78R12864 MCK-D
By: Capelo H.B. No. 1921
Substitute the following for H.B. No. 1921:
By: Truitt C.S.H.B. No. 1921
A BILL TO BE ENTITLED
AN ACT
relating to the immunization registry.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 161, Health and Safety
Code, is amended by adding Section 161.0001 to read as follows:
Sec. 161.0001. DEFINITION. In this subchapter, "payor"
means an insurance company, a health maintenance organization, or
another organization that pays a health care provider to provide
health care benefits, including providing immunizations to a person
younger than 18 years of age.
SECTION 2. Section 161.007, Health and Safety Code, is
amended to read as follows:
Sec. 161.007. IMMUNIZATION REGISTRY; REPORTS TO
DEPARTMENT. (a) The department, for purposes of establishing and
maintaining a single repository of accurate, complete, and current
immunization records to be used in aiding, coordinating, and
promoting efficient and cost-effective childhood communicable
disease prevention and control efforts, shall establish and
maintain a childhood immunization registry. The department by rule
shall develop guidelines to:
(1) protect the confidentiality of patients in
accordance with Section 159.002, Occupations Code;
(2) inform a parent, managing conservator, or guardian
of each patient about the registry;
(3) require the written consent of a parent, managing
conservator, or guardian of a patient before any information
relating to the patient is included in the registry; and
(4) permit a parent, managing conservator, or guardian
to withdraw consent for the patient to be included in the registry.
(a-1) The written consent required by Subsection (a)(3) is
required to be obtained only one time. The written consent is valid
until the child becomes 18 years of age unless the consent is
withdrawn in writing. A parent, managing conservator, or guardian
of a child may provide the written consent by using an electronic
signature on the child's birth certificate.
(b) The childhood immunization registry must contain
information on the immunization history that is obtained by the
department under this section of each person who is younger than 18
years of age and for whom consent has been obtained in accordance
with guidelines adopted under Subsection (a). The department shall
remove from the registry information for any person for whom
consent has been withdrawn. The department may not retain
individually identifiable information about any person for whom
consent has been withdrawn.
(c) A payor that receives data elements from a health care
provider who administers [An insurance company, a health
maintenance organization, or another organization that pays or
reimburses a claim for] an immunization to [of] a person younger
than 18 years of age shall provide the data elements to the
department. A payor is required to provide the department with only
the data elements the payor receives from a health care provider.
The data elements shall be submitted in a format prescribed by the
department. The department shall verify consent before including
the reported information in the immunization registry. The
department may not retain individually identifiable information
about a person for whom consent cannot be verified. [an
immunization history to the department. An insurance company,
health maintenance organization, or other organization is not
required to provide an immunization history to the department under
this subsection for a person for whom consent has not been obtained
in accordance with guidelines adopted under Subsection (a) or for
whom consent has been withdrawn.]
(d) A health care provider who administers an immunization
to a person younger than 18 years of age shall provide data elements
regarding an immunization [history] to the department [unless the
immunization history is submitted to an insurance company, a health
maintenance organization, or another organization that pays or
reimburses a claim for an immunization to a person younger than 18
years of age]. The data elements [report] shall be submitted in a
format prescribed by the department. The department shall verify
consent before including the information in the immunization
registry. The department may not retain individually identifiable
information about a person for whom consent cannot be verified. [,
which may include submission in writing, by electronic means, or by
voice. A health care provider is not required to provide an
immunization history to the department under this subsection for a
person for whom consent has not been obtained in accordance with
guidelines adopted under Subsection (a) or for whom consent has
been withdrawn.]
(e) The department may provide notice to a health care
provider that submits an immunization history for a person for whom
consent cannot be verified. The notice shall contain instructions
for obtaining consent in accordance with guidelines adopted under
Subsection (a) and resubmitting the immunization history to the
department.
(f) The department and health care providers may use the
registry to provide notices by mail, telephone, personal contact,
or other means to a parent, managing conservator, or guardian
regarding his or her child or ward who is due or overdue for a
particular type of immunization according to the department's
immunization schedule. The department shall consult with health
care providers to determine the most efficient and cost-effective
manner of using the registry to provide those notices.
(g) [(f)] Nothing in this section diminishes a parent's,
managing conservator's, or guardian's responsibility for having a
child immunized properly, subject to Section 161.004(d).
(h) [(g)] A person, including a health care provider,
payor, or an employee of the department who submits or obtains in
good faith [an] immunization [history or] data elements to or from
the department in compliance with the provisions of this section
and any rules adopted under this section is not liable for any civil
damages.
(i) Except as provided by Section 161.008, information
[(h) Information] obtained by the department for the immunization
registry is confidential and may be disclosed only with the written
consent of the child's parent, managing conservator, or guardian.
(j) [(i)] The board shall adopt rules to implement this
section.
SECTION 3. Subchapter A, Chapter 161, Health and Safety
Code, is amended by adding Sections 161.0071, 161.0072, 161.0073,
161.0074, and 161.0075 to read as follows:
Sec. 161.0071. NOTICE OF RECEIPT OF REGISTRY DATA;
EXCLUSION FROM REGISTRY. (a) The first time the department
receives registry data for a child from a person other than the
child's parent, managing conservator, or guardian, the department
shall send a written notice to the child's parent, managing
conservator, or guardian disclosing:
(1) that providers and payors may be sending the
child's immunization information to the department;
(2) the information that is included in the registry;
(3) the persons to whom the information may be
released under Section 161.008(d);
(4) the purpose and use of the registry;
(5) the procedure to exclude a child from the
registry; and
(6) the procedure to report a violation if a parent,
managing conservator, or guardian discovers a child is included in
the registry after exclusion has been requested.
(b) The department shall delete the child's immunization
records from the registry and any other registry-related department
record that individually identifies the child not later than the
30th day after the date the department receives from the parent,
managing conservator, or guardian of the child a written request
that the child be excluded from the registry.
(c) The department shall send to a parent, managing
conservator, or guardian who makes a written request under
Subsection (b) a written confirmation of receipt of the request for
exclusion and the exclusion of the child's records from the
registry.
(d) The department commits a violation if the department
fails to exclude a child from the registry within the period
required by Subsection (b).
(e) The department shall accept a written statement from a
parent, managing conservator, or guardian communicating to the
department that a child should be excluded from the registry,
including a statement on the child's birth certificate, as a
request for exclusion under Subsection (b).
Sec. 161.0072. PROVIDING IMMUNIZATION INFORMATION TO
DEPARTMENT. (a) If the parent, managing conservator, or guardian
of a child has reasonable concern that the child's health care
provider is not submitting the immunization history to the
department and the parent, managing conservator, or guardian wants
the child included in the registry, the parent, managing
conservator, or guardian may provide the child's immunization
history directly to the department to be included in the
immunization registry.
(b) The parent, managing conservator, or guardian of a child
may send evidence of the child's immunization history to the
department by facsimile transmission or by mail. The evidence may
include a copy of:
(1) the child's medical record indicating the
immunization history;
(2) an invoice from a health care provider for the
immunization; or
(3) documentation showing that a claim for the
immunization was paid by a payor.
Sec. 161.0073. REGISTRY CONFIDENTIALITY. (a) The
information that individually identifies a child received by the
department for the immunization registry is confidential and may be
used by the department for registry purposes only.
(b) Unless specifically authorized under this subchapter,
the department may not release registry information to any
individual or entity without the consent of the person or, if a
minor, the parent, managing conservator, or guardian of the child.
(c) A person required to report information to the
department for registry purposes or authorized to receive
information from the registry may not disclose the individually
identifiable information to any other person without written
consent of the parent, managing conservator, or guardian of the
child, except as provided by Chapter 159, Occupations Code, or
Article 28B.04, Insurance Code.
(d) Registry information is not:
(1) subject to discovery, subpoena, or other means of
legal compulsion for release to any person or entity except as
provided by this subchapter; or
(2) admissible in any civil, administrative, or
criminal proceeding.
Sec. 161.0074. REPORT TO LEGISLATURE. (a) The department
shall report to the Legislative Budget Board, the governor, the
lieutenant governor, the speaker of the house of representatives,
and appropriate committees of the legislature not later than
September 30 of each even-numbered year.
(b) The department shall use the report required under
Subsection (a) to develop ways to increase immunization rates using
state and federal resources.
(c) The report must:
(1) include the current immunization rates by
geographic region of the state, where available;
(2) focus on the geographic regions of the state with
immunization rates below the state average for preschool children;
(3) describe the approaches identified to increase
immunization rates in underserved areas and the estimated cost for
each;
(4) identify changes to department procedures needed
to increase immunization rates;
(5) identify the services provided under and
provisions of contracts entered into by the department to increase
immunization rates in underserved areas;
(6) identify performance measures used in contracts
described by Subdivision (5);
(7) include the number and type of exemptions used in
the past year;
(8) include the number of complaints received by the
department related to the department's failure to comply with
requests for exclusion of individuals from the registry; and
(9) identify all reported incidents of discrimination
for requesting exclusion from the registry or for using an
exemption for a required immunization.
Sec. 161.0075. IMMUNITY FROM LIABILITY. Except as provided
by Section 161.009, the following persons subject to this
subchapter that act in compliance with Sections 161.007, 161.0071,
161.0073, 161.0074, and 161.008 are not civilly or criminally
liable for furnishing the information required under this
subchapter:
(1) a payor;
(2) a health care provider who administers
immunizations; and
(3) an employee of the department.
SECTION 4. Section 161.008, Health and Safety Code, is
amended by amending Subsections (c) and (d) and adding Subsections
(e)-(h) to read as follows:
(c) The department[, only with the consent of a child's
parent, managing conservator, or guardian,] may[:
[(1)] obtain the data constituting an immunization
record for a [the] child from a public health district, a local
health department, the child's parent, managing conservator, or
guardian, a physician to the child, a payor, or any health care
provider licensed or otherwise authorized to administer vaccines.
The department shall verify consent before including the reported
information in the immunization registry. The department may not
retain individually identifiable information about a person for
whom consent cannot be verified.
(d) The department may [or a physician to the child; or
[(2)] release the data constituting an immunization
record for the child to any entity that is described by Subsection
(c), to [a public health district, a local health department, a
physician to the child, or] a school or child care facility in which
the child is enrolled, or to a state agency responsible for the
health care of the child.
(e) [(d)] A parent, managing conservator, or legal guardian
may obtain and on request to the department shall be provided with
all individually identifiable immunization registry information
concerning his or her child or ward.
(f) A person, including a health care provider, a payor, or
an employee of the department that submits in good faith an
immunization history or data to or obtains in good faith an
immunization history or data from the department in compliance with
the provisions of this section and any rules adopted under this
section, is not liable for any civil damages.
(g) The department may release nonidentifying summary
statistics related to the registry that do not individually
identify a child.
(h) The board shall adopt rules to implement this section.
SECTION 5. Section 161.009(a), Health and Safety Code, is
amended to read as follows:
(a) A person commits an offense if the person:
(1) negligently releases or discloses individually
identifiable immunization registry information in violation of
Section 161.007, 161.0071, 161.0073, or 161.008; or
(2) negligently uses individually identifiable [the]
information in the immunization registry to solicit new patients or
clients or for other purposes that are not associated with
immunization or quality-of-care purposes, unless authorized under
this section.
SECTION 6. (a) As soon as practicable, but not later than
September 1, 2004, the Texas Board of Health shall:
(1) adopt rules necessary to implement the procedure
for excluding children from the immunization registry required by
this Act; and
(2) make available for use a form for requesting
exclusion from the immunization registry under Section 161.0071,
Health and Safety Code, as added by this Act.
(b) The data reported under Sections 161.007(c) and (d),
Health and Safety Code, as amended by this Act, may not be accepted
or released by the Texas Department of Health until the department
has adopted rules and prescribed the forms required by this Act.
SECTION 7. (a) Except as provided by Subsection (b) of this
section, this Act takes effect immediately if it receives a vote of
two-thirds of all the members elected to each house, as provided by
Section 39, Article III, Texas Constitution. If this Act does not
receive the vote necessary for immediate effect, this Act takes
effect September 1, 2003.
(b) The change in law made by this Act to Sections
161.007(c) and (d), Health and Safety Code, takes effect September
1, 2004.