By: Nelson, Shapleigh S.B. No. 346
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to information submitted to and maintained in the
  immunization registry after an individual becomes an adult.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 161.0001, Health and Safety Code, is
  amended by adding Subdivisions (1-c) and (3) and amending
  Subdivision (2) to read as follows:
               (1-c)  "Individual's legally authorized
  representative" means:
                     (A)  a parent, managing conservator, or guardian
  of an individual, if the individual is a minor;
                     (B)  a guardian of the individual, if the
  individual has been adjudicated incompetent to manage the
  individual's personal affairs; or
                     (C)  an agent of the individual authorized under a
  durable power of attorney for health care.
               (2)  "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].
               (3)  "Electronically," as related to a communication
  authorized under this chapter, means by e-mail, text message,
  online communication, or another electronic method of
  communication approved by the department.
         SECTION 2.  Section 161.007, Health and Safety Code, is
  amended by amending Subsections (a), (a-1), (b), (b-1), (c), (d),
  (e), (f), (j), and (k) and adding Subsections (a-2) and (a-3) to
  read as follows:
         (a)  The department, for the primary purpose 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 an immunization registry. The executive
  commissioner of the Health and Human Services Commission 
  [department] by rule shall develop guidelines to:
               (1)  protect the confidentiality of patients in
  accordance with Section 159.002, Occupations Code;
               (2)  inform the individual or the individual's legally
  authorized representative [a parent, managing conservator, or
  guardian of each patient younger than 18 years of age] about the
  registry;
               (3)  require the written or electronic consent of the
  individual or the individual's legally authorized representative 
  [a parent, managing conservator, or guardian of a patient younger
  than 18 years of age] before any information relating to the
  individual [patient] is included in the registry;
               (4)  permit the individual or the individual's legally
  authorized representative [a parent, managing conservator, or
  guardian of a patient younger than 18 years of age] to withdraw
  consent for the individual [patient] to be included in the
  registry; and
               (5)  determine the process by which consent is
  verified, including affirmation by a health care provider, birth
  registrar, regional health information exchange, or local
  immunization registry that consent has been obtained.
         (a-1)  The written or electronic consent required by
  Subsection (a)(3) for an individual younger than 18 years of age is
  required to be obtained only one time. The [written] consent is
  valid until the individual [child] becomes 18 years of age unless
  the consent is withdrawn in writing or electronically. A parent,
  managing conservator, or guardian of a minor [child] may provide
  the [written] consent by using an electronic signature on the
  minor's [child's] birth certificate.
         (a-2)  An individual's legally authorized representative or
  the individual, after the individual has attained 18 years of age,
  may consent in writing or electronically for the individual's
  information to remain in the registry after the individual's 18th
  birthday and for the individual's subsequent immunizations to be
  included in the registry.  The written or electronic consent of the
  minor's legally authorized representative as described by Section
  161.0001(1-c)(A) must be submitted to the department before the
  individual's 18th birthday.  The written or electronic consent of
  the individual or the individual's legally authorized
  representative as described by Section 161.0001(1-c)(B) or (C) must
  be submitted to the department not later than the individual's 19th
  birthday.  The consent of the representative or individual is valid
  until the individual or the individual's legally authorized
  representative withdraws consent in writing  or electronically.  
  The department may not include in the registry the immunization
  information of an individual who is 18 years of age or older until
  written or electronic consent has been obtained as provided by this
  subsection.  The department shall coordinate with the Texas
  Education Agency to distribute materials described in Section
  161.0095(a)(2) to students and parents through local school
  districts.
         (a-3)  The executive commissioner of the Health and Human
  Services Commission by rule shall develop guidelines and procedures
  for obtaining consent from an individual after the individual's
  18th birthday, including procedures for retaining immunization
  information in a separate database that is inaccessible by any
  person other than the department during the one-year period during
  which an 18-year-old may consent to inclusion in the registry under
  Subsection (a-2).
         (b)  Except as provided by Section 161.0071, the [The]
  immunization registry must contain information on the immunization
  history that is obtained by the department under:
               (1)  this section of each individual [person who is
  younger than 18 years of age and] for whom consent has been obtained
  in accordance with guidelines adopted under Subsection (a) or
  (a-3), as applicable;
               (2)  Section 161.00705 of persons immunized to prepare
  for or in response to a declared disaster, public health emergency,
  terrorist attack, hostile military or paramilitary action, or
  extraordinary law enforcement emergency; and
               (3)  Section 161.00706 of first responders or their
  immediate family members.
         (b-1)  The department shall remove from the registry
  information for any individual [person] for whom consent has been
  withdrawn. The department may not retain individually identifiable
  information about any individual [person]:
               (1)  for whom consent has been withdrawn;
               (2)  for whom a consent for continued inclusion in the
  registry following the end of the declared disaster, public health
  emergency, terrorist attack, hostile military or paramilitary
  action, or extraordinary law enforcement emergency has not been
  received under Section 161.00705(f); or
               (3)  for whom a request to be removed from the registry
  has been received under Section 161.00706(e).
         (c)  A payor that receives data elements from a health care
  provider who administers an immunization to an individual [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. A payor that receives data elements from a health care
  provider who administers an immunization to an individual 18 years
  of age or older may provide the data elements to the department.  
  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 an individual [a person] for whom consent cannot be verified.
         (d)  A health care provider who administers an immunization
  to an individual [a person] younger than 18 years of age shall
  provide data elements regarding an immunization to the department.  
  A health care provider who administers an immunization to an
  individual 18 years of age or older may submit data elements
  regarding an immunization to the department.  The data elements
  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 an individual [a
  person] for whom consent cannot be verified.
         (e)  The department shall provide notice to a health care
  provider that submits an immunization history for an individual [a
  person] for whom consent cannot be verified. The notice shall
  contain instructions for obtaining consent in accordance with
  guidelines adopted under Subsections [Subsection] (a) and (a-3) 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 an individual or the individual's legally
  authorized representative [a parent, managing conservator, or
  guardian] regarding an individual [his or her child or ward] who is
  due or overdue for a particular type of immunization according to
  the department's immunization schedule for children or another
  analogous schedule recognized by the department for individuals 18
  years of age or older. 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.
         (j)  Except as provided by Sections 161.00705, 161.00706,
  and 161.008, information obtained by the department for the
  immunization registry is confidential and may be disclosed only
  with the written or electronic consent of the individual or the
  individual's legally authorized representative [, if a child, the
  child's parent, managing conservator, or guardian].
         (k)  The executive commissioner of the Health and Human
  Services Commission [board] shall adopt rules to implement this
  section.
         SECTION 3.  Subsection (f), Section 161.00705, Health and
  Safety Code, is amended to read as follows:
         (f)  Unless an individual or the individual's legally
  authorized representative[, if a child, the child's parent,
  managing conservator, or guardian] consents in writing or
  electronically to continued inclusion of the [child's or other]
  individual's information in the registry, the department shall
  remove the immunization records collected under this section from
  the registry on expiration of the period prescribed under
  Subsection (e).
         SECTION 4.  Subsection (e), Section 161.00706, Health and
  Safety Code, is amended to read as follows:
         (e)  A person whose immunization records are included in the
  immunization registry as authorized by this section may request in
  writing or electronically that the department remove that
  information from the registry. Not later than the 10th day after
  receiving a request under this subsection, the department shall
  remove the person's immunization records from the registry.
         SECTION 5.  Section 161.0071, Health and Safety Code, is
  amended 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 an individual [a child] for whom the
  department has received consent to be included in the registry,
  [from a person other than the child's parent, managing conservator,
  or guardian,] the department shall send [a written] notice to the
  individual or the individual's legally authorized representative
  [child's parent, managing conservator, or guardian] disclosing:
               (1)  that providers and payors may be sending the
  individual's [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 an individual [a child]
  from the registry; and
               (6)  the procedure to report a violation if an
  individual's information [a parent, managing conservator, or
  guardian discovers a child] is included in the registry after
  exclusion has been requested or consent has been withdrawn.
         (b)  On discovering that consent to be included in the
  registry has not been granted or has been withdrawn, the department
  shall exclude the individual's [child's] immunization records from
  the registry and any other registry-related department record that
  individually identifies the individual [child].
         (c)  On receipt of a written or electronic request to exclude
  an individual's [a child's] immunization records from the registry,
  the department shall send to the individual or the individual's
  legally authorized representative [a parent, managing conservator,
  or guardian] who makes the request a written confirmation of
  receipt of the request for exclusion and shall exclude the
  individual's [child's] records from the registry.
         (d)  The department commits a violation if the department
  fails to exclude an individual's [a child's] immunization
  information from the registry as required by Subsection (b) or (c).
         (e)  The department shall accept a written or electronic 
  statement from an individual or the individual's legally authorized
  representative [a parent, managing conservator, or guardian]
  communicating to the department that an individual's information [a
  child] should be excluded from the registry, including a statement
  on a minor's [the child's] birth certificate, as a request for
  exclusion under Subsection (c). [The written statement may include
  the electronic signature on the child's birth certificate.]
         SECTION 6.  Section 161.0072, Health and Safety Code, is
  amended to read as follows:
         Sec. 161.0072.  PROVIDING IMMUNIZATION INFORMATION TO
  DEPARTMENT.  (a)  If the individual or the individual's legally
  authorized representative [parent, managing conservator, or
  guardian of a child] has reasonable concern that the individual's
  [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 individual
  or the individual's legally authorized representative [parent,
  managing conservator, or guardian] may provide the individual's
  [child's] immunization history directly to the department to be
  included in the immunization registry.
         (b)  The individual or the individual's legally authorized
  representative [parent, managing conservator, or guardian of a
  child] may send evidence of the individual's [child's] immunization
  history to the department electronically, by facsimile
  transmission, or by mail. The evidence may include a copy of:
               (1)  the individual's [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.
         (c)  The board shall develop rules to ensure that the
  immunization history submitted by an individual or the individual's
  legally authorized representative [a parent, managing conservator,
  or guardian] is medically verified immunization information.
         SECTION 7.  Subsections (a), (b), and (c), Section 161.0073,
  Health and Safety Code, are amended to read as follows:
         (a)  Except as provided by Section 161.00705, information
  that individually identifies an [a child or other] individual that
  is 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 individual or the
  individual's legally authorized representative [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 of an [a child or other] individual to any
  other person without the written or electronic consent of the
  individual or the individual's legally authorized representative
  [, if a child, the parent, managing conservator, or guardian of the
  child], except as provided by Chapter 159, Occupations Code, or
  Section 602.053, Insurance Code.
         SECTION 8.  Subsections (c), (d), (e), (g), and (h), Section
  161.008, Health and Safety Code, are amended to read as follows:
         (c)  The department may obtain the data constituting an
  immunization record for an individual [a child] from a public
  health district, a local health department, the individual or the
  individual's legally authorized representative [child's parent,
  managing conservator, or guardian], a physician to the individual
  [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 an individual [a person] for whom
  consent cannot be verified.
         (d)  The department may release the data constituting an
  immunization record for the individual [child] to:
               (1)  any entity that is described by Subsection (c);
               (2)  [, to] a school or child care facility in which the
  individual [child] is enrolled; or
               (3)  [, or to] a state agency having legal custody of
  the individual [child].
         (e)  An individual or the individual's legally authorized
  representative [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 the individual [his or her child or ward].
         (g)  The department may release nonidentifying summary
  statistics related to the registry that do not individually
  identify an individual [a child].
         (h)  The executive commissioner of the Health and Human
  Services Commission [board] shall adopt rules to implement this
  section.
         SECTION 9.  Subsection (a), Section 161.009, Health and
  Safety Code, is amended to read as follows:
         (a)  A person commits an offense if the person:
               (1)  negligently releases or discloses immunization
  registry information in violation of Section 161.007, 161.0071,
  161.0073, or 161.008;
               (2)  fails to exclude an individual's [a child's]
  immunization information in violation of Section 161.0071;
               (3)  fails to remove a person's immunization
  information in violation of Section 161.00705 or 161.00706; or
               (4)  negligently uses 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 10.  Section 161.0095, Health and Safety Code, is
  amended to read as follows:
         Sec. 161.0095.  [PROVIDER] EDUCATION PROGRAMS AND
  INFORMATION.  (a) The department shall develop:
               (1)  continuing education programs for health care
  providers relating to immunizations and the vaccines for children
  program operated by the department under authority of 42 U.S.C.
  Section 1396s; and
               (2)  educational information, for health care
  providers, health care clinics, hospitals, and any other health
  care facility that provides health care to children 14 to 18 years
  of age, relating to the immunization registry and the option for an
  individual who is 18 years of age or older to consent to submission
  and retention of the individual's information in the immunization
  registry[, as amended].
         (b)  The department shall establish a work group to assist
  the department in developing the continuing education programs and
  educational information [materials]. The work group shall include
  physicians, nurses, department representatives, representatives of
  managed care organizations that provide health care services under
  Chapter 533, Government Code, representatives of health plan
  providers that provide health care services under Chapter 62, and
  members of the public.
         SECTION 11.  This Act takes effect September 1, 2009.