81R4413 YDB-D
By: Zaffirini S.B. No. 1251
A BILL TO BE ENTITLED
AN ACT
relating to information submitted to, maintained in, and released
from the immunization registry.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 161.0001, Health and Safety Code, is
amended by adding Subdivision (1-c) 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].
SECTION 2. Sections 161.007(a), (a-1), (b), (b-1), (c),
(d), (e), (f), (j), and (k), Health and Safety Code, are amended 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 and that registry information may be released under
Section 161.00705(g)(2) or (3) in the event of certain disasters,
emergencies, attacks, or actions;
(3) require the written consent of the individual or
the individual's legally authorized representative for the
individual's inclusion in the registry [a parent, managing
conservator, or guardian of a patient younger than 18 years of age]
before any information relating to the individual [patient] is
disclosed to any other user of [included in] the registry except as
otherwise provided by this subchapter;
(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, except as provided by Section 161.00705(e); [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; and
(6) allow the department to retain information in the
registry until a person's death.
(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 individual or the individual's legally authorized
representative withdraws [child becomes 18 years of age unless] the
consent [is withdrawn] in writing. 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. The executive commissioner of the Health and Human
Services Commission by rule shall develop procedures for obtaining
consent from an individual who is 18 years of age or older.
(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);
(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 in this state or another
state; 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. Except as provided by this subchapter, the [The]
department shall verify consent before disclosing [including] the
reported information to other users of [in] the immunization
registry. The department may [not] retain individually
identifiable information about an individual obtained under this
subsection [a person] for whom consent cannot be verified. The
department may not disclose the information to other users of the
registry until consent is verified, except that the department may
disclose the information to public health officials or health
authorities during a disaster, emergency, attack, or action
described by Section 161.00705(a).
(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. Except
as provided by this subchapter, the [The] department shall verify
consent before disclosing [including] the information to other
users of [in] the immunization registry. The department may [not]
retain individually identifiable information about an individual
obtained under this subsection [a person] for whom consent cannot
be verified. The department may not disclose the information to
other users of the registry until consent is verified, except that
the department may disclose the information to public health
officials or health authorities during a disaster, emergency,
attack, or action described by Section 161.00705(a).
(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 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 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 minors 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 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. Section 161.00705, Health and Safety Code, is
amended by amending Subsections (a), (c), (e), (f), and (g) and
adding Subsections (a-1) and (j) to read as follows:
(a) The department shall maintain a registry of persons who
receive an immunization, antiviral, and other medication
administered to prepare for a potential disaster, public health
emergency, terrorist attack, hostile military or paramilitary
action, or extraordinary law enforcement emergency in this state or
another state or in response to a declared disaster, public health
emergency, terrorist attack, hostile military or paramilitary
action, or extraordinary law enforcement emergency in this state or
in another state. A health care provider who administers an
immunization, antiviral, or other medication to a resident of this
state or to a resident of another state that has relocated or
evacuated to this state shall provide the data elements to the
department.
(a-1) The department may accept from a health authority in
another state or a local health authority in another state
immunization information for inclusion in the registry under this
section if the department determines that:
(1) residents of that state have evacuated or
relocated to this state in response to a declared disaster, public
health emergency, terrorist attack, hostile military or
paramilitary action, or extraordinary law enforcement emergency in
that state; or
(2) residents of this state have evacuated or
relocated to that state in response to a declared disaster, public
health emergency, terrorist attack, hostile military or
paramilitary action, or extraordinary law enforcement emergency in
this state.
(c) The department shall track adverse reactions to an
immunization, antiviral, and other medication administered to
prepare for a potential disaster, public health emergency,
terrorist attack, hostile military or paramilitary action, or
extraordinary law enforcement emergency in this state or another
state or in response to a declared disaster, public health
emergency, terrorist attack, hostile military or paramilitary
action, or extraordinary law enforcement emergency in this state or
another state. A health care provider who administers an
immunization, antiviral, or other medication to a resident of this
state or to a resident of another state that has relocated or
evacuated to this state may provide data related to adverse
reactions to the department.
(e) The executive commissioner of the Health and Human
Services Commission by rule shall determine the period during which
the information collected under this section must remain in the
immunization registry following the end of the disaster, public
health emergency, terrorist attack, hostile military or
paramilitary action, or extraordinary law enforcement emergency in
this state or another state.
(f) Unless an individual or, if a minor [child], the minor's
[child's] parent, managing conservator, or guardian consents in
writing to continued inclusion of the minor's [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).
(g) The immunization information of a minor [child] or other
individual received by the department under this section, including
individually identifiable information, may be released only:
(1) on consent of the individual or, if a minor
[child], the minor's [child's] parent, managing conservator, or
guardian; [or]
(2) to a state agency or health care provider in this
state consistent with the purposes of this subchapter or the
purposes of aiding or coordinating communicable disease prevention
and control efforts during a declared disaster, public health
emergency, terrorist attack, hostile military or paramilitary
action, or extraordinary law enforcement emergency in this state or
another state; or
(3) to an appropriate health authority or local health
authority of another state to which residents of this state have
evacuated or relocated in response to a declared disaster, public
health emergency, terrorist attack, hostile military or
paramilitary action, or extraordinary law enforcement emergency
consistent with the purposes of this subchapter or the purposes of
aiding or coordinating communicable disease prevention and control
efforts during a declared disaster, public health emergency,
terrorist attack, hostile military or paramilitary action, or
extraordinary law enforcement emergency.
(j) The executive commissioner of the Health and Human
Services Commission may enter into a memorandum of agreement with
another state on:
(1) the release and use of registry information under
this section to the appropriate health authority or local health
authority of that state; or
(2) the receipt and use of information submitted by
the health authority or local health authority of that state for
inclusion in the registry under this section.
SECTION 4. Sections 161.00706(c) and (d), Health and Safety
Code, are amended to read as follows:
(c) The executive commissioner of the Health and Human
Services Commission shall:
(1) develop rules to ensure that immunization history
submitted under Subsection (a)(2) is medically verified
immunization information;
(2) develop guidelines for use by the department in
informing first responders about the registry and that registry
information may be released under Section 161.00705 in the event of
certain disasters, emergencies, attacks, or actions; and
(3) adopt rules necessary for the implementation of
this section.
(d) Except as provided by Section 161.00705, in the event of
certain disasters, emergencies, attacks, or actions, a [A] person's
immunization history or data received by the department under this
section may be released only:
(1) on consent of the person; or
(2) to any health care provider licensed or otherwise
authorized to administer vaccines.
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 161.00705(g)(2) or (3) and 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 [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 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 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 minor's [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 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. Sections 161.0073(a), (b), and (c), 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 written 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 this subchapter, Chapter 159, Occupations Code, or
Section 602.053, Insurance Code.
SECTION 8. Sections 161.008(c), (d), (e), (g), and (h),
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. Except as provided by this
subchapter, the [The] department shall verify consent before
disclosing [including] the reported information in the
immunization registry. The department may [not] retain
individually identifiable information about an individual obtained
under this subsection [a person] for whom consent cannot be
verified. The department may not disclose the information to other
users of the registry until consent is verified, except that the
department may disclose the information to public health officials
or health authorities during a disaster, emergency, attack, or
action described by Section 161.00705 in accordance with that
section.
(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;
(3) [, or to] a state agency having legal custody of
the individual; or
(4) any entity as necessary to verify an immunization
required for:
(A) admittance in a professional school,
college, or university;
(B) certification in a health care profession;
(C) enlistment in the United States armed forces;
or
(D) any other purpose at the request 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. 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 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. This Act takes effect September 1, 2009.