1-1 By: Moncrief S.B. No. 1237
1-2 (In the Senate - Filed March 7, 2001; March 12, 2001, read
1-3 first time and referred to Committee on Health and Human Services;
1-4 May 7, 2001, reported adversely, with favorable Committee
1-5 Substitute by the following vote: Yeas 5, Nays 1; May 7, 2001,
1-6 sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 1237 By: Moncrief
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to immunizations and the immunization registry.
1-11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-12 SECTION 1. The legislature finds that vaccination represents
1-13 an important aspect of public health programs and has been shown to
1-14 be one of the most efficient tools available for suppressing
1-15 disease. Vaccinations protect individuals from certain diseases
1-16 and, when combined with appropriate education, help the community
1-17 by reducing the spread of infectious agents. When implemented
1-18 effectively and responsibly, vaccination can provide an overall
1-19 protection for communities.
1-20 SECTION 2. Section 161.007, Health and Safety Code, is
1-21 amended to read as follows:
1-22 Sec. 161.007. IMMUNIZATION REGISTRY; REPORTS TO DEPARTMENT.
1-23 (a) The department, for purposes of establishing and maintaining a
1-24 single repository of accurate, complete, and current immunization
1-25 records to be used in aiding, coordinating, and promoting efficient
1-26 and cost-effective childhood communicable disease prevention and
1-27 control efforts, shall establish and maintain a childhood
1-28 immunization registry. The department by rule shall develop
1-29 guidelines to:
1-30 (1) protect the confidentiality of registrants in
1-31 accordance with state and federal law [patients in accordance with
1-32 Section 5.08, Medical Practice Act (Article 4495b, Vernon's Texas
1-33 Civil Statutes)];
1-34 (2) inform a parent, managing conservator, or guardian
1-35 of each registrant [patient] about the registry;
1-36 (3) permit [require the written consent of] a parent,
1-37 managing conservator, or guardian of a registrant to choose in
1-38 writing to have the registrant excluded from [patient before any
1-39 information relating to the patient is included in] the registry;
1-40 and
1-41 (4) encourage schools to apply for a Texas Department
1-42 of Health ImmTrac user number to enable an authorized school
1-43 employee to:
1-44 (A) track the immunization records of students
1-45 enrolled at the school and included in the registry; and
1-46 (B) verify whether a child has received the
1-47 required vaccinations [permit a parent, managing conservator, or
1-48 guardian to withdraw consent for the patient to be included in the
1-49 registry].
1-50 (b) Except as provided by Section 161.0071, the [The]
1-51 childhood immunization registry must contain information on the
1-52 immunization history that is obtained by the department under this
1-53 section of each person who is younger than 18 years of age [and for
1-54 whom consent has been obtained in accordance with guidelines
1-55 adopted under Subsection (a). The department shall remove from the
1-56 registry information for any person for whom consent has been
1-57 withdrawn].
1-58 (c) An insurance company, a health maintenance organization,
1-59 or another organization that pays or reimburses a claim for an
1-60 immunization of a person younger than 18 years of age shall provide
1-61 an immunization history to the department. The report shall
1-62 contain the elements prescribed by the department. The report may
1-63 be submitted in writing or by electronic means [An insurance
1-64 company, health maintenance organization, or other organization is
2-1 not required to provide an immunization history to the department
2-2 under this subsection for a person for whom consent has not been
2-3 obtained in accordance with guidelines adopted under Subsection (a)
2-4 or for whom consent has been withdrawn].
2-5 (d) A health care provider who administers an immunization
2-6 to a person younger than 18 years of age shall provide an
2-7 immunization history to the department unless the immunization
2-8 history is submitted to an insurance company, a health maintenance
2-9 organization, or another organization that pays or reimburses a
2-10 claim for an immunization to a person younger than 18 years of age.
2-11 The report shall contain the elements [be in a format] prescribed
2-12 by the department. The report may be submitted[, which may include
2-13 submission] in writing or[,] by electronic means[, or by voice].
2-14 [A health care provider is not required to provide an immunization
2-15 history to the department under this subsection for a person for
2-16 whom consent has not been obtained in accordance with guidelines
2-17 adopted under Subsection (a) or for whom consent has been
2-18 withdrawn.]
2-19 (e) The department may use the registry to provide notices
2-20 by mail, telephone, personal contact, or other means to a parent,
2-21 managing conservator, or guardian regarding his or her child or
2-22 ward who is due or overdue for a particular type of immunization
2-23 according to the department's immunization schedule. The notice
2-24 must contain instructions for the parent, managing conservator, or
2-25 guardian to request that future notices not be sent and to remove
2-26 the child's immunization record from the registry and any other
2-27 registry-related record that individually identifies the child.
2-28 The notice must describe the procedure to report a violation if a
2-29 child is included in the registry after the submission of a written
2-30 request for exclusion. The department shall consult with health
2-31 care providers to determine the most efficient and cost-effective
2-32 manner of using the registry to provide those notices.
2-33 (f) Nothing in this subchapter [section] diminishes a
2-34 parent's, managing conservator's, or guardian's responsibility for
2-35 having a child immunized properly, subject to Section 161.004(d).
2-36 (g) A person, including a health care provider or an
2-37 insurance company, a health maintenance organization, or another
2-38 organization that pays or reimburses a claim for immunization, who
2-39 submits or obtains in good faith an immunization history or data to
2-40 or from the department in compliance with the provisions of this
2-41 subchapter [section] and any rules adopted under this subchapter
2-42 [section] is not liable for any civil damages.
2-43 (h) [Information obtained by the department for the
2-44 immunization registry is confidential and may be disclosed only
2-45 with the written consent of the child's parent, managing
2-46 conservator, or guardian.]
2-47 [(i)] The board shall adopt rules to implement this
2-48 subchapter [section].
2-49 SECTION 3. Subchapter A, Chapter 161, Health and Safety
2-50 Code, is amended by adding Section 161.0071 to read as follows:
2-51 Sec. 161.0071. NOTICE OF RECEIPT OF REGISTRY DATA; EXCLUSION
2-52 FROM REGISTRY. (a) The first time the department receives
2-53 registry data for a child, the department shall send a written
2-54 notification to the child's parent, managing conservator, or
2-55 guardian disclosing:
2-56 (1) that providers and insurers may be sending the
2-57 child's immunization information to the department, but the
2-58 department may not keep the information if the parent, managing
2-59 conservator, or guardian chooses to exclude the child from the
2-60 registry;
2-61 (2) the information that is included in the registry;
2-62 (3) the persons to whom the information may be
2-63 released under Section 161.008(d);
2-64 (4) the purpose and use of the registry;
2-65 (5) the procedure to exclude a child from the
2-66 registry; and
2-67 (6) the procedure to report a violation if a parent,
2-68 managing conservator, or guardian discovers a child is included in
2-69 the registry after exclusion has been requested.
3-1 (b) The department shall delete the child's immunization
3-2 records from the registry and any other registry-related department
3-3 record that individually identifies the child, not later than the
3-4 30th day after the date the department receives from the parent,
3-5 managing conservator, or guardian of the child a written request
3-6 that the child be excluded from the registry. The department shall
3-7 maintain only those records related to the child necessary to
3-8 ensure that the child continues to be excluded from the registry
3-9 and may not release the identity of a child excluded from the
3-10 registry.
3-11 (c) The department shall send to a parent, managing
3-12 conservator, or guardian who makes a written request under
3-13 Subsection (b) a written confirmation of receipt of the request for
3-14 exclusion and the exclusion of the child's records from the
3-15 registry.
3-16 (d) The department commits a violation if the department
3-17 fails to exclude a child from the registry within the period
3-18 required by Subsection (b).
3-19 (e) The department shall accept a written statement from a
3-20 parent, managing conservator, or guardian communicating to the
3-21 department that a child should be excluded from the registry,
3-22 including a statement on the child's birth certificate, as a
3-23 request for exclusion under Subsection (b).
3-24 SECTION 4. Subchapter A, Chapter 161, Health and Safety
3-25 Code, is amended by adding Section 161.0072 to read as follows:
3-26 Sec. 161.0072. REGISTRY CONFIDENTIALITY. (a) The
3-27 information that individually identifies a child received by the
3-28 department for the immunization registry is confidential and may be
3-29 used by the department for registry purposes only.
3-30 (b) Unless specifically authorized under this subchapter,
3-31 the department may not release registry information to any
3-32 individual or entity without the consent of the person or, if a
3-33 minor, the parent, managing conservator, or guardian of the child.
3-34 (c) A person required to report information to the
3-35 department for registry purposes or authorized to receive
3-36 information from the registry may not disclose the individually
3-37 identifiable information to any other person without written
3-38 consent of the parent, managing conservator, or guardian of the
3-39 child, except as provided by Chapter 159, Occupations Code.
3-40 (d) Registry information is not:
3-41 (1) subject to discovery, subpoena, or other means of
3-42 legal compulsion for release to any person or entity except as
3-43 provided by this subchapter; or
3-44 (2) admissible in any civil, administrative, or
3-45 criminal proceeding.
3-46 SECTION 5. Subchapter A, Chapter 161, Health and Safety
3-47 Code, is amended by adding Section 161.0075 to read as follows:
3-48 Sec. 161.0075. REPORT TO LEGISLATURE. (a) The department
3-49 shall report to the Legislative Budget Board, the governor, the
3-50 lieutenant governor, the speaker of the house of representatives,
3-51 and appropriate committees of the legislature not later than
3-52 September 30 of each even-numbered year.
3-53 (b) The department shall use the report required under
3-54 Subsection (a) to develop ways to increase immunization rates using
3-55 state and federal resources.
3-56 (c) The report must:
3-57 (1) include the current immunization rates by
3-58 geographic region of the state, where available;
3-59 (2) focus on the geographic regions of the state with
3-60 immunization rates below the state average for preschool children;
3-61 (3) describe the approaches identified to increase
3-62 immunization rates in underserved areas and the estimated cost for
3-63 each;
3-64 (4) identify changes to department procedures needed
3-65 to increase immunization rates;
3-66 (5) identify the services provided under and
3-67 provisions of contracts entered into by the department to increase
3-68 immunization rates in underserved areas;
3-69 (6) identify performance measures used in contracts
4-1 described by Subdivision (5);
4-2 (7) include the number and type of exemptions used in
4-3 the past year;
4-4 (8) include the number of complaints received by the
4-5 department related to the department's failure to comply with
4-6 requests for exclusion of individuals from the registry; and
4-7 (9) identify all reported incidents of discrimination
4-8 for requesting exclusion from the registry or for using an
4-9 exemption for a required immunization.
4-10 SECTION 6. Section 161.008, Health and Safety Code, is
4-11 amended by amending Subsections (c) and (d) and adding Subsections
4-12 (e) through (h) to read as follows:
4-13 (c) The department[, only with the consent of a child's
4-14 parent, managing conservator, or guardian,] may[:]
4-15 [(1)] obtain the data constituting an immunization
4-16 record for the child from a public health district, a local health
4-17 department, an insurance company, a health maintenance
4-18 organization, or any other organization that pays or reimburses a
4-19 claim for immunization, or any physician, health care professional,
4-20 or health care facility personnel licensed or otherwise authorized
4-21 to administer vaccines.
4-22 (d) After the 30th day after the date notice was sent by the
4-23 department to the child's parent, managing conservator, or guardian
4-24 under Section 161.0071, the department, if the department has not
4-25 received a written request to exclude the child from the registry,
4-26 shall:
4-27 (1) enter the child into the registry; and [or a
4-28 physician to the child; or]
4-29 (2) release the data constituting an immunization
4-30 record for the child to any entity in this state that is described
4-31 by Subsection (c) and is providing immunization services to the
4-32 child or is paying or reimbursing a claim for an immunization for
4-33 the child, to [a public health district, a local health department,
4-34 a physician to the child, or] a school or child care facility in
4-35 which the child is enrolled, or to a state agency responsible for
4-36 the health care of the child.
4-37 (e) [(d)] A parent, managing conservator, or legal guardian
4-38 may obtain and on request to the department shall be provided with
4-39 all individually identifiable immunization registry information
4-40 concerning his or her child or ward.
4-41 (f) The department may release nonidentifying summary
4-42 statistics related to the registry that do not individually
4-43 identify a child.
4-44 (g) The department may not release individually identifiable
4-45 information under Subsection (d)(2) to an entity outside of this
4-46 state.
4-47 (h) The department shall develop a secure Internet-based
4-48 system to allow a school that has obtained an ImmTrac user number
4-49 to verify whether a child has received the vaccinations required by
4-50 Sections 38.001 and 51.933, Education Code. Except as provided by
4-51 board rules, a school that obtains an ImmTrac user number for this
4-52 purpose may not require verification of vaccination of a child from
4-53 the child's parent, managing conservator, or guardian.
4-54 SECTION 7. Subsection (a), Section 161.009, Health and
4-55 Safety Code, is amended to read as follows:
4-56 (a) A person commits an offense if the person:
4-57 (1) negligently releases or discloses immunization
4-58 registry information in violation of Section 161.007, 161.0071,
4-59 161.0072, or 161.008; or
4-60 (2) negligently uses the information in the
4-61 immunization registry to solicit new patients or clients or for
4-62 other purposes that are not associated with immunization purposes,
4-63 unless authorized under this section.
4-64 SECTION 8. Subsection (a), Section 38.002, Education Code,
4-65 is amended to read as follows:
4-66 (a) Each public school shall keep an individual immunization
4-67 record or a record of the number and type of exemptions as
4-68 permitted under Section 38.001(c) during the period of attendance
4-69 for each student admitted. The school shall annually submit a
5-1 report on a form prescribed by the Texas Department of Health to
5-2 the department stating the number and type of exemptions on file
5-3 for children who are attending the school and exercising the
5-4 exemption. The report may not include individually identifiable
5-5 information. The report must include the total student enrollment
5-6 on campus. The records shall be open for inspection at all
5-7 reasonable times by the Texas Education Agency or by
5-8 representatives of local health departments or the Texas Department
5-9 of Health.
5-10 SECTION 9. (a) The Texas Department of Health shall conduct
5-11 a study to determine the most effective methods of increasing
5-12 immunization rates. To determine the methods, the department
5-13 shall:
5-14 (1) identify and analyze existing and proposed
5-15 immunization outreach strategies of this state and other states;
5-16 (2) analyze the effect exemptions, including medical
5-17 and religious exemptions, have on the immunization rate;
5-18 (3) identify and analyze the advantages,
5-19 disadvantages, and feasibility of expanding exemption policies;
5-20 (4) identify and analyze the benefits and the
5-21 financial and disease-related costs encountered by other states
5-22 after the implementation of an expanded exemption policy,
5-23 including:
5-24 (A) a comparison of immunization rates before
5-25 and after the adoption of expanded exemptions; and
5-26 (B) specific details of other states' statutes;
5-27 (5) analyze the capacity of individual vaccines to
5-28 reduce the occurrence of disease and the risk factors associated
5-29 with individual vaccines;
5-30 (6) analyze current immunization research conducted by
5-31 leading health organizations and government programs; and
5-32 (7) determine if a correlation exists between
5-33 immunization rates and exemption options.
5-34 (b) The Texas Department of Health shall submit, not later
5-35 than November 1, 2002, a written report of the results of the study
5-36 to the lieutenant governor and the speaker of the house of
5-37 representatives.
5-38 (c) Notwithstanding the date specified in Subsection (a),
5-39 Section 161.0075, Health and Safety Code, as added by this Act, the
5-40 Texas Department of Health may coordinate the report required under
5-41 that section with the report of the study required under this
5-42 section.
5-43 SECTION 10. (a) As soon as practicable, but not later than
5-44 August 1, 2002, the Texas Board of Health shall:
5-45 (1) adopt rules necessary to implement the procedure
5-46 for excluding children from the immunization registry required by
5-47 this Act; and
5-48 (2) make available for use a form for requesting
5-49 exclusion from the immunization registry required under Section
5-50 161.0071, Health and Safety Code, as added by this Act.
5-51 (b) The report required under Subsection (c), Section
5-52 161.007, Health and Safety Code, as amended by this Act, and the
5-53 data obtained or released under Section 161.008, Health and Safety
5-54 Code, as amended by this Act, may not be accepted or released by
5-55 the Texas Department of Health until the department has adopted
5-56 rules and prescribed the forms required by this Act.
5-57 SECTION 11. This Act takes effect immediately if it receives
5-58 a vote of two-thirds of all the members elected to each house, as
5-59 provided by Section 39, Article III, Texas Constitution. If this
5-60 Act does not receive the vote necessary for immediate effect, this
5-61 Act takes effect September 1, 2001.
5-62 * * * * *