By Moncrief S.B. No. 1237
77R8691 YDB-D
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 14 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 who have children who are residents
2-5 of this state and who are not, and whose immediate family members
2-6 are not, affiliated with a business related to immunizations;
2-7 (11) one parent who has a child residing in this state
2-8 and who:
2-9 (A) is a representative of an organization
2-10 advocating informed consent for immunizations, if available; or
2-11 (B) has taken an exemption from immunization for
2-12 the child for reasons of conscience or religious belief, if a
2-13 parent described by Paragraph (A) is not available;
2-14 (12) one parent who has a child residing in this state
2-15 and who:
2-16 (A) has been compensated by the National Vaccine
2-17 Injury Compensation Program established under 42 U.S.C. Section
2-18 300aa-10, as amended, if available; or
2-19 (B) has reported an adverse reaction to an
2-20 immunization to the Vaccine Adverse Event Reporting System, if a
2-21 parent described by Paragraph (A) is not available; and
2-22 (13) one representative from a health maintenance
2-23 organization that holds a certificate of authority under the Texas
2-24 Health Maintenance Organization Act (Article 20A.01 et seq.,
2-25 Vernon's Texas Insurance Code).
2-26 Sec. 110.004. DUTIES. The committee shall:
2-27 (1) evaluate the existing immunization program
3-1 operated by the department and identify needs not met by the
3-2 program;
3-3 (2) review the goals and targets of the program;
3-4 (3) evaluate ongoing program efforts;
3-5 (4) recommend both short-term and long-term goals and
3-6 objectives for the immunization program;
3-7 (5) review and evaluate immunization requirements and
3-8 exemptions; and
3-9 (6) carry out any other tasks given to the committee
3-10 by the board.
3-11 Sec. 110.005. APPLICABLE LAW. The committee is subject to
3-12 Chapter 2110, Government Code.
3-13 SECTION 2. Sections 161.001(b) and (c), Health and Safety
3-14 Code, are amended to read as follows:
3-15 (b) A person who administers or authorizes the
3-16 administration of a vaccine or immunizing agent is not liable or
3-17 responsible for the failure to immunize a child because of the
3-18 failure or refusal of a parent, managing conservator, or guardian
3-19 to consent to the vaccination or immunization required under this
3-20 chapter, including the failure or refusal to consent to the
3-21 immunization because immunization is declined for reasons of
3-22 conscience or because of a religious belief. Consent to the
3-23 vaccination or immunization must be given in the manner authorized
3-24 by Chapter 32, Family Code.
3-25 (c) A parent, managing conservator, or guardian who fails or
3-26 refuses to consent to the vaccination or immunization required
3-27 under this chapter, including a parent, managing conservator, or
4-1 guardian who fails or refuses to consent to the immunization
4-2 because the immunization is declined for reasons of conscience or
4-3 religious belief, may not bring a cause of action against any
4-4 person for the other person's failure to immunize the child [A
4-5 person who fails to comply with Section 161.004 is not liable or
4-6 responsible for that failure, and that failure does not create a
4-7 cause of action].
4-8 SECTION 3. Section 161.004(d), Health and Safety Code, is
4-9 amended to read as follows:
4-10 (d) A child is exempt from an immunization required by this
4-11 section if:
4-12 (1) [immunization conflicts with the tenets of an
4-13 organized religion to which] a parent, managing conservator, or
4-14 guardian of the child states that the immunization is being
4-15 declined for reasons of conscience or because of a religious belief
4-16 [belongs]; or
4-17 (2) the immunization is medically contraindicated
4-18 based on an examination of the child by a physician licensed by any
4-19 state in the United States.
4-20 SECTION 4. Subchapter A, Chapter 161, Health and Safety Code,
4-21 is amended by adding Section 161.0045 to read as follows:
4-22 Sec. 161.0045. IMMUNIZATION EXEMPTION FORM. (a) The
4-23 department shall develop and provide an exemption form to a person
4-24 subject to exclusion from a school or facility because the person
4-25 declines a required immunization for reasons of conscience or
4-26 because of a religious belief.
4-27 (b) The exemption form must:
5-1 (1) include a statement of the department's position
5-2 regarding the benefits of immunization;
5-3 (2) include educational information on immunizations
5-4 and a reference to an Internet website, phone number, and other
5-5 contact information for the department that provides additional
5-6 information on the benefits of immunizations and the risks of not
5-7 being immunized; and
5-8 (3) include a statement indicating the applicant, or
5-9 if a minor, the applicant's parent, managing conservator, or
5-10 guardian understands the benefits and risks of immunizations and
5-11 the risks of not being immunized.
5-12 (c) The department shall make the exemption form available
5-13 in a printable format on the department's Internet website and
5-14 shall provide the form on request by facsimile transmission, mail,
5-15 or electronic mail.
5-16 SECTION 5. Section 161.007, Health and Safety Code, is
5-17 amended to read as follows:
5-18 Sec. 161.007. IMMUNIZATION REGISTRY; REPORTS TO DEPARTMENT.
5-19 (a) The department, for purposes of establishing and maintaining a
5-20 single repository of accurate, complete, and current immunization
5-21 records to be used in aiding, coordinating, and promoting efficient
5-22 and cost-effective childhood communicable disease prevention and
5-23 control efforts, shall establish and maintain a childhood
5-24 immunization registry. The department by rule shall develop
5-25 guidelines to:
5-26 (1) protect the confidentiality of patients [in
5-27 accordance with Section 5.08, Medical Practice Act (Article 4495b,
6-1 Vernon's Texas Civil Statutes)];
6-2 (2) inform a parent, managing conservator, or guardian
6-3 of each patient about the registry; and
6-4 (3) permit [require the written consent of] a parent,
6-5 managing conservator, or guardian of a patient to choose to have
6-6 the patient excluded from [before any information relating to the
6-7 patient is included in] the registry[; and]
6-8 [(4) permit a parent, managing conservator, or
6-9 guardian to withdraw consent for the patient to be included in the
6-10 registry].
6-11 (b) Except as provided by Section 161.0071, the [The]
6-12 childhood immunization registry must contain information on the
6-13 immunization history that is obtained by the department under this
6-14 section of each person who is younger than 18 years of age [and for
6-15 whom consent has been obtained in accordance with guidelines
6-16 adopted under Subsection (a). The department shall remove from the
6-17 registry information for any person for whom consent has been
6-18 withdrawn].
6-19 (c) An insurance company, a health maintenance organization,
6-20 or another organization that pays or reimburses a claim for an
6-21 immunization of a person younger than 18 years of age shall provide
6-22 an immunization history to the department. The report shall
6-23 contain the elements prescribed by the department, which may
6-24 include submission in writing, by electronic format, or by voice.
6-25 An insurance company, health maintenance organization, or other
6-26 organization is not required to provide an immunization history to
6-27 the department under this subsection for a person excluded from the
7-1 registry. The department shall consult with entities required to
7-2 report under this section to determine the most efficient and
7-3 cost-effective manner of reporting immunization histories [for whom
7-4 consent has not been obtained in accordance with guidelines adopted
7-5 under Subsection (a) or for whom consent has been withdrawn].
7-6 (d) A health care provider who administers an immunization
7-7 to a person younger than 18 years of age shall provide an
7-8 immunization history to the department unless the immunization
7-9 history is submitted to an insurance company, a health maintenance
7-10 organization, or another organization that pays or reimburses a
7-11 claim for an immunization to a person younger than 18 years of age.
7-12 The report shall contain the elements [be in a format] prescribed
7-13 by the department, which may include submission in writing, by
7-14 electronic means, or by voice. A health care provider is not
7-15 required to provide an immunization history to the department under
7-16 this subsection for a person excluded from the registry. The
7-17 department shall consult with health care providers to determine
7-18 the most efficient and cost-effective manner of reporting
7-19 immunization histories [for whom consent has not been obtained in
7-20 accordance with guidelines adopted under Subsection (a) or for whom
7-21 consent has been withdrawn].
7-22 (e) The department may use the registry to provide notices
7-23 by mail, telephone, personal contact, or other means to a parent,
7-24 managing conservator, or guardian regarding his or her child or
7-25 ward who is due or overdue for a particular type of immunization
7-26 according to the department's immunization schedule. The notice
7-27 must contain instructions for the parent, managing conservator, or
8-1 guardian to request that future notices not be sent and to remove
8-2 the child's immunization record from the registry and any other
8-3 registry-related record that individually identifies the child.
8-4 The notice must describe the procedure to report a violation if a
8-5 child is included in the registry after requesting exclusion. The
8-6 department shall consult with health care providers to determine
8-7 the most efficient and cost-effective manner of using the registry
8-8 to provide those notices.
8-9 (f) Nothing in this subchapter [section] diminishes a
8-10 parent's, managing conservator's, or guardian's responsibility for
8-11 having a child immunized properly, subject to Section 161.004(d).
8-12 (g) A person, including a health care provider, who submits
8-13 or obtains in good faith an immunization history or data to or from
8-14 the department in compliance with the provisions of this subchapter
8-15 [section] and any rules adopted under this subchapter [section] is
8-16 not liable for any civil damages.
8-17 (h) [Information obtained by the department for the
8-18 immunization registry is confidential and may be disclosed only
8-19 with the written consent of the child's parent, managing
8-20 conservator, or guardian.]
8-21 [(i)] The board shall adopt rules to implement this
8-22 subchapter [section].
8-23 (i) To the extent that the confidentiality requirements
8-24 imposed under this subchapter are more stringent than those imposed
8-25 under Chapter 159, Occupations Code, the requirements of this
8-26 subchapter prevail.
8-27 SECTION 6. Subchapter A, Chapter 161, Health and Safety Code,
9-1 is amended by adding Section 161.0071 to read as follows:
9-2 Sec. 161.0071. NOTICE OF RECEIPT OF REGISTRY DATA; EXCLUSION
9-3 FROM REGISTRY. (a) The first time the department receives registry
9-4 data for a child, the department shall send a written notification
9-5 to the child's parent, managing conservator, or guardian
9-6 disclosing:
9-7 (1) that providers and insurers may be sending the
9-8 child's immunization information to the department, but the
9-9 department may not keep the information if the parent, managing
9-10 conservator, or guardian chooses to exclude the child from the
9-11 registry;
9-12 (2) the information that is included in the registry;
9-13 (3) the persons to whom the information may be
9-14 released under Section 161.008(d);
9-15 (4) the purpose and use of the registry;
9-16 (5) the procedure to exclude a child from the
9-17 registry; and
9-18 (6) the procedure to report a violation if a parent,
9-19 managing conservator, or guardian discovers a child is included in
9-20 the registry after exclusion has been requested.
9-21 (b) The department shall delete the child's immunization
9-22 records from the registry and any other registry-related department
9-23 record that individually identifies the child, not later than the
9-24 30th day after the date the department receives from the parent,
9-25 managing conservator, or guardian of the child a written request
9-26 that the child be excluded from the registry. The department shall
9-27 maintain only those records related to the child necessary to
10-1 ensure that the child continues to be excluded from the registry
10-2 and may not release the identity of a child excluded from the
10-3 registry.
10-4 (c) The department shall send to a parent, managing
10-5 conservator, or guardian who makes a written request under
10-6 Subsection (b) a written confirmation of receipt of the request
10-7 for exclusion and the exclusion of the child's records from the
10-8 registry.
10-9 (d) The department commits a violation if the department
10-10 fails to exclude a child from the registry within the period
10-11 required by Subsection (b).
10-12 (e) The department shall accept any written indication from
10-13 a parent, managing conservator, or guardian communicating to the
10-14 department that a child should be excluded from the registry,
10-15 including a statement on the child's birth certificate, as a
10-16 request for exclusion under Subsection (b).
10-17 SECTION 7. Subchapter A, Chapter 161, Health and Safety Code,
10-18 is amended by adding Section 161.0072 to read as follows:
10-19 Sec. 161.0072. REGISTRY CONFIDENTIALITY. (a) The
10-20 information that individually identifies a child received by the
10-21 department for the immunization registry is confidential and may be
10-22 used by the department for registry purposes only.
10-23 (b) Unless specifically authorized under this subchapter,
10-24 the department may not release registry information to any
10-25 individual or entity without the consent of the person, or if a
10-26 minor, the parent, managing conservator, or guardian of the child.
10-27 (c) A person required to report information to the
11-1 department for registry purposes or authorized to receive
11-2 information from the registry, may not disclose the individually
11-3 identifiable information to any other person without written
11-4 consent of the parent, managing conservator, or guardian of the
11-5 child, except as provided by Chapter 159, Occupations Code.
11-6 (d) Registry information is not:
11-7 (1) subject to discovery, subpoena, or other means of
11-8 legal compulsion for release to any person or entity except as
11-9 provided by this subchapter; or
11-10 (2) admissible in any civil, administrative, or
11-11 criminal proceeding.
11-12 SECTION 8. Subchapter A, Chapter 161, Health and Safety Code,
11-13 is amended by adding Section 161.0075 to read as follows:
11-14 Sec. 161.0075. REPORT TO LEGISLATURE. (a) The department
11-15 shall report to the Legislative Budget Board, the governor, the
11-16 lieutenant governor, the speaker of the house of representatives,
11-17 and appropriate committees of the legislature not later than
11-18 September 30 of each even-numbered year.
11-19 (b) The department shall use the report required under
11-20 Subsection (a) to develop ways to increase immunization rates using
11-21 state and federal resources.
11-22 (c) The report must:
11-23 (1) include the current immunization rates by
11-24 geographic region of the state, where available;
11-25 (2) focus on the geographic regions of the state with
11-26 immunization rates below the state average for preschool children;
11-27 (3) describe the approaches identified to increase
12-1 immunization rates in underserved areas and the estimated cost for
12-2 each;
12-3 (4) identify changes to department procedures needed
12-4 to increase immunization rates;
12-5 (5) identify the services provided under and
12-6 provisions of contracts entered into by the department to increase
12-7 immunization rates in underserved areas;
12-8 (6) identify performance measures used in contracts
12-9 described by Subdivision (5);
12-10 (7) include the number and type of exemptions used in
12-11 the past year;
12-12 (8) include the number of complaints received by the
12-13 department related to the department's failure to comply with
12-14 requests for exclusion of individuals from the registry; and
12-15 (9) identify all reported incidents of discrimination
12-16 for requesting exclusion from the registry or for using an
12-17 exemption for a required immunization.
12-18 SECTION 9. Section 161.008, Health and Safety Code, is
12-19 amended by amending Subsections (c) and (d) and adding Subsections
12-20 (e)-(g) to read as follows:
12-21 (c) The department[, only with the consent of a child's
12-22 parent, managing conservator, or guardian,] may[:]
12-23 [(1)] obtain the data constituting an immunization
12-24 record for the child from a public health district, a local health
12-25 department, an insurance company, a health maintenance
12-26 organization, or any other organization that pays or reimburses a
12-27 claim for immunization, or any physician, health care professional,
13-1 or health care facility personnel licensed or otherwise authorized
13-2 to administer vaccines.
13-3 (d) After the 30th day after the date notice was sent by the
13-4 department to the child's parent, managing conservator, or guardian
13-5 under Section 161.0071, the department, if the department has not
13-6 received a written request to exclude the child from the registry,
13-7 may:
13-8 (1) enter the child into the registry; and [or a
13-9 physician to the child; or]
13-10 (2) release the data constituting an immunization
13-11 record for the child to any entity in this state that is described
13-12 by Subsection (c) and is providing immunization services to the
13-13 child or is paying or reimbursing a claim for an immunization for
13-14 the child or to [a public health district, a local health
13-15 department, a physician to the child, or] a school or child care
13-16 facility in which the child is enrolled.
13-17 (e) [(d)] A parent, managing conservator, or legal guardian
13-18 may obtain and on request to the department shall be provided with
13-19 all individually identifiable immunization registry information
13-20 concerning his or her child or ward.
13-21 (f) The department may release nonidentifying summary
13-22 statistics related to the registry that do not individually
13-23 identify a child.
13-24 (g) The department may not release individually identifiable
13-25 information under Subsection (d)(2) to an entity outside of this
13-26 state.
13-27 SECTION 10. Section 161.009(a), Health and Safety Code, is
14-1 amended to read as follows:
14-2 (a) A person commits an offense if the person:
14-3 (1) negligently releases or discloses immunization
14-4 registry information in violation of Section 161.007, 161.0071,
14-5 161.0072, or 161.008; or
14-6 (2) negligently uses the information in the
14-7 immunization registry to solicit new patients or clients or for
14-8 other purposes that are not associated with immunization purposes,
14-9 unless authorized under this section.
14-10 SECTION 11. Section 38.001, Education Code, is amended by
14-11 amending Subsection (c) and adding Subsection (f) to read as
14-12 follows:
14-13 (c) Immunization is not required for a person's admission to
14-14 any elementary or secondary school if the person applying for
14-15 admission:
14-16 (1) submits, on request, to the admitting official:
14-17 (A) a letter [an affidavit or a certificate]
14-18 signed by a physician who is duly registered and licensed to
14-19 practice medicine in the United States, in which it is stated that,
14-20 in the physician's opinion, the immunization required would be
14-21 injurious to the health and well-being of the applicant or any
14-22 member of the applicant's family or household; or
14-23 (B) a form provided by the Texas Department of
14-24 Health in accordance with Section 161.0045, Health and Safety Code,
14-25 [an affidavit] signed by the applicant or, if a minor, by the
14-26 applicant's parent or guardian, and notarized, stating that the
14-27 applicant declines a required immunization for reasons of
15-1 conscience or because of a religious belief [conflicts with the
15-2 tenets and practice of a recognized church or religious
15-3 denomination of which the applicant is an adherent or member],
15-4 except that an applicant admitted to a school without a required
15-5 immunization under this subdivision is subject to exclusion from
15-6 the school [this exemption does not apply] in times of emergency or
15-7 epidemic declared by the commissioner of public health; or
15-8 (2) is a member of the armed forces of the United
15-9 States and is on active duty.
15-10 (f) An admitting official of a school may not request the
15-11 submission of a letter or form under Subsection (c) more than once
15-12 each year.
15-13 SECTION 12. Section 38.002(a), Education Code, is amended to
15-14 read as follows:
15-15 (a) Each public school shall keep an individual immunization
15-16 record or a record of the number and type of exemptions as
15-17 permitted under Section 38.001(c) during the period of attendance
15-18 for each student admitted. The school shall annually submit a
15-19 report on a form prescribed by the Texas Department of Health to
15-20 the department stating the number and type of exemptions on file
15-21 for children who are attending the school and exercising the
15-22 exemption. The records shall be open for inspection at all
15-23 reasonable times by the Texas Education Agency or by
15-24 representatives of local health departments or the Texas Department
15-25 of Health.
15-26 SECTION 13. Section 51.933, Education Code, is amended by
15-27 amending Subsection (d) and adding Subsection (f) to read as
16-1 follows:
16-2 (d) Immunization [No form of immunization] is not required
16-3 for a person's admission to an institution of higher education if
16-4 the person applying for admission:
16-5 (1) submits, on request, to the admitting official:
16-6 (A) a letter [an affidavit or a certificate]
16-7 signed by a physician who is duly registered and licensed to
16-8 practice medicine within the United States in which it is stated
16-9 that, in the physician's opinion, the immunization required would
16-10 be injurious to the health and well-being of the applicant or any
16-11 member of the applicant's family or household; or
16-12 (B) a form provided by the Texas Department of
16-13 Health in accordance with Section 161.0045, Health and Safety Code,
16-14 [an affidavit] signed by the applicant or, if a minor, by the
16-15 applicant's parent or guardian, and notarized, stating that the
16-16 applicant declines a required immunization for reasons of
16-17 conscience or because of a religious belief, except that an
16-18 applicant admitted to an institution without a required
16-19 immunization under this subdivision is subject to exclusion from
16-20 the institution in times of emergency or epidemic declared by the
16-21 commissioner of public health [conflicts with the tenets and
16-22 practice of a recognized church or religious denomination of which
16-23 the applicant is an adherent or member]; or
16-24 (2) is a member of the armed forces of the United
16-25 States and is on active duty.
16-26 (f) An admitting official of an institution of higher
16-27 education may not request a letter or form under Subsection (d)
17-1 more than once each year.
17-2 SECTION 14. Section 42.043(d), Human Resources Code, is
17-3 amended to read as follows:
17-4 (d) A facility may refuse admission to a child who has not
17-5 received a required immunization. Immunization is not [No
17-6 immunization may be] required for admission to a facility regulated
17-7 under this chapter if a person applying for a child's admission
17-8 submits, on request, one of the following [affidavits]:
17-9 (1) a letter [an affidavit] signed by a [licensed]
17-10 physician who is duly registered and licensed to practice medicine
17-11 in the United States in which it is stated [stating] that in the
17-12 physician's opinion the immunization would be injurious to the
17-13 health and well-being of the child or a member of the child's
17-14 family or household; or
17-15 (2) a form provided by the Texas Department of Health
17-16 in accordance with Section 161.0045, Health and Safety Code, [an
17-17 affidavit] signed by the child's parent or guardian, and notarized,
17-18 stating that the applicant declines a required immunization for
17-19 reasons of conscience or because of a religious belief, except that
17-20 an applicant admitted to a facility without a required immunization
17-21 under this subdivision is subject to exclusion from the facility in
17-22 times of emergency or epidemic declared by the commissioner of
17-23 public health [conflicts with the tenets and practices of a
17-24 recognized religious organization of which the applicant is an
17-25 adherent or a member].
17-26 SECTION 15. (a) The Texas Board of Health shall appoint the
17-27 members of the Texas immunization advisory committee not later than
18-1 November 1, 2001.
18-2 (b) As soon as practicable, but not later than August 1,
18-3 2002, the Texas Board of Health shall:
18-4 (1) adopt rules necessary to implement procedure for
18-5 excluding children from the immunization registry required by this
18-6 Act; and
18-7 (2) make available for use the form for requesting
18-8 exclusion from the immunization registry required under Section
18-9 161.0071, Health and Safety Code, as added by this Act.
18-10 (c) As soon as practicable, but not later than November 1,
18-11 2001, the Texas Board of Health shall make available for use the
18-12 form for exemption from immunizations required under Section
18-13 161.0045, Health and Safety Code, as added by this Act.
18-14 (d) The report required under Section 161.007(c), Health and
18-15 Safety Code, as amended by this Act, and the data obtained or
18-16 released under Section 161.008, Health and Safety Code, as amended
18-17 by this Act, may not be accepted or released by the Texas
18-18 Department of Health until the department has adopted rules and
18-19 prescribed the forms required by this Act.
18-20 SECTION 16. This Act takes effect immediately if it receives
18-21 a vote of two-thirds of all the members elected to each house, as
18-22 provided by Section 39, Article III, Texas Constitution. If this
18-23 Act does not receive the vote necessary for immediate effect, this
18-24 Act takes effect September 1, 2001.