|
|
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. |