83R20242 YDB-F
By: Howard, Zerwas, Callegari H.B. No. 772
Substitute the following for H.B. No. 772:
By: Collier C.S.H.B. No. 772
A BILL TO BE ENTITLED
AN ACT
relating to the immunization data included in and excluded from the
immunization registry.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 161.007, Health and Safety Code, is
amended by amending Subsections (a), (a-2), (b), (b-1), (c), (d),
and (e) and adding Subsections (e-1), (l), and (m) 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 communicable disease
prevention and control efforts, shall establish and maintain an
immunization registry. The executive commissioner of the Health
and Human Services Commission 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 about the registry and that registry
information may be released under Section 161.00735;
(3) [require the written or electronic consent of the
individual or the individual's legally authorized representative
before any information relating to the individual is included in
the registry;
[(4)] permit the individual or the individual's
legally authorized representative to request that the individual's
information be removed from [withdraw consent for the individual to
be included in] the registry;
(4) provide opportunities for the individual or the
individual's legally authorized representative to request removal:
(A) at the time of the individual's birth if
attended by a health care provider who administers immunizations;
(B) at the time the individual receives any
immunization administered by a health care provider in this state;
(C) through electronic submission of a request
for removal using a request for removal procedure available on the
department's Internet website;
(D) through submission to the department of a
written request for removal; and
(E) following a natural or man-made disaster; and
(5) include on each immunization record generated by
the registry the procedures for requesting removal from the
registry [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-2) An individual's legally authorized representative or
the individual, after the individual has attained 18 years of age,
may submit a request [consent] in writing or electronically for the
individual's information to be removed from [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.
(b) Except as provided by Section 161.0071, the
immunization registry must contain information on the immunization
history that is obtained by the department under:
(1) this section of each individual for whom
immunization information [consent] has been obtained, unless the
individual or the individual's legally authorized representative
has requested that the individual's information be removed from the
registry 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;
(3) Section 161.00706 of first responders or their
immediate family members; and
(4) Section 161.00735 of persons evacuated or
relocated to this state because of a disaster.
(b-1) The department shall remove from the registry
information for any individual for whom [consent has been
withdrawn. The department may not retain individually identifiable
information about any individual:
[(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);
[(3) for whom a request to be removed from the registry
has been received under Section 161.00706(e);
[(4) for whom consent for continued inclusion in the
registry following the end of a disaster has not been received under
Section 161.00735(f); or
[(5) for whom] a request to remove information from
the registry has been received under this subchapter [Section
161.00735(g)].
(c) A payor that receives data elements from a health care
provider who administers an immunization to an individual 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 for whom consent cannot be verified.]
(d) A health care provider who administers an immunization
to an individual 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. A health care
provider who administers an immunization to any individual and
provides data elements to the department shall notify the
individual or the individual's legally authorized representative:
(1) that the individual's immunization information
will be included in the registry unless removal from the registry is
requested in accordance with the guidelines adopted under
Subsection (a); and
(2) of the procedures for requesting removal from the
registry. [The department shall verify consent before including the
information in the immunization registry. The department may not
retain individually identifiable information about an individual
for whom consent cannot be verified.]
(e) The department shall:
(1) make available on the department's Internet
website a printable form that states an individual's immunization
information will be included in the registry unless removal from
the registry is requested and that details the procedures for
submitting an electronic or written request for removal from the
registry [provide notice to a health care provider that submits an
immunization history for an individual for whom consent cannot be
verified. The notice shall contain instructions for obtaining
consent] in accordance with guidelines adopted under Subsection
[Subsections] (a); and
(2) make the form described by Subdivision (1)
available for distribution to health care providers [and (a-3) and
resubmitting the immunization history to the department].
(e-1) A health care provider may use the printable form
described by Subsection (e) to provide the notification required
under Subsection (d).
(l) Registry information may not be used to exclude any
individual from the receipt of any service during a natural or
man-made disaster unless the service is withheld because of a
medical contraindication.
(m) The department may not sell registry information to any
public or private entity.
SECTION 2. Section 161.00705(f), Health and Safety Code, is
amended to read as follows:
(f) Unless an individual or the individual's legally
authorized representative [consents] in writing or electronically
requests that [to continued inclusion of] the individual's
information be removed from [in] the registry, the department shall
include [remove] the immunization records collected under this
section in [from] the registry [on expiration of the period
prescribed under Subsection (e)].
SECTION 3. Sections 161.0071(a) and (b), Health and Safety
Code, are amended to read as follows:
(a) The first time the department receives registry data for
an individual [for whom the department has received consent] to be
included in the registry, the department shall send notice to the
individual or the individual's legally authorized representative
disclosing:
(1) that providers and payors may be sending the
individual'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 Sections 161.00735(b) and 161.008(d);
(4) the purpose and use of the registry;
(5) the procedure to exclude an individual from the
registry; and
(6) the procedure to report a violation if an
individual's information is included in the registry after
exclusion has been requested [or consent has been withdrawn].
(b) The [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 immunization records]
from the registry and any other registry-related department record
that individually identifies the individual the immunization
record of any individual from whom a request for exclusion has been
received by the department.
SECTION 4. Section 161.0073, Health and Safety Code, is
amended by amending Subsection (a) and adding Subsections (e), (f),
and (g) to read as follows:
(a) Except as provided by this section and Sections 161.007,
161.00705, 161.00706, [and] 161.00735, and 161.008, information
that individually identifies an individual that is received by the
department for the immunization registry is confidential and may be
used by the department for registry purposes only.
(e) The department may use registry information for
internal public health research on approval of the department's
institutional review board.
(f) The department may release registry information for
external public health research if:
(1) the individual or the individual's legally
authorized representative submits a written authorization to the
department for release of the individual's registry data;
(2) the department does not disclose individually
identifiable information; or
(3) the department's institutional review board
approves the release of individually identifiable information
subject to Subsection (g).
(g) The department's institutional review board may not
approve the release of individually identifiable information for a
research proposal unless the proposal includes a provision
requiring the proposal's researchers to obtain informed consent
from each individual or the individual's legally authorized
representative before the department releases the individual's
registry data to the researchers.
SECTION 5. Sections 161.00735(c) and (h), Health and Safety
Code, are amended to read as follows:
(c) The department may receive immunization information
from a health authority of another state or from a local health
authority in another state if the department determines that
residents of that state have evacuated or relocated to this state in
response to a disaster. The department shall include information
received under this subsection in the registry. [Notwithstanding
Section 161.007, the department is not required to obtain written
consent for the inclusion in the registry of information received
under this subsection.]
(h) The executive commissioner of the Health and Human
Services Commission shall make every effort to enter into a
memorandum of agreement with each state to which residents of this
state are likely to evacuate in a disaster on:
(1) the release to and use by [of registry information
under this section to] the appropriate health authority or local
health authority of that state of registry information under this
section[, including the length of time the information may be
retained by that state]; and
(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 6. Sections 161.008(c) and (e), Health and Safety
Code, are amended to read as follows:
(c) The department may obtain the data constituting an
immunization record for an individual from a public health
district, a local health department, the individual or the
individual's legally authorized representative, a physician to the
individual, 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 for whom consent
cannot be verified.]
(e) An individual or the individual's legally authorized
representative may obtain and on request to the department shall be
provided with all individually identifiable immunization registry
information concerning the individual and information on the
procedure for requesting removal from the registry.
SECTION 7. Section 161.0095(a), Health and Safety Code, is
amended to read as follows:
(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 or the individual's legally authorized representative
to request removal [who is 18 years of age or older to consent to
submission and retention] of the individual's information from [in]
the immunization registry.
SECTION 8. Section 161.0107(c), Health and Safety Code, is
amended to read as follows:
(c) The executive commissioner of the Health and Human
Services Commission by rule shall specify:
(1) the fields necessary to populate the immunization
registry[, including a field that indicates the patient's consent
to be listed in the immunization registry has been obtained]; and
(2) the data standards that must be used for
electronic submission of immunization information.
SECTION 9. The following provisions of the Health and
Safety Code are repealed:
(1) Sections 161.007(a-1) and (a-3);
(2) Sections 161.00705(e) and (h); and
(3) Sections 161.00735(e) and (f).
SECTION 10. The changes in law made by this Act to
Subchapter A, Chapter 161, Health and Safety Code, apply to
immunization information received by the Department of State Health
Services before, on, or after January 1, 2015. An individual whose
immunization information was included immediately before January
1, 2015, in the immunization registry established under Subchapter
A, Chapter 161, Health and Safety Code, is subject to the changes in
law made by this Act to that subchapter, including the procedures
established by that subchapter as amended by this Act.
SECTION 11. As soon as practicable after the effective date
of this Act, the Department of State Health Services shall conduct a
public awareness campaign to educate health care providers,
parents, payors, schools, and the public about the changes in law
made by this Act.
SECTION 12. (a) Except as provided by Subsection (b) of this
section, this Act takes effect January 1, 2015.
(b) Section 11 of this Act takes effect September 1, 2013.