By Green H.B. No. 1702
77R6538 YDB-F
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. Subtitle E, Title 2, Health and Safety Code, is
1-5 amended by adding Chapter 110 to read as follows:
1-6 CHAPTER 110. TEXAS IMMUNIZATION ADVISORY COMMITTEE
1-7 Sec. 110.001. DEFINITION. In this chapter, "committee" means
1-8 the Texas immunization advisory committee.
1-9 Sec. 110.002. COMMITTEE ESTABLISHED. The Texas immunization
1-10 advisory committee is established to assist the board and the
1-11 department in the development of procedures, guidelines, and
1-12 policies related to immunizations in this state.
1-13 Sec. 110.003. COMPOSITION OF COMMITTEE. The committee is
1-14 composed of the following 13 members appointed by the board as
1-15 follows:
1-16 (1) one registered nurse;
1-17 (2) one epidemiologist;
1-18 (3) one school board official;
1-19 (4) one local health official;
1-20 (5) one physician who is a representative of organized
1-21 medicine;
1-22 (6) one physician who is a practicing family
1-23 physician;
1-24 (7) one physician who is a practicing pediatrician;
2-1 (8) one pharmacist;
2-2 (9) one representative from a pharmaceutical company
2-3 that manufactures vaccines administered in this state;
2-4 (10) two parents with children who are residents of
2-5 this state and who are not, and whose immediate family members are
2-6 not, affiliated with a business related to immunizations;
2-7 (11) one parent who is a representative of an
2-8 organization advocating informed consent for immunizations; and
2-9 (12) one parent of a child who has been compensated by
2-10 the National Vaccine Injury Compensation Program established under
2-11 42 U.S.C. Section 300aa-10, as amended.
2-12 Sec. 110.004. DUTIES. The committee shall:
2-13 (1) evaluate the existing immunization program
2-14 operated by the department and identify needs not met by the
2-15 program;
2-16 (2) review the goals and targets of the program;
2-17 (3) evaluate ongoing program efforts;
2-18 (4) recommend both short-term and long-term goals and
2-19 objectives for the immunization program;
2-20 (5) review and evaluate immunization requirements and
2-21 exemptions; and
2-22 (6) carry out any other tasks given to the committee
2-23 by the board.
2-24 SECTION 2. Section 161.001(b), Health and Safety Code, is
2-25 amended to read as follows:
2-26 (b) A person who administers or authorizes the
2-27 administration of a vaccine or immunizing agent is not liable or
3-1 responsible for the failure to immunize a child because of the
3-2 failure or refusal of a parent, managing conservator, or guardian
3-3 to consent to the vaccination or immunization required under this
3-4 chapter, including the failure or refusal to consent to the
3-5 immunization because immunization is declined for reasons of
3-6 conscience or because of a religious belief. Consent to the
3-7 vaccination or immunization must be given in the manner authorized
3-8 by Chapter 32, Family Code.
3-9 SECTION 3. Section 161.004(d), Health and Safety Code, is
3-10 amended to read as follows:
3-11 (d) A child is exempt from an immunization required by this
3-12 section if:
3-13 (1) [immunization conflicts with the tenets of an
3-14 organized religion to which] a parent, managing conservator, or
3-15 guardian of the child states that the immunization is being
3-16 declined for reasons of conscience or because of a religious belief
3-17 [belongs]; or
3-18 (2) the immunization is medically contraindicated
3-19 based on an examination of the child by a physician licensed by any
3-20 state in the United States.
3-21 SECTION 4. Subchapter A, Chapter 161, Health and Safety Code,
3-22 is amended by adding Section 161.0045 to read as follows:
3-23 Sec. 161.0045. IMMUNIZATION EXEMPTION FORM. (a) The
3-24 department shall develop and provide an exemption form to a person
3-25 subject to exclusion from a school or facility because the person
3-26 declines a required immunization for reasons of conscience or
3-27 because of a religious belief.
4-1 (b) The exemption form must:
4-2 (1) include a statement of the department's position
4-3 regarding the benefits of immunization;
4-4 (2) include educational information on immunizations
4-5 and a reference to an Internet website, phone number, and other
4-6 contact information for the department that provides additional
4-7 information on the benefits of immunizations and the risks of not
4-8 being immunized; and
4-9 (3) include a statement indicating the applicant, or
4-10 if a minor, the applicant's parent, managing conservator, or
4-11 guardian understands the benefits of immunizations and the risks of
4-12 not being immunized.
4-13 (c) The department shall make the exemption form available
4-14 in a printable format on the department's Internet website and
4-15 shall provide the form on request by facsimile transmission, mail,
4-16 or electronic mail.
4-17 SECTION 5. Section 161.007, Health and Safety Code, is
4-18 amended to read as follows:
4-19 Sec. 161.007. IMMUNIZATION REGISTRY; REPORTS TO DEPARTMENT.
4-20 (a) The department, for purposes of establishing and maintaining a
4-21 single repository of accurate, complete, and current immunization
4-22 records to be used in aiding, coordinating, and promoting efficient
4-23 and cost-effective childhood communicable disease prevention and
4-24 control efforts, shall establish and maintain a childhood
4-25 immunization registry. The department by rule shall develop
4-26 guidelines to:
4-27 (1) protect the confidentiality of patients in
5-1 accordance with Chapter 159, Occupations Code [Section 5.08,
5-2 Medical Practice Act (Article 4495b, Vernon's Texas Civil
5-3 Statutes)];
5-4 (2) inform a parent, managing conservator, or guardian
5-5 of each patient about the registry; and
5-6 (3) permit [require the written consent of] a parent,
5-7 managing conservator, or guardian of a patient to choose to have
5-8 the patient excluded from [before any information relating to the
5-9 patient is included in] the registry[; and]
5-10 [(4) permit a parent, managing conservator, or
5-11 guardian to withdraw consent for the patient to be included in the
5-12 registry].
5-13 (b) Except as provided by Section 161.0071, the [The]
5-14 childhood immunization registry must contain information on the
5-15 immunization history that is obtained by the department under this
5-16 section of each person who is younger than 18 years of age [and for
5-17 whom consent has been obtained in accordance with guidelines
5-18 adopted under Subsection (a). The department shall remove from the
5-19 registry information for any person for whom consent has been
5-20 withdrawn].
5-21 (c) An insurance company, a health maintenance organization,
5-22 or another organization that pays or reimburses a claim for an
5-23 immunization of a person younger than 18 years of age shall provide
5-24 an immunization history to the department. The report shall be in
5-25 a format prescribed by the department, which may include submission
5-26 in writing, by electronic format, or by voice. An insurance
5-27 company, health maintenance organization, or other organization is
6-1 not required to provide an immunization history to the department
6-2 under this subsection for a person excluded from the registry. The
6-3 department shall consult with entities required to report under
6-4 this section to determine the most efficient and cost-effective
6-5 manner of reporting immunization histories [for whom consent has
6-6 not been obtained in accordance with guidelines adopted under
6-7 Subsection (a) or for whom consent has been withdrawn].
6-8 (d) A health care provider who administers an immunization
6-9 to a person younger than 18 years of age shall provide an
6-10 immunization history to the department unless the immunization
6-11 history is submitted to an insurance company, a health maintenance
6-12 organization, or another organization that pays or reimburses a
6-13 claim for an immunization to a person younger than 18 years of age.
6-14 The report shall be in a format prescribed by the department, which
6-15 may include submission in writing, by electronic means, or by
6-16 voice. A health care provider is not required to provide an
6-17 immunization history to the department under this subsection for a
6-18 person excluded from the registry. The department shall consult
6-19 with health care providers to determine the most efficient and
6-20 cost-effective manner of reporting immunization histories [for whom
6-21 consent has not been obtained in accordance with guidelines adopted
6-22 under Subsection (a) or for whom consent has been withdrawn].
6-23 (e) The department may use the registry to provide notices
6-24 by mail, telephone, personal contact, or other means to a parent,
6-25 managing conservator, or guardian regarding his or her child or
6-26 ward who is due or overdue for a particular type of immunization
6-27 according to the department's immunization schedule. The notice
7-1 must contain instructions for the parent, managing conservator, or
7-2 guardian to request that future notices not be sent and to remove
7-3 the child's immunization record from the registry and all
7-4 department files. The notice must describe the procedure to report
7-5 a violation if a child is included in the registry after requesting
7-6 exclusion. The department shall consult with health care providers
7-7 to determine the most efficient and cost-effective manner of using
7-8 the registry to provide those notices.
7-9 (f) Nothing in this subchapter [section] diminishes a
7-10 parent's, managing conservator's, or guardian's responsibility for
7-11 having a child immunized properly, subject to Section 161.004(d).
7-12 (g) A person, including a health care provider, who submits
7-13 or obtains in good faith an immunization history or data to or from
7-14 the department in compliance with the provisions of this subchapter
7-15 [section] and any rules adopted under this subchapter [section] is
7-16 not liable for any civil damages.
7-17 (h) [Information obtained by the department for the
7-18 immunization registry is confidential and may be disclosed only
7-19 with the written consent of the child's parent, managing
7-20 conservator, or guardian.]
7-21 [(i)] The board shall adopt rules to implement this
7-22 subchapter [section].
7-23 SECTION 6. Subchapter A, Chapter 161, Health and Safety Code,
7-24 is amended by adding Section 161.0071 to read as follows:
7-25 Sec. 161.0071. NOTICE OF RECEIPT OF REGISTRY DATA; EXCLUSION
7-26 FROM REGISTRY. (a) The first time the department receives data for
7-27 a child, the department shall send a written notification to the
8-1 child's parent, managing conservator, or guardian disclosing:
8-2 (1) that providers and insurers may be sending the
8-3 child's immunization information to the department, but the
8-4 department may not keep the information if the parent, managing
8-5 conservator, or guardian chooses to exclude the child from the
8-6 registry;
8-7 (2) the information that is included in the registry;
8-8 (3) the persons to whom the information may be
8-9 released under Section 161.008(d);
8-10 (4) the purpose and use of the registry;
8-11 (5) the procedure to exclude a child from the
8-12 registry; and
8-13 (6) the procedure to report a violation if a parent,
8-14 managing conservator, or guardian discovers a child is included in
8-15 the registry after exclusion has been requested.
8-16 (b) The department shall destroy all of a child's
8-17 immunization records in the possession of the department and shall
8-18 delete the child's immunization records from the registry and any
8-19 other registry-related department record that individually
8-20 identifies the child, not later than the 30th day after the date
8-21 the department receives from the parent, managing conservator, or
8-22 guardian of the child a written request that the child be excluded
8-23 from the registry. The department shall maintain only those
8-24 records related to the child necessary to ensure that the child
8-25 continues to be excluded from the registry.
8-26 (c) The department shall send to a parent, managing
8-27 conservator, or guardian who makes a written request under
9-1 Subsection (b) a written confirmation of receipt of the request
9-2 for exclusion and the exclusion of the child's records from the
9-3 registry.
9-4 (d) The department commits a violation if the department
9-5 fails to exclude a child from the registry within the period
9-6 required by Subsection (b).
9-7 (e) A parent, managing conservator, or guardian may request
9-8 that the birth certificate of a child be excluded from the
9-9 registry.
9-10 (f) The department shall accept any written indication from
9-11 a parent, managing conservator, or guardian communicating to the
9-12 department that a child should be excluded from the registry,
9-13 including a statement on the child's birth certificate, as a
9-14 request for exclusion under Subsection (b).
9-15 SECTION 7. Subchapter A, Chapter 161, Health and Safety Code,
9-16 is amended by adding Section 161.0072 to read as follows:
9-17 Sec. 161.0072. REGISTRY CONFIDENTIALITY. (a) The
9-18 information that individually identifies a child received by the
9-19 department for the immunization registry is confidential and may be
9-20 used by the department for registry purposes only.
9-21 (b) Unless specifically authorized under this subchapter,
9-22 the department may not release registry information to any
9-23 individual or entity without the consent of the person, or if a
9-24 minor, the parent, managing conservator, or guardian of the child.
9-25 (c) A person required to report information to the
9-26 department for registry purposes or authorized to receive
9-27 information from the registry, may not disclose the individually
10-1 identifiable information to any other person without written
10-2 consent of the parent, managing conservator, or guardian of the
10-3 child, except as provided by Chapter 159, Occupations Code.
10-4 (d) Registry information is not:
10-5 (1) subject to discovery, subpoena, or other means of
10-6 legal compulsion for release to any person or entity except as
10-7 provided by this subchapter; or
10-8 (2) admissible in any civil, administrative, or
10-9 criminal proceeding.
10-10 SECTION 8. Subchapter A, Chapter 161, Health and Safety Code,
10-11 is amended by adding Section 161.0075 to read as follows:
10-12 Sec. 161.0075. REPORT TO LEGISLATURE. (a) The department
10-13 shall report to the Legislative Budget Board and the governor not
10-14 later than September 30 of each even-numbered year.
10-15 (b) The department shall use the report required under
10-16 Subsection (a) to develop ways to increase immunization rates using
10-17 state and federal resources.
10-18 (c) The report must:
10-19 (1) include the current immunization rates by
10-20 geographic region of the state, where available;
10-21 (2) focus on the geographic regions of the state with
10-22 immunization rates below the state average for preschool children;
10-23 (3) describe the approaches identified to increase
10-24 immunization rates in underserved areas and the estimated cost for
10-25 each;
10-26 (4) identify changes to department procedures needed
10-27 to increase immunization rates;
11-1 (5) identify the services provided under and
11-2 provisions of contracts entered into by the department to increase
11-3 immunization rates in underserved areas;
11-4 (6) identify performance measures used in contracts
11-5 described by Subdivision (5);
11-6 (7) include the number and type of exemptions used in
11-7 the past year;
11-8 (8) include the number of complaints received by the
11-9 department related to the department's failure to comply with
11-10 requests for exclusion of individuals from the registry; and
11-11 (9) identify all reported incidents of discrimination
11-12 for requesting exclusion from the registry.
11-13 SECTION 9. Section 161.008, Health and Safety Code, is
11-14 amended by amending Subsections (c) and (d) and adding Subsections
11-15 (e) and (f) to read as follows:
11-16 (c) The department[, only with the consent of a child's
11-17 parent, managing conservator, or guardian,] may[:]
11-18 [(1)] obtain the data constituting an immunization
11-19 record for the child from a public health district, a local health
11-20 department, an insurance company, a health maintenance
11-21 organization, or any other organization that pays or reimburses a
11-22 claim for immunization, or any physician, health care professional,
11-23 or health care facility personnel licensed or otherwise authorized
11-24 to administer vaccines.
11-25 (d) After the 30th day after the date notice was sent by the
11-26 department to the child's parent, managing conservator, or guardian
11-27 under Section 161.0071, the department, if the department has not
12-1 received a written request to exclude the child from the registry,
12-2 may:
12-3 (1) enter the child into the registry; and [or a
12-4 physician to the child; or]
12-5 (2) release the data constituting an immunization
12-6 record for the child to any entity in this state that is described
12-7 by Subsection (c) and is providing immunization services to the
12-8 child or to [a public health district, a local health department, a
12-9 physician to the child, or] a school or child care facility in
12-10 which the child is enrolled.
12-11 (e) [(d)] A parent, managing conservator, or legal guardian
12-12 may obtain and on request to the department shall be provided with
12-13 all individually identifiable immunization registry information
12-14 concerning his or her child or ward.
12-15 (f) The department may release nonidentifying summary
12-16 statistics related to the registry that do not individually
12-17 identify a child.
12-18 SECTION 10. Section 38.001, Education Code, is amended by
12-19 amending Subsection (c) and adding Subsection (f) to read as
12-20 follows:
12-21 (c) Immunization is not required for a person's admission to
12-22 any elementary or secondary school if the person applying for
12-23 admission:
12-24 (1) submits, on request, to the admitting official:
12-25 (A) an affidavit, [or a certificate] signed by a
12-26 physician who is duly registered and licensed to practice medicine
12-27 in the United States, in which it is stated that, in the
13-1 physician's opinion, the immunization required is medically
13-2 contraindicated based on an examination of the child [would be
13-3 injurious to the health and well-being of the applicant or any
13-4 member of the applicant's family or household]; or
13-5 (B) a form provided by the Texas Department of
13-6 Health in accordance with Section 161.0045, Health and Safety Code,
13-7 [an affidavit] signed by the applicant or, if a minor, by the
13-8 applicant's parent or guardian, and notarized, stating that the
13-9 applicant declines a required immunization for reasons of
13-10 conscience or because of a religious belief [conflicts with the
13-11 tenets and practice of a recognized church or religious
13-12 denomination of which the applicant is an adherent or member],
13-13 except that an applicant admitted to a school without a required
13-14 immunization under this subdivision is subject to exclusion from
13-15 the school [this exemption does not apply] in times of emergency or
13-16 epidemic declared by the commissioner of public health; or
13-17 (2) is a member of the armed forces of the United
13-18 States and is on active duty.
13-19 (f) An admitting official of a school may not request the
13-20 submission of an affidavit or form under Subsection (c) more than
13-21 once each year.
13-22 SECTION 11. Section 38.002(a), Education Code, is amended to
13-23 read as follows:
13-24 (a) Each public school shall keep an individual immunization
13-25 record or a record of personal or religious exemption as permitted
13-26 under Section 38.001(c) during the period of attendance for each
13-27 student admitted. The school shall submit a report annually to the
14-1 Texas Department of Health stating the number and type of
14-2 exemptions on file for children who are attending the school and
14-3 exercising the exemption. The records shall be open for inspection
14-4 at all reasonable times by the Texas Education Agency or by
14-5 representatives of local health departments or the Texas Department
14-6 of Health.
14-7 SECTION 12. Section 51.933, Education Code, is amended by
14-8 amending Subsection (d) and adding Subsection (f) to read as
14-9 follows:
14-10 (d) Immunization [No form of immunization] is not required
14-11 for a person's admission to an institution of higher education if
14-12 the person applying for admission:
14-13 (1) submits, on request, to the admitting official:
14-14 (A) an affidavit, [or a certificate] signed by a
14-15 physician who is duly registered and licensed to practice medicine
14-16 within the United States in which it is stated that, in the
14-17 physician's opinion, the immunization required is medically
14-18 contraindicated based on an examination of the person [would be
14-19 injurious to the health and well-being of the applicant or any
14-20 member of the applicant's family or household]; or
14-21 (B) a form provided by the Texas Department of
14-22 Health in accordance with Section 161.0045, Health and Safety Code,
14-23 [an affidavit] signed by the applicant or, if a minor, by the
14-24 applicant's parent or guardian, and notarized, stating that the
14-25 applicant declines a required immunization for reasons of
14-26 conscience or because of a religious belief, except that an
14-27 applicant admitted to an institution without a required
15-1 immunization under this subdivision is subject to exclusion from
15-2 the institution in times of emergency or epidemic declared by the
15-3 commissioner of public health [conflicts with the tenets and
15-4 practice of a recognized church or religious denomination of which
15-5 the applicant is an adherent or member]; or
15-6 (2) is a member of the armed forces of the United
15-7 States and is on active duty.
15-8 (f) An admitting official of an institution of higher
15-9 education may not request an affidavit or form under Subsection (d)
15-10 more than once each year.
15-11 SECTION 13. Section 42.043(d), Human Resources Code, is
15-12 amended to read as follows:
15-13 (d) A facility may refuse admission to a child who has not
15-14 received the required immunization. Immunization is not [No
15-15 immunization may be] required for admission to a facility regulated
15-16 under this chapter if a person applying for a child's admission
15-17 submits, on request, one of the following [affidavits]:
15-18 (1) an affidavit signed by a [licensed] physician who
15-19 is duly registered and licensed to practice medicine in the United
15-20 States in which it is stated [stating] that in the physician's
15-21 opinion the immunization required is medically contraindicated
15-22 based on an examination of the child [would be injurious to the
15-23 health and well-being of the child or a member of the child's
15-24 family or household]; or
15-25 (2) a form provided by the Texas Department of Health
15-26 in accordance with Section 161.0045, Health and Safety Code, [an
15-27 affidavit] signed by the child's parent or guardian, and notarized,
16-1 stating that the applicant declines a required immunization for
16-2 reasons of conscience or because of a religious belief, except that
16-3 an applicant admitted to a facility without a required immunization
16-4 under this subdivision is subject to exclusion from the facility in
16-5 times of emergency or epidemic declared by the commissioner of
16-6 public health [conflicts with the tenets and practices of a
16-7 recognized religious organization of which the applicant is an
16-8 adherent or a member].
16-9 SECTION 14. (a) The Texas Board of Health shall appoint the
16-10 members of the Texas immunization advisory committee not later than
16-11 September 1, 2001.
16-12 (b) As soon as practicable, but not later than August 1,
16-13 2002, the Texas Board of Health shall:
16-14 (1) adopt rules necessary to implement procedure for
16-15 excluding children from the immunization registry required by this
16-16 Act; and
16-17 (2) make available for use the form for requesting
16-18 exclusion from the immunization registry required under Section
16-19 161.0045, Health and Safety Code, as added by this Act.
16-20 (c) The report required under Section 161.007(c), Health and
16-21 Safety Code, as amended by this Act, and the data obtained or
16-22 released under Section 161.008, Health and Safety Code, as amended
16-23 by this Act, may not be accepted or released by the Texas
16-24 Department of Health until the department has adopted rules and
16-25 prescribed the forms required by this Act.
16-26 SECTION 15. This Act takes effect immediately if it receives
16-27 a vote of two-thirds of all the members elected to each house, as
17-1 provided by Section 39, Article III, Texas Constitution. If this
17-2 Act does not receive the vote necessary for immediate effect, this
17-3 Act takes effect September 1, 2001.