By: Moncrief S.B. No. 1237
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 diseases
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. Section 161.007, Health and Safety Code, is
1-13 amended to read as follows:
1-14 Sec. 161.007. IMMUNIZATION REGISTRY; REPORTS TO DEPARTMENT.
1-15 (a) The department, for purposes of establishing and maintaining a
1-16 single repository of accurate, complete, and current immunization
1-17 records to be used in aiding, coordinating, and promoting efficient
1-18 and cost-effective childhood communicable disease prevention and
1-19 control efforts, shall establish and maintain a childhood
1-20 immunization registry. The department by rule shall develop
1-21 guidelines to:
1-22 (1) protect the confidentiality of registrants in
1-23 accordance with state and federal law [patients in accordance with
1-24 Section 5.08, Medical Practice Act (Article 4495b, Vernon's Texas
1-25 Civil Statutes)];
2-1 (2) inform a parent, managing conservator, or guardian
2-2 of each registrant [patient] about the registry;
2-3 (3) permit [require the written consent of] a parent,
2-4 managing conservator, or guardian of a registrant to choose in
2-5 writing to have the registrant excluded from [patient before any
2-6 information relating to the patient is included in] the registry;
2-7 and
2-8 (4) encourage schools to apply for a Texas Department
2-9 of Health ImmTrac user number to enable an authorized school
2-10 employee to:
2-11 (A) track the immunization records of students
2-12 enrolled at the school and included in the registry; and
2-13 (B) verify whether a child has received the
2-14 required vaccinations [permit a parent, managing conservator, or
2-15 guardian to withdraw consent for the patient to be included in the
2-16 registry].
2-17 (b) Except as provided by Section 161.0071, the [The]
2-18 childhood immunization registry must contain information on the
2-19 immunization history that is obtained by the department under this
2-20 section of each person who is younger than 18 years of age [and for
2-21 whom consent has been obtained in accordance with guidelines
2-22 adopted under Subsection (a). The department shall remove from the
2-23 registry information for any person for whom consent has been
2-24 withdrawn].
2-25 (c) An insurance company, a health maintenance organization,
2-26 or another organization that pays or reimburses a claim for an
3-1 immunization of a person younger than 18 years of age shall provide
3-2 an immunization history to the department. The report shall
3-3 contain the elements prescribed by the department. The report may
3-4 be submitted in writing or by electronic means [An insurance
3-5 company, health maintenance organization, or other organization is
3-6 not required to provide an immunization history to the department
3-7 under this subsection for a person for whom consent has not been
3-8 obtained in accordance with guidelines adopted under Subsection (a)
3-9 or for whom consent has been withdrawn].
3-10 (d) A health care provider who administers an immunization
3-11 to a person younger than 18 years of age shall provide an
3-12 immunization history to the department unless the immunization
3-13 history is submitted to an insurance company, a health maintenance
3-14 organization, or another organization that pays or reimburses a
3-15 claim for an immunization to a person younger than 18 years of age.
3-16 The report shall contain the elements [be in a format] prescribed
3-17 by the department. The report may be submitted[, which may include
3-18 submission] in writing or[,] by electronic means[, or by voice].
3-19 [A health care provider is not required to provide an immunization
3-20 history to the department under this subsection for a person for
3-21 whom consent has not been obtained in accordance with guidelines
3-22 adopted under Subsection (a) or for whom consent has been
3-23 withdrawn.]
3-24 (e) The department may use the registry to provide notices
3-25 by mail, telephone, personal contact, or other means to a parent,
3-26 managing conservator, or guardian regarding his or her child or
4-1 ward who is due or overdue for a particular type of immunization
4-2 according to the department's immunization schedule. The notice
4-3 must contain instructions for the parent, managing conservator, or
4-4 guardian to request that future notices not be sent and to remove
4-5 the child's immunization record from the registry and any other
4-6 registry-related record that individually identifies the child.
4-7 The notice must describe the procedure to report a violation if a
4-8 child is included in the registry after the submission of a written
4-9 request for exclusion. The department shall consult with health
4-10 care providers to determine the most efficient and cost-effective
4-11 manner of using the registry to provide those notices.
4-12 (f) Nothing in this subchapter [section] diminishes a
4-13 parent's, managing conservator's, or guardian's responsibility for
4-14 having a child immunized properly, subject to Section 161.004(d).
4-15 (g) A person, including a health care provider or an
4-16 insurance company, a health maintenance organization, or another
4-17 organization that pays or reimburses a claim for immunization, who
4-18 submits or obtains in good faith an immunization history or data to
4-19 or from the department in compliance with the provisions of this
4-20 subchapter [section] and any rules adopted under this subchapter
4-21 [section] is not liable for any civil damages.
4-22 (h) [Information obtained by the department for the
4-23 immunization registry is confidential and may be disclosed only
4-24 with the written consent of the child's parent, managing
4-25 conservator, or guardian.]
4-26 [(i)] The board shall adopt rules to implement this
5-1 subchapter [section].
5-2 SECTION 3. Subchapter A, Chapter 161, Health and Safety
5-3 Code, is amended by adding Section 161.0071 to read as follows:
5-4 Sec. 161.0071. NOTICE OF RECEIPT OF REGISTRY DATA; EXCLUSION
5-5 FROM REGISTRY. (a) The first time the department receives
5-6 registry data for a child, the department shall send a written
5-7 notification to the child's parent, managing conservator, or
5-8 guardian disclosing:
5-9 (1) that providers and insurers may be sending the
5-10 child's immunization information to the department, but the
5-11 department may not keep the information if the parent, managing
5-12 conservator, or guardian chooses to exclude the child from the
5-13 registry;
5-14 (2) the information that is included in the registry;
5-15 (3) the persons to whom the information may be
5-16 released under Section 161.008(d);
5-17 (4) the purpose and use of the registry;
5-18 (5) the procedure to exclude a child from the
5-19 registry; and
5-20 (6) the procedure to report a violation if a parent,
5-21 managing conservator, or guardian discovers a child is included in
5-22 the registry after exclusion has been requested.
5-23 (b) The department shall delete the child's immunization
5-24 records from the registry and any other registry-related department
5-25 record that individually identifies the child, not later than the
5-26 30th day after the date the department receives from the parent,
6-1 managing conservator, or guardian of the child a written request
6-2 that the child be excluded from the registry. The department shall
6-3 maintain only those records related to the child necessary to
6-4 ensure that the child continues to be excluded from the registry
6-5 and may not release the identity of a child excluded from the
6-6 registry. The department may not:
6-7 (1) maintain a list of children who have opted out of
6-8 the registry; or
6-9 (2) release the identity of a child excluded from the
6-10 registry.
6-11 (c) The department shall send to a parent, managing
6-12 conservator, or guardian who makes a written request under
6-13 Subsection (b) a written confirmation of receipt of the request for
6-14 exclusion and the exclusion of the child's records from the
6-15 registry.
6-16 (d) The department commits a violation if the department
6-17 fails to exclude a child from the registry within the period
6-18 required by Subsection (b).
6-19 (e) The department shall accept a written statement from a
6-20 parent, managing conservator, or guardian communicating to the
6-21 department that a child should be excluded from the registry,
6-22 including a statement on the child's birth certificate, as a
6-23 request for exclusion under Subsection (b).
6-24 SECTION 4. Subchapter A, Chapter 161, Health and Safety
6-25 Code, is amended by adding Section 161.0072 to read as follows:
6-26 Sec. 161.0072. REGISTRY CONFIDENTIALITY. (a) The
7-1 information that individually identifies a child received by the
7-2 department for the immunization registry is confidential and may be
7-3 used by the department for registry purposes only.
7-4 (b) Unless specifically authorized under this subchapter,
7-5 the department may not release registry information to any
7-6 individual or entity without the consent of the person or, if a
7-7 minor, the parent, managing conservator, or guardian of the child.
7-8 (c) A person required to report information to the
7-9 department for registry purposes or authorized to receive
7-10 information from the registry may not disclose the individually
7-11 identifiable information to any other person without written
7-12 consent of the parent, managing conservator, or guardian of the
7-13 child, except as provided by Chapter 159, Occupations Code.
7-14 (d) Registry information is not:
7-15 (1) subject to discovery, subpoena, or other means of
7-16 legal compulsion for release to any person or entity except as
7-17 provided by this subchapter; or
7-18 (2) admissible in any civil, administrative, or
7-19 criminal proceeding.
7-20 SECTION 5. Subchapter A, Chapter 161, Health and Safety
7-21 Code, is amended by adding Section 161.0075 to read as follows:
7-22 Sec. 161.0075. REPORT TO LEGISLATURE. (a) The department
7-23 shall report to the Legislative Budget Board, the governor, the
7-24 lieutenant governor, the speaker of the house of representatives,
7-25 and appropriate committees of the legislature not later than
7-26 September 30 of each even-numbered year.
8-1 (b) The department shall use the report required under
8-2 Subsection (a) to develop ways to increase immunization rates using
8-3 state and federal resources.
8-4 (c) The report must:
8-5 (1) include the current immunization rates by
8-6 geographic region of the state, where available;
8-7 (2) focus on the geographic regions of the state with
8-8 immunization rates below the state average for preschool children;
8-9 (3) describe the approaches identified to increase
8-10 immunization rates in underserved areas and the estimated cost for
8-11 each;
8-12 (4) identify changes to department procedures needed
8-13 to increase immunization rates;
8-14 (5) identify the services provided under and
8-15 provisions of contracts entered into by the department to increase
8-16 immunization rates in underserved areas;
8-17 (6) identify performance measures used in contracts
8-18 described by Subdivision (5);
8-19 (7) include the number and type of exemptions used in
8-20 the past year;
8-21 (8) include the number of complaints received by the
8-22 department related to the department's failure to comply with
8-23 requests for exclusion of individuals from the registry; and
8-24 (9) identify all reported incidents of discrimination
8-25 for requesting exclusion from the registry or for using an
8-26 exemption for a required immunization.
9-1 SECTION 6. Section 161.008, Health and Safety Code, is
9-2 amended by amending Subsections (c) and (d) and adding Subsections
9-3 (e) through (h) to read as follows:
9-4 (c) The department[, only with the consent of a child's
9-5 parent, managing conservator, or guardian,] may[:]
9-6 [(1)] obtain the data constituting an immunization
9-7 record for the child from a public health district, a local health
9-8 department, an insurance company, a health maintenance
9-9 organization, or any other organization that pays or reimburses a
9-10 claim for immunization, or any physician, health care professional,
9-11 or health care facility personnel licensed or otherwise authorized
9-12 to administer vaccines.
9-13 (d) After the 30th day after the date notice was sent by the
9-14 department to the child's parent, managing conservator, or guardian
9-15 under Section 161.0071, the department, if the department has not
9-16 received a written request to exclude the child from the registry,
9-17 shall:
9-18 (1) enter the child into the registry; and [or a
9-19 physician to the child; or]
9-20 (2) release the data constituting an immunization
9-21 record for the child to any entity in this state that is described
9-22 by Subsection (c) and is providing immunization services to the
9-23 child or is paying or reimbursing a claim for an immunization for
9-24 the child, to [a public health district, a local health department,
9-25 a physician to the child, or] a school or child care facility in
9-26 which the child is enrolled, or to a state agency responsible for
10-1 the health care of the child.
10-2 (e) [(d)] A parent, managing conservator, or legal guardian
10-3 may obtain and on request to the department shall be provided with
10-4 all individually identifiable immunization registry information
10-5 concerning his or her child or ward.
10-6 (f) The department may release nonidentifying summary
10-7 statistics related to the registry that do not individually
10-8 identify a child.
10-9 (g) The department may not release individually identifiable
10-10 information under Subsection (d)(2) to an entity outside of this
10-11 state.
10-12 (h) The department shall develop a secure Internet-based
10-13 system to allow a school that has obtained an ImmTrac user number
10-14 to verify whether a child has received the vaccinations required by
10-15 Sections 38.001 and 51.933, Education Code. Except as provided by
10-16 board rules, a school that obtains an ImmTrac user number for this
10-17 purpose may not require verification of vaccination of a child from
10-18 the child's parent, managing conservator, or guardian.
10-19 SECTION 7. Subsection (a), Section 161.009, Health and
10-20 Safety Code, is amended to read as follows:
10-21 (a) A person commits an offense if the person:
10-22 (1) negligently releases or discloses immunization
10-23 registry information in violation of Section 161.007, 161.0071,
10-24 161.0072, or 161.008; or
10-25 (2) negligently uses the information in the
10-26 immunization registry to solicit new patients or clients or for
11-1 other purposes that are not associated with immunization purposes,
11-2 unless authorized under this section.
11-3 SECTION 8. Subsection (a), Section 38.002, Education Code,
11-4 is amended to read as follows:
11-5 (a) Each public school shall keep an individual immunization
11-6 record or a record of the number and type of exemptions as
11-7 permitted under Section 38.001(c) during the period of attendance
11-8 for each student admitted. The school shall annually submit a
11-9 report on a form prescribed by the Texas Department of Health to
11-10 the department stating the number and type of exemptions on file
11-11 for children who are attending the school and exercising the
11-12 exemption. The report may not include individually identifiable
11-13 information. The report must include the total student enrollment
11-14 on campus. The records shall be open for inspection at all
11-15 reasonable times by the Texas Education Agency or by
11-16 representatives of local health departments or the Texas Department
11-17 of Health.
11-18 SECTION 9. (a) The Texas Department of Health shall conduct
11-19 a study to determine the most effective methods of increasing
11-20 immunization rates. To determine the methods, the department
11-21 shall:
11-22 (1) identify and analyze existing and proposed
11-23 immunization outreach strategies of this state and other states;
11-24 (2) analyze the effect exemptions, including medical
11-25 and religious exemptions, have on the immunization rate;
11-26 (3) identify and analyze the advantages,
12-1 disadvantages, and feasibility of expanding exemption policies;
12-2 (4) identify and analyze the benefits and the
12-3 financial and disease-related costs encountered by other states
12-4 after the implementation of an expanded exemption policy,
12-5 including:
12-6 (A) a comparison of immunization rates before
12-7 and after the adoption of expanded exemptions; and
12-8 (B) specific details of other states' statutes;
12-9 (5) analyze the capacity of individual vaccines to
12-10 reduce the occurrence of disease and the risk factors associated
12-11 with individual vaccines;
12-12 (6) analyze current immunization research conducted by
12-13 leading health organizations and government programs; and
12-14 (7) determine if a correlation exists between
12-15 immunization rates and exemption options.
12-16 (b) The Texas Department of Health shall submit, not later
12-17 than November 1, 2002, a written report of the results of the study
12-18 to the lieutenant governor and the speaker of the house of
12-19 representatives.
12-20 (c) Notwithstanding the date specified in Subsection (a),
12-21 Section 161.0075, Health and Safety Code, as added by this Act, the
12-22 Texas Department of Health may coordinate the report required under
12-23 that section with the report of the study required under this
12-24 section.
12-25 SECTION 10. (a) As soon as practicable, but not later than
12-26 August 1, 2002, the Texas Board of Health shall:
13-1 (1) adopt rules necessary to implement the procedure
13-2 for excluding children from the immunization registry required by
13-3 this Act; and
13-4 (2) make available for use a form for requesting
13-5 exclusion from the immunization registry required under Section
13-6 161.0071, Health and Safety Code, as added by this Act.
13-7 (b) The report required under Subsection (c), Section
13-8 161.007, Health and Safety Code, as amended by this Act, and the
13-9 data obtained or released under Section 161.008, Health and Safety
13-10 Code, as amended by this Act, may not be accepted or released by
13-11 the Texas Department of Health until the department has adopted
13-12 rules and prescribed the forms required by this Act.
13-13 SECTION 11. This Act takes effect immediately if it receives
13-14 a vote of two-thirds of all the members elected to each house, as
13-15 provided by Section 39, Article III, Texas Constitution. If this
13-16 Act does not receive the vote necessary for immediate effect, this
13-17 Act takes effect September 1, 2001.