The board shall adopt rules to implement this
8-1 subchapter [section].
8-2 (i) To the extent that the confidentiality requirements
8-3 imposed under this subchapter are more stringent than those imposed
8-4 under Chapter 159, Occupations Code, the requirements of this
8-5 subchapter prevail.
8-6 SECTION 7. Subchapter A, Chapter 161, Health and Safety Code,
8-7 is amended by adding Section 161.0071 to read as follows:
8-8 Sec. 161.0071. NOTICE OF RECEIPT OF REGISTRY DATA; EXCLUSION
8-9 FROM REGISTRY. (a) The first time the department receives registry
8-10 data for a child, the department shall send a written notification
8-11 to the child's parent, managing conservator, or guardian
8-12 disclosing:
8-13 (1) that providers and insurers may be sending the
8-14 child's immunization information to the department, but the
8-15 department may not keep the information if the parent, managing
8-16 conservator, or guardian chooses to exclude the child from the
8-17 registry;
8-18 (2) the information that is included in the registry;
8-19 (3) the persons to whom the information may be
8-20 released under Section 161.008(d);
8-21 (4) the purpose and use of the registry;
8-22 (5) the procedure to exclude a child from the
8-23 registry; and
8-24 (6) the procedure to report a violation if a parent,
8-25 managing conservator, or guardian discovers a child is included in
8-26 the registry after exclusion has been requested.
8-27 (b) The department shall delete the child's immunization
9-1 records from the registry and any other registry-related department
9-2 record that individually identifies the child, not later than the
9-3 30th day after the date the department receives from the parent,
9-4 managing conservator, or guardian of the child a written request
9-5 that the child be excluded from the registry. The department shall
9-6 maintain only those records related to the child necessary to
9-7 ensure that the child continues to be excluded from the registry
9-8 and may not release the identity of a child excluded from the
9-9 registry.
9-10 (c) The department shall send to a parent, managing
9-11 conservator, or guardian who makes a written request under
9-12 Subsection (b) a written confirmation of receipt of the request
9-13 for exclusion and the exclusion of the child's records from the
9-14 registry.
9-15 (d) The department commits a violation if the department
9-16 fails to exclude a child from the registry within the period
9-17 required by Subsection (b).
9-18 (e) The department shall accept any written indication from
9-19 a parent, managing conservator, or guardian communicating to the
9-20 department that a child should be excluded from the registry,
9-21 including a statement on the child's birth certificate, as a
9-22 request for exclusion under Subsection (b).
9-23 SECTION 8. Subchapter A, Chapter 161, Health and Safety Code,
9-24 is amended by adding Section 161.0072 to read as follows:
9-25 Sec. 161.0072. REGISTRY CONFIDENTIALITY. (a) The
9-26 information that individually identifies a child received by the
9-27 department for the immunization registry is confidential and may be
10-1 used by the department for registry purposes only.
10-2 (b) Unless specifically authorized under this subchapter,
10-3 the department may not release registry information to any
10-4 individual or entity without the consent of the person or, if a
10-5 minor, the parent, managing conservator, or guardian of the child.
10-6 (c) A person required to report information to the
10-7 department for registry purposes or authorized to receive
10-8 information from the registry may not disclose the individually
10-9 identifiable information to any other person without written
10-10 consent of the parent, managing conservator, or guardian of the
10-11 child, except as provided by Chapter 159, Occupations Code.
10-12 (d) Registry information is not:
10-13 (1) subject to discovery, subpoena, or other means of
10-14 legal compulsion for release to any person or entity except as
10-15 provided by this subchapter; or
10-16 (2) admissible in any civil, administrative, or
10-17 criminal proceeding.
10-18 SECTION 9. Subchapter A, Chapter 161, Health and Safety Code,
10-19 is amended by adding Section 161.0075 to read as follows:
10-20 Sec. 161.0075. REPORT TO LEGISLATURE. (a) The department
10-21 shall report to the Legislative Budget Board, the governor, the
10-22 lieutenant governor, the speaker of the house of representatives,
10-23 and appropriate committees of the legislature not later than
10-24 September 30 of each even-numbered year.
10-25 (b) The department shall use the report required under
10-26 Subsection (a) to develop ways to increase immunization rates using
10-27 state and federal resources.
11-1 (c) The report must:
11-2 (1) include the current immunization rates by
11-3 geographic region of the state, where available;
11-4 (2) focus on the geographic regions of the state with
11-5 immunization rates below the state average for preschool children;
11-6 (3) describe the approaches identified to increase
11-7 immunization rates in underserved areas and the estimated cost for
11-8 each;
11-9 (4) identify changes to department procedures needed
11-10 to increase immunization rates;
11-11 (5) identify the services provided under and
11-12 provisions of contracts entered into by the department to increase
11-13 immunization rates in underserved areas;
11-14 (6) identify performance measures used in contracts
11-15 described by Subdivision (5);
11-16 (7) include the number and type of exemptions used in
11-17 the past year;
11-18 (8) include the number of complaints received by the
11-19 department related to the department's failure to comply with
11-20 requests for exclusion of individuals from the registry; and
11-21 (9) identify all reported incidents of discrimination
11-22 for requesting exclusion from the registry or for using an
11-23 exemption for a required immunization.
11-24 SECTION 10. Section 161.008, Health and Safety Code, is
11-25 amended by amending Subsections (c) and (d) and adding Subsections
11-26 (e)-(h) to read as follows:
11-27 (c) The department[, only with the consent of a child's
12-1 parent, managing conservator, or guardian,] may[:]
12-2 [(1)] obtain the data constituting an immunization
12-3 record for the child from a public health district, a local health
12-4 department, an insurance company, a health maintenance
12-5 organization, or any other organization that pays or reimburses a
12-6 claim for immunization, or any physician, health care professional,
12-7 or health care facility personnel licensed or otherwise authorized
12-8 to administer vaccines.
12-9 (d) After the 30th day after the date notice was sent by the
12-10 department to the child's parent, managing conservator, or guardian
12-11 under Section 161.0071, the department, if the department has not
12-12 received a written request to exclude the child from the registry,
12-13 may:
12-14 (1) enter the child into the registry; and [or a
12-15 physician to the child; or]
12-16 (2) release the data constituting an immunization
12-17 record for the child to any entity in this state that is described
12-18 by Subsection (c) and is providing immunization services to the
12-19 child or is paying or reimbursing a claim for an immunization for
12-20 the child or to [a public health district, a local health
12-21 department, a physician to the child, or] a school or child care
12-22 facility in which the child is enrolled.
12-23 (e) [(d)] A parent, managing conservator, or legal guardian
12-24 may obtain and on request to the department shall be provided with
12-25 all individually identifiable immunization registry information
12-26 concerning his or her child or ward.
12-27 (f) The department may release nonidentifying summary
13-1 statistics related to the registry that do not individually
13-2 identify a child.
13-3 (g) The department may not release individually identifiable
13-4 information under Subsection (d)(2) to an entity outside of this
13-5 state.
13-6 (h) The department shall develop a secure Internet-based
13-7 system to allow a school that has obtained an ImmTrac user number
13-8 to verify whether a child has received the vaccinations required by
13-9 Sections 38.001 and 51.933, Education Code. Except as provided by
13-10 board rules, a school that obtains an ImmTrac user number for this
13-11 purpose may not require verification of vaccination of a child from
13-12 the child's parent, managing conservator, or guardian.
13-13 SECTION 11. Section 161.009(a), Health and Safety Code, is
13-14 amended to read as follows:
13-15 (a) A person commits an offense if the person:
13-16 (1) negligently releases or discloses immunization
13-17 registry information in violation of Section 161.007, 161.0071,
13-18 161.0072, or 161.008; or
13-19 (2) negligently uses the information in the
13-20 immunization registry to solicit new patients or clients or for
13-21 other purposes that are not associated with immunization purposes,
13-22 unless authorized under this section.
13-23 SECTION 12. Section 38.001, Education Code, is amended by
13-24 amending Subsection (c) and adding Subsections (f) and (g) to read
13-25 as follows:
13-26 (c) Immunization is not required for a person's admission to
13-27 any elementary or secondary school if the person applying for
14-1 admission:
14-2 (1) submits, on request, to the admitting official:
14-3 (A) an affidavit or a certificate signed by a
14-4 physician who is duly registered and licensed to practice medicine
14-5 in the United States, in which it is stated that, in the
14-6 physician's opinion, the immunization required would be injurious
14-7 to the health and well-being of the applicant or any member of the
14-8 applicant's family or household; or
14-9 (B) a form provided by the Texas Department of
14-10 Health in accordance with Section 161.0045, Health and Safety Code,
14-11 [an affidavit] signed by the applicant or, if a minor, by the
14-12 applicant's parent or guardian, and notarized, stating that the
14-13 applicant declines a required immunization for reasons of personal
14-14 belief or because of a religious belief [conflicts with the tenets
14-15 and practice of a recognized church or religious denomination of
14-16 which the applicant is an adherent or member], except that an
14-17 applicant admitted to a school without a required immunization
14-18 under this subdivision is subject to exclusion from the school
14-19 [this exemption does not apply] in times of emergency or epidemic
14-20 declared by the commissioner of public health; or
14-21 (2) is a member of the armed forces of the United
14-22 States and is on active duty.
14-23 (f) An admitting official of a school may not request the
14-24 submission of an affidavit, certificate, or form under Subsection
14-25 (c) more than once each year.
14-26 (g) A school may not provide to a parent, managing
14-27 conservator, or guardian the exemption affidavit form required by
15-1 Section 161.0045, Health and Safety Code. A notary may not
15-2 notarize the form on school premises.
15-3 SECTION 13. Section 38.002(a), Education Code, is amended to
15-4 read as follows:
15-5 (a) Each public school shall keep an individual immunization
15-6 record or a record of the number and type of exemptions as
15-7 permitted under Section 38.001(c) during the period of attendance
15-8 for each student admitted. The school shall annually submit a
15-9 report on a form prescribed by the Texas Department of Health to
15-10 the department stating the number and type of exemptions on file
15-11 for children who are attending the school and exercising the
15-12 exemption. The report may not include individually identifiable
15-13 information. The report must include the total student enrollment
15-14 on campus. The records shall be open for inspection at all
15-15 reasonable times by the Texas Education Agency or by
15-16 representatives of local health departments or the Texas Department
15-17 of Health.
15-18 SECTION 14. Section 51.933, Education Code, is amended by
15-19 amending Subsection (d) and adding Subsection (f) to read as
15-20 follows:
15-21 (d) Immunization [No form of immunization] is not required
15-22 for a person's admission to an institution of higher education if
15-23 the person applying for admission:
15-24 (1) submits, on request, to the admitting official:
15-25 (A) an affidavit or a certificate signed by a
15-26 physician who is duly registered and licensed to practice medicine
15-27 within the United States in which it is stated that, in the
16-1 physician's opinion, the immunization required would be injurious
16-2 to the health and well-being of the applicant or any member of the
16-3 applicant's family or household; or
16-4 (B) a form provided by the Texas Department of
16-5 Health in accordance with Section 161.0045, Health and Safety Code,
16-6 [an affidavit] signed by the applicant or, if a minor, by the
16-7 applicant's parent or guardian, and notarized, stating that the
16-8 applicant declines a required immunization for reasons of personal
16-9 belief or because of a religious belief, except that an applicant
16-10 admitted to an institution without a required immunization under
16-11 this subdivision is subject to exclusion from the institution in
16-12 times of emergency or epidemic declared by the commissioner of
16-13 public health [conflicts with the tenets and practice of a
16-14 recognized church or religious denomination of which the applicant
16-15 is an adherent or member]; or
16-16 (2) is a member of the armed forces of the United
16-17 States and is on active duty.
16-18 (f) An admitting official of an institution of higher
16-19 education may not request an affidavit, certificate, or form under
16-20 Subsection (d) more than once each year.
16-21 SECTION 15. Section 42.043(d), Human Resources Code, is
16-22 amended to read as follows:
16-23 (d) A facility may refuse admission to a child who has not
16-24 received a required immunization. Immunization is not [No
16-25 immunization may be] required for admission to a facility regulated
16-26 under this chapter if a person applying for a child's admission
16-27 submits, on request, one of the following [affidavits]:
17-1 (1) an affidavit signed by a [licensed] physician who
17-2 is duly registered and licensed to practice medicine in the United
17-3 States in which it is stated [stating] that in the physician's
17-4 opinion the immunization would be injurious to the health and
17-5 well-being of the child or a member of the child's family or
17-6 household; or
17-7 (2) a form provided by the Texas Department of Health
17-8 in accordance with Section 161.0045, Health and Safety Code, [an
17-9 affidavit] signed by the child's parent or guardian, and notarized,
17-10 stating that the applicant declines a required immunization for
17-11 reasons of personal belief or because of a religious belief, except
17-12 that an applicant admitted to a facility without a required
17-13 immunization under this subdivision is subject to exclusion from
17-14 the facility in times of emergency or epidemic declared by the
17-15 commissioner of public health [conflicts with the tenets and
17-16 practices of a recognized religious organization of which the
17-17 applicant is an adherent or a member].
17-18 SECTION 16. (a) As soon as practicable, but not later than
17-19 August 1, 2002, the Texas Board of Health shall:
17-20 (1) adopt rules necessary to implement the procedure
17-21 for excluding children from the immunization registry required by
17-22 this Act; and
17-23 (2) make available for use a form for requesting
17-24 exclusion from the immunization registry required under Section
17-25 161.0071, Health and Safety Code, as added by this Act.
17-26 (b) As soon as practicable, but not later than November 1,
17-27 2001, the Texas Board of Health shall make available for use the
18-1 form for exemption from immunizations required under Section
18-2 161.0045, Health and Safety Code, as added by this Act.
18-3 (c) The report required under Section 161.007(c), Health and
18-4 Safety Code, as amended by this Act, and the data obtained or
18-5 released under Section 161.008, Health and Safety Code, as amended
18-6 by this Act, may not be accepted or released by the Texas
18-7 Department of Health until the department has adopted rules and
18-8 prescribed the forms required by this Act.
18-9 SECTION 17. This Act takes effect immediately if it receives
18-10 a vote of two-thirds of all the members elected to each house, as
18-11 provided by Section 39, Article III, Texas Constitution. If this
18-12 Act does not receive the vote necessary for immediate effect, this
18-13 Act takes effect September 1, 2001.