Texas 2023 - 88th Regular

Texas Senate Bill SB304 Latest Draft

Bill / Introduced Version Filed 12/19/2022

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                            88R1036 MCF-F
 By: Hall S.B. No. 304


 A BILL TO BE ENTITLED
 AN ACT
 relating to prohibited immunization status discrimination and
 vaccine mandates; authorizing administrative penalties.
 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 ARTICLE 1. PROHIBITED IMMUNIZATION STATUS DISCRIMINATION
 SECTION 1.01.  Subtitle C, Title 5, Business & Commerce
 Code, is amended by adding Chapter 122 to read as follows:
 CHAPTER 122. PROHIBITED IMMUNIZATION STATUS DISCRIMINATION
 Sec. 122.001.  DEFINITION. In this chapter, "public
 accommodation" means a disposition, service, financial aid, or
 benefit provided to members of the public.
 Sec. 122.002.  DISCRIMINATION PROHIBITED. A person may not
 discriminate against or refuse to provide a public accommodation to
 an individual based on the individual's vaccination history or
 immunity status for a communicable disease by:
 (1)  providing to the individual a public accommodation
 that is different or provided in a different manner than the
 accommodation provided or manner of providing the accommodation to
 other members of the public;
 (2)  subjecting the individual to segregation or
 separate treatment in any matter related to providing the public
 accommodation to the individual;
 (3)  restricting in any way the individual's enjoyment
 of a public accommodation in a manner that distinguishes the
 individual's enjoyment from the enjoyment of other members of the
 public;
 (4)  treating the individual differently from other
 members of the public in determining whether the individual
 satisfies any admission, enrollment, quota, eligibility,
 membership, or other requirement or condition that individuals must
 satisfy before a public accommodation is provided; or
 (5)  denying the individual an opportunity to
 participate in a program in a manner that differs from the manner
 the opportunity is provided to other members of the public.
 Sec. 122.003.  COMPLAINT; EQUITABLE RELIEF. (a) A person may
 file a complaint with the attorney general if the person asserts
 facts supporting an allegation that another person has violated
 Section 122.002. The person filing the complaint must include a
 sworn affidavit stating that to the person's knowledge, all of the
 facts asserted in the complaint are true and correct.
 (b)  If the attorney general determines a complaint filed
 under Subsection (a) is valid, the attorney general may file a
 petition for a writ of mandamus or apply for other appropriate
 equitable relief in a district court in Travis County or in a county
 in which the person against whom relief is sought resides to compel
 the person to comply with Section 122.002.
 Sec. 122.004.  EFFECT ON OTHER LAW. This chapter prevails to
 the extent of a conflict between this chapter and any other law.
 SECTION 1.02.  Subchapter A, Chapter 161, Health and Safety
 Code, is amended by adding Sections 161.0057 and 161.0086 to read as
 follows:
 Sec. 161.0057.  PROHIBITED IMMUNIZATION DISCRIMINATION BY
 LONG-TERM CARE FACILITIES.  (a)  In this section, "long-term care
 facility" means a facility licensed or regulated under Chapter 242,
 247, or 252.
 (b)  A long-term care facility may not refuse to provide
 services to a resident based on the resident's vaccination history
 or immunity status for a communicable disease.
 (c)  A long-term care facility that violates this section is
 ineligible to receive state money for services provided to
 residents.
 (d)  A violation of this section is a violation of the
 long-term care facility's applicable licensing law and subjects the
 facility to disciplinary action and the imposition of
 administrative penalties under that law.
 (e)  This section prevails to the extent of a conflict
 between this section and any other law.
 Sec. 161.0086.  PROHIBITED IMMUNIZATION DISCRIMINATION.
 (a) A health care provider or health care facility may not refuse to
 provide a health care service to a patient based on a patient's
 vaccination history or immunity status for a communicable disease.
 (b)  A health care facility providing clinical experience to
 satisfy a student's degree requirements may not discriminate
 against a student or prohibit admission, enrollment, or employment
 as a student, intern, or resident based on the student's
 vaccination history or immunity status for a communicable disease.
 (c)  Notwithstanding any other law, a health care provider or
 health care facility that violates this section is ineligible to
 receive state money for health care services provided to patients.
 (d)  A violation of this section is a violation of the health
 care provider's or health care facility's applicable licensing law
 and subjects the provider or facility to disciplinary action and
 the imposition of administrative penalties under that law.
 (e)  This section prevails to the extent of a conflict
 between this section and any other law.
 SECTION 1.03.  Chapter 544, Insurance Code, is amended by
 adding Subchapter O to read as follows:
 SUBCHAPTER O. IMMUNIZATION STATUS
 Sec. 544.701.  DEFINITIONS. In this subchapter:
 (1)  "Health benefit plan issuer" means an issuer,
 administrator, or sponsor of a health benefit plan described by
 Section 544.702.
 (2)  "Participating provider" means a health care
 provider who has contracted with a health benefit plan issuer to
 provide services to enrollees.
 Sec. 544.702.  APPLICABILITY OF SUBCHAPTER. (a) This
 subchapter applies only to a health benefit plan that provides
 benefits for medical or surgical expenses incurred as a result of a
 health condition, accident, or sickness, including a group,
 blanket, or franchise insurance policy or insurance agreement, a
 group hospital service contract, or a group evidence of coverage or
 similar coverage document that is offered by:
 (1)  an insurance company;
 (2)  a group hospital service corporation operating
 under Chapter 842;
 (3)  a health maintenance organization operating under
 Chapter 843;
 (4)  an approved nonprofit health corporation that
 holds a certificate of authority under Chapter 844;
 (5)  a multiple employer welfare arrangement that holds
 a certificate of authority under Chapter 846;
 (6)  a stipulated premium company operating under
 Chapter 884;
 (7)  a fraternal benefit society operating under
 Chapter 885;
 (8)  a Lloyd's plan operating under Chapter 941; or
 (9)  an exchange operating under Chapter 942.
 (b)  Notwithstanding any other law, this subchapter applies
 to:
 (1)  a small employer health benefit plan subject to
 Chapter 1501, including coverage provided through a health group
 cooperative under Subchapter B of that chapter;
 (2)  a standard health benefit plan issued under
 Chapter 1507;
 (3)  a basic coverage plan under Chapter 1551;
 (4)  a basic plan under Chapter 1575;
 (5)  a primary care coverage plan under Chapter 1579;
 (6)  a plan providing basic coverage under Chapter
 1601;
 (7)  health benefits provided by or through a church
 benefits board under Subchapter I, Chapter 22, Business
 Organizations Code;
 (8)  the state Medicaid program, including the Medicaid
 managed care program operated under Chapter 533, Government Code;
 (9)  the child health plan program under Chapter 62,
 Health and Safety Code;
 (10)  a regional or local health care program operated
 under Section 75.104, Health and Safety Code;
 (11)  a self-funded health benefit plan sponsored by a
 professional employer organization under Chapter 91, Labor Code;
 (12)  county employee group health benefits provided
 under Chapter 157, Local Government Code; and
 (13)  health and accident coverage provided by a risk
 pool created under Chapter 172, Local Government Code.
 (c)  This subchapter applies to a life insurance company
 that:
 (1)  issues or delivers a life insurance policy in this
 state; or
 (2)  is organized under the laws of this state.
 Sec. 544.703.  PROHIBITED DISCRIMINATION AGAINST
 INDIVIDUAL. A group health benefit plan issuer or a life insurance
 company may not use an individual's vaccination history or immunity
 status for a communicable disease to:
 (1)  reject, deny, limit, cancel, refuse to renew, or
 increase the premiums for coverage of the individual under a plan
 offered by the issuer or company;
 (2)  limit the amount, extent, or kind of coverage
 available to the individual; or
 (3)  otherwise adversely affect the individual's
 eligibility for coverage.
 Sec. 544.704.  PROHIBITED DISCRIMINATION IN GROUP PLAN
 RATING. The vaccination history or immunity status for a
 communicable disease of individuals covered under a group health
 benefit plan that provides coverage in this state may not be used as
 a factor in the rating of the plan.
 Sec. 544.705.  PROHIBITED DISCRIMINATION AGAINST
 PARTICIPATING PROVIDER. (a) A health benefit plan issuer may not
 use the vaccination history or immunity status for a communicable
 disease of a health care provider's patients as a qualification or
 requirement for contracting with the provider or as a basis for
 terminating a contract with the provider.
 (b)  A health benefit plan issuer may not use the vaccination
 history or immunity status for a communicable disease of enrollees
 as a factor in providing a financial incentive or assessing a
 financial or other penalty against a participating provider.
 Sec. 544.706.  EFFECT ON OTHER LAW. This subchapter
 prevails to the extent of a conflict between this subchapter and any
 other law.
 SECTION 1.04.  Chapter 21, Labor Code, is amended by adding
 Subchapter H-1 to read as follows:
 SUBCHAPTER H-1. DISCRIMINATION BASED ON IMMUNIZATION STATUS
 Sec. 21.421.  PROHIBITED DISCRIMINATION BASED ON
 IMMUNIZATION STATUS. (a) An employer commits an unlawful
 employment practice if the employer fails or refuses to hire,
 discharges, or otherwise discriminates against an individual with
 respect to the compensation or the terms, conditions, or privileges
 of employment based on the individual's vaccination history or
 immunity status for a communicable disease.
 (b)  A labor organization commits an unlawful employment
 practice if the labor organization excludes or expels from
 membership or otherwise discriminates against an individual based
 on the individual's vaccination history or immunity status for a
 communicable disease.
 (c)  An employment agency commits an unlawful employment
 practice if the employment agency classifies or refers for
 employment, fails or refuses to refer for employment, or otherwise
 discriminates against an individual based on the individual's
 vaccination history or immunity status for a communicable disease.
 (d)  An employer, labor organization, or employment agency
 commits an unlawful employment practice if the employer, labor
 organization, or employment agency limits, segregates, or
 classifies an employee, member, or applicant for employment or
 membership in a way that would deprive or tend to deprive the
 employee, member, or applicant of employment opportunities or
 otherwise adversely affect the status of the employee, member, or
 applicant based on the employee's, member's, or applicant's
 vaccination history or immunity status for a communicable disease.
 Sec. 21.422.  EFFECT ON OTHER LAW. This subchapter prevails
 to the extent of a conflict between this subchapter and any other
 law.
 SECTION 1.05.  Title 2, Occupations Code, is amended by
 adding Chapter 60 to read as follows:
 CHAPTER 60. IMMUNIZATION DISCRIMINATION
 Sec. 60.001.  PROHIBITED IMMUNIZATION DISCRIMINATION. A
 licensing authority may not deny an application for an occupational
 license, suspend, revoke, or refuse to renew an occupational
 license, or take any other disciplinary action against an
 individual based on:
 (1)  the individual's vaccination history or immunity
 status for a communicable disease; or
 (2)  the individual's refusal to be vaccinated or
 participate in administering a vaccine.
 Sec. 60.002.  EFFECT ON OTHER LAW. This chapter prevails to
 the extent of a conflict between this chapter and any other law.
 SECTION 1.06.  Subtitle A, Title 3, Occupations Code, is
 amended by adding Chapter 103A to read as follows:
 CHAPTER 103A. RIGHT TO OBJECT TO VACCINATIONS; PROHIBITED
 IMMUNIZATION DISCRIMINATION
 Sec. 103A.001.  RIGHT TO OBJECT. A hospital or other health
 care facility may not require as a condition of employment that an
 employee, including a physician, nurse, or staff member:
 (1)  be vaccinated; or
 (2)  participate in administering a vaccine.
 Sec. 103A.002.  PROHIBITED IMMUNIZATION DISCRIMINATION.
 (a) A hospital or other health care facility may not discriminate
 against an employee, including a physician, nurse, or staff member,
 or an applicant who:
 (1)  refuses to:
 (A)  be vaccinated; or
 (B)  participate in administering a vaccine; or
 (2)  is not immune to a communicable disease.
 (b)  An educational institution may not discriminate against
 an applicant for admission or employment as a student, intern, or
 resident based on:
 (1)  the applicant's vaccination history or immunity
 status for a communicable disease; or
 (2)  the applicant's refusal to be vaccinated or
 participate in administering a vaccine.
 Sec. 103A.003.  REMEDIES. A person aggrieved by a violation
 of this chapter may bring an action against a hospital, other health
 care facility, or educational institution that administers a
 hospital or other health care facility in a district court in the
 county where the hospital, facility, or institution is located for:
 (1)  an injunction against any further violation;
 (2)  appropriate equitable relief, including:
 (A)  admission or reinstatement of employment;
 and
 (B)  back pay and 10 percent interest on the back
 pay; and
 (3)  any other relief necessary to ensure compliance
 with this chapter.
 Sec. 103A.004.  EFFECT ON OTHER LAW. This chapter prevails
 to the extent of a conflict between this chapter and any other law.
 SECTION 1.07.  Subchapter A, Chapter 521, Transportation
 Code, is amended by adding Section 521.015 to read as follows:
 Sec. 521.015.  PROHIBITED IMMUNIZATION DISCRIMINATION. (a)
 The department may not use an individual's vaccination history or
 immunity status for a communicable disease as a requirement for the
 issuance or renewal of a driver's license, election identification
 certificate, or personal identification certificate.
 (b)  The department may not discriminate against, deny
 services or access to, or otherwise penalize any individual based
 on the individual's vaccination history or immunity status or
 refusal to provide proof of vaccination or immunity to a
 communicable disease.
 (c)  This section prevails to the extent of a conflict
 between this section and any other law.
 ARTICLE 2. PROHIBITED VACCINATION MANDATES
 SECTION 2.01.  Section 25.002(a), Education Code, is amended
 to read as follows:
 (a)  If a parent or other person with legal control of a child
 under a court order enrolls the child in a public school, the parent
 or other person or the school district in which the child most
 recently attended school shall furnish to the school district:
 (1)  the child's birth certificate or another document
 suitable as proof of the child's identity; and
 (2)  a copy of the child's records from the school the
 child most recently attended if the child has been previously
 enrolled in a school in this state or another state[; and
 [(3) a record showing that the child has the
 immunizations as required under Section 38.001, in the case of a
 child required under that section to be immunized, proof as
 required by that section showing that the child is not required to
 be immunized, or proof that the child is entitled to provisional
 admission under that section and under rules adopted under that
 section].
 SECTION 2.02.  The heading to Section 38.001, Education
 Code, is amended to read as follows:
 Sec. 38.001.  RECOMMENDED IMMUNIZATIONS AND VACCINES
 [IMMUNIZATION; REQUIREMENTS; EXCEPTIONS].
 SECTION 2.03.  Section 38.001(b-1), Education Code, is
 amended to read as follows:
 (b-1)  Each year, the Department of State Health Services
 shall prepare a list of the immunizations and vaccines [required
 under this section for admission to public schools and of any
 additional immunizations] the department recommends for school-age
 children. The department shall prepare the list in English and
 Spanish and make the list available in a manner that permits a
 school district to easily post the list on the district's Internet
 website as required by Section 38.019. A school district or a
 school, including a private school, may not require any
 immunization or vaccine as a condition of admission to or
 attendance at an elementary or secondary school.
 SECTION 2.04.  Sections 38.019(a) and (b), Education Code,
 are amended to read as follows:
 (a)  A school district that maintains an Internet website
 shall post prominently on the website[:
 [(1)] a list, in English and Spanish, of:
 (1)  [(A) the immunizations required for admission to
 public school by rules of the Department of State Health Services
 adopted under Section 38.001;
 [(B)] any immunizations or vaccines recommended
 for public school students by the Department of State Health
 Services; and
 (2) [(C)]  health clinics in the district that offer
 the influenza vaccine, to the extent those clinics are known to the
 district[; and
 [(2) a link to the Department of State Health Services
 Internet website where a person may obtain information relating to
 the procedures for claiming an exemption from the immunization
 requirements of Section 38.001].
 (b)  The list of recommended immunizations or vaccines under
 Subsection (a)(1) [(a)(2)] must include the influenza vaccine[,
 unless the Department of State Health Services requires the
 influenza vaccine for admission to public school].
 SECTION 2.05.  The heading to Section 51.933, Education
 Code, is amended to read as follows:
 Sec. 51.933.  IMMUNIZATION INFORMATION [REQUIREMENTS;
 EXCEPTION].
 SECTION 2.06.  Section 51.933(a), Education Code, is amended
 to read as follows:
 (a)  An institution of higher education may not require
 students or applicants for admission to be immunized against any
 communicable disease [diphtheria, rubeola, rubella, mumps,
 tetanus, and poliomyelitis, except as provided in Subsection (d)].
 SECTION 2.07.  Section 264.1076(d), Family Code, is amended
 to read as follows:
 (d)  A physician or other health care provider conducting an
 examination under Subsection (b) may not administer a vaccination
 as part of the examination without parental consent[, except that a
 physician or other health care provider may administer a tetanus
 vaccination to a child in a commercially available preparation if
 the physician or other health care provider determines that an
 emergency circumstance requires the administration of the
 vaccination]. The prohibition on the administration of a
 vaccination under this subsection does not apply after the
 department has been named managing conservator of the child after a
 hearing conducted under Subchapter C, Chapter 262.
 SECTION 2.08.  Section 531.0335(b), Government Code, is
 amended to read as follows:
 (b)  The executive commissioner by rule shall prohibit a
 health and human services agency from taking a punitive action
 against a person responsible for a child's care, custody, or
 welfare for declining [failure of the person] to immunize or
 vaccinate the child for any communicable disease [ensure that the
 child receives the immunization series prescribed by Section
 161.004, Health and Safety Code].
 SECTION 2.09.  Section 12.033(a), Health and Safety Code, is
 amended to read as follows:
 (a)  Except as otherwise provided by this section, the
 executive commissioner by rule shall adopt fees to be collected by
 the department for the distribution and administration of vaccines
 and sera provided under[:
 [(1) Section 38.001, Education Code;
 [(2) Section 42.043, Human Resources Code;
 [(3)] Chapter 826 (Rabies Control Act of 1981)[;
 [(4) Chapter 81 (Communicable Disease Prevention and
 Control Act); and
 [(5) Section 161.005].
 SECTION 2.10.  Section 81.082(f), Health and Safety Code, is
 amended to read as follows:
 (f)  In this section, "control measures" does not include
 administration of a vaccine and includes:
 (1)  [immunization;
 [(2)] detention;
 (2) [(3)]  restriction;
 (3) [(4)]  disinfection;
 (4) [(5)]  decontamination;
 (5) [(6)]  isolation;
 (6) [(7)]  quarantine;
 (7) [(8)]  disinfestation;
 (8) [(9)]  chemoprophylaxis;
 (9) [(10)]  preventive therapy;
 (10) [(11)]  prevention; and
 (11) [(12)]  education.
 SECTION 2.11.  Section 81.085(i), Health and Safety Code, is
 amended to read as follows:
 (i)  On request of the department during a public health
 disaster, an individual shall disclose the individual's
 immunization information. If the individual does not have updated
 or appropriate immunizations, the department may take appropriate
 action during a quarantine to protect that individual and the
 public from the communicable disease, but the department may not
 administer a vaccine to the individual without the individual's
 consent.
 SECTION 2.12.  The heading to Section 161.0051, Health and
 Safety Code, is amended to read as follows:
 Sec. 161.0051.  REQUIRED OFFER OF IMMUNIZATIONS FOR NURSING
 HOMES.
 SECTION 2.13.  Subchapter A, Chapter 161, Health and Safety
 Code, is amended by adding Section 161.0055 to read as follows:
 Sec. 161.0055.  PROHIBITED VACCINE MANDATES AND
 DISCRIMINATION. (a) A governmental entity or official, including
 the governor, a state agency, a political subdivision, or a
 political subdivision official, may not:
 (1)  require an individual to be vaccinated;
 (2)  require an individual to participate in the
 administration of a vaccine; or
 (3)  discriminate or impose a civil or criminal penalty
 against an individual who refuses vaccination or participation in
 the administration of a vaccine.
 (b)  This section applies to all other law, including a state
 agency rule, executive order, or emergency order.
 (c)  This section prevails to the extent of a conflict
 between this section and any other law.
 SECTION 2.14.  Section 161.0074(c), Health and Safety Code,
 is amended to read as follows:
 (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;
 (9)  identify all reported incidents of discrimination
 for requesting exclusion from the registry [or for using an
 exemption for a required immunization]; and
 (10)  include ways to increase provider participation
 in the registry.
 SECTION 2.15.  Section 161.0105(c), Health and Safety Code,
 is amended to read as follows:
 (c)  The immunity created by this section is in addition to
 any immunity created by Section [Sections 161.001 and] 161.007(i).
 SECTION 2.16.  Section 224.002, Health and Safety Code, is
 amended by amending Subsection (b) and adding Subsection (b-1) to
 read as follows:
 (b)  The policy must:
 (1)  encourage [require] covered individuals to
 receive vaccines for the vaccine preventable diseases specified by
 the facility based on the level of risk the individual presents to
 patients by the individual's routine and direct exposure to
 patients;
 (2)  specify the recommended vaccines a covered
 individual is encouraged [required] to receive based on the level
 of risk the individual presents to patients by the individual's
 routine and direct exposure to patients;
 (3)  [include procedures for verifying whether a
 covered individual has complied with the policy;
 [(4) include procedures for a covered individual to be
 exempt from the required vaccines for the medical conditions
 identified as contraindications or precautions by the Centers for
 Disease Control and Prevention;
 [(5)] for a covered individual who declines to receive
 [is exempt from] the recommended [required] vaccines, include
 procedures the individual must follow to protect facility patients
 from exposure to disease, such as the use of protective medical
 equipment, such as gloves and masks, based on the level of risk the
 individual presents to patients by the individual's routine and
 direct exposure to patients;
 (4) [(6)]  prohibit discrimination or retaliatory
 action against a covered individual who declines to receive [is
 exempt from] the recommended [required] vaccines [for the medical
 conditions identified as contraindications or precautions by the
 Centers for Disease Control and Prevention], except that required
 use of protective medical equipment, such as gloves and masks, may
 not be considered retaliatory action for purposes of this
 subdivision; and
 (5) [(7)]  require the health care facility to maintain
 a written or electronic record of each covered individual's
 immunization history [compliance with or exemption from the policy;
 and
 [(8) include disciplinary actions the health care
 facility is authorized to take against a covered individual who
 fails to comply with the policy].
 (b-1)  A health care facility shall maintain as confidential
 an immunization history described by Subsection (b)(5) and may not
 disclose the history to any other person unless the disclosure is
 otherwise required by law.
 SECTION 2.17.  Section 31.0031(d), Human Resources Code, is
 amended to read as follows:
 (d)  The responsibility agreement shall require that:
 (1)  the parent of a dependent child cooperate with the
 commission and the Title IV-D agency if necessary to establish the
 paternity of the dependent child and to establish or enforce child
 support;
 (2)  if adequate and accessible providers of the
 services are available in the geographic area and subject to the
 availability of funds, each dependent child, as appropriate,
 complete early and periodic screening, diagnosis, and treatment
 checkups on schedule [and receive the immunization series
 prescribed by Section 161.004, Health and Safety Code, unless the
 child is exempt under that section];
 (3)  each adult recipient, or teen parent recipient who
 has completed the requirements regarding school attendance in
 Subdivision (6), not voluntarily terminate paid employment of at
 least 30 hours each week without good cause in accordance with rules
 adopted by the executive commissioner;
 (4)  each adult recipient for whom a needs assessment
 is conducted participate in an activity to enable that person to
 become self-sufficient by:
 (A)  continuing the person's education or
 becoming literate;
 (B)  entering a job placement or employment skills
 training program;
 (C)  serving as a volunteer in the person's
 community; or
 (D)  serving in a community work program or other
 work program approved by the commission;
 (5)  each caretaker relative or parent receiving
 assistance not use, sell, or possess marihuana or a controlled
 substance in violation of Chapter 481, Health and Safety Code, or
 abuse alcohol;
 (6)  each dependent child younger than 18 years of age
 or teen parent younger than 19 years of age attend school regularly,
 unless the child has a high school diploma or high school
 equivalency certificate or is specifically exempted from school
 attendance under Section 25.086, Education Code;
 (7)  each recipient comply with commission rules
 regarding proof of school attendance; and
 (8)  each recipient attend appropriate parenting
 skills training classes, as determined by the needs assessment.
 SECTION 2.18.  Sections 42.043(b) and (d), Human Resources
 Code, are amended to read as follows:
 (b)  The department shall require that each child at an
 appropriate age have a test for tuberculosis [and be immunized
 against diphtheria, tetanus, poliomyelitis, mumps, rubella,
 rubeola, invasive pneumococcal disease, and hepatitis A and against
 any other communicable disease as recommended by the Department of
 State Health Services. The immunization must be effective on the
 date of first entry into the facility. However, a child may be
 provisionally admitted if the required immunizations have begun and
 are completed as rapidly as medically feasible].
 (d)  No immunization may be required for admission to a
 facility regulated under this chapter [if a person applying for a
 child's admission submits one of the following affidavits:
 [(1) an affidavit signed by a licensed physician
 stating that the immunization poses a significant risk to the
 health and well-being of the child or a member of the child's family
 or household; or
 [(2) an affidavit signed by the child's parent or
 guardian stating that the applicant declines immunization for
 reasons of conscience, including a religious belief].
 SECTION 2.19.  Section 42.04305, Human Resources Code, is
 amended by amending Subsection (c) and adding Subsection (c-1) to
 read as follows:
 (c)  The policy must:
 (1)  encourage [require] each facility employee to
 receive vaccines for the vaccine-preventable diseases specified by
 the child-care facility based on the level of risk the employee
 presents to children by the employee's routine and direct exposure
 to children;
 (2)  specify the recommended vaccines a facility
 employee is encouraged [required] to receive based on the level of
 risk the employee presents to children by the employee's routine
 and direct exposure to children;
 (3)  [include procedures for verifying whether a
 facility employee has complied with the policy;
 [(4) include procedures for a facility employee to be
 exempt from the required vaccines for the medical conditions
 identified as contraindications or precautions by the Centers for
 Disease Control and Prevention;
 [(5)] for a facility employee who declines to receive
 [is exempt from] the recommended [required] vaccines, include
 procedures the employee must follow to protect children in the
 facility's care from exposure to disease, such as the use of
 protective medical equipment, including gloves and masks, based on
 the level of risk the employee presents to children by the
 employee's routine and direct exposure to children;
 (4) [(6)]  prohibit discrimination or retaliatory
 action against a facility employee who declines to receive [is
 exempt from] the recommended [required] vaccines [for the medical
 conditions identified as contraindications or precautions by the
 Centers for Disease Control and Prevention], except that required
 use of protective medical equipment, including gloves and masks,
 may not be considered retaliatory action for purposes of this
 subdivision; and
 (5) [(7)]  require the child-care facility to maintain
 a written or electronic record of each facility employee's
 immunization history [compliance with or exemption from the policy;
 and
 [(8) state the disciplinary actions the child-care
 facility is authorized to take against a facility employee who
 fails to comply with the policy].
 (c-1)  A facility shall maintain as confidential an
 immunization history described by Subsection (c)(5) and may not
 disclose the history to any other person unless the disclosure is
 otherwise required by law.
 SECTION 2.20.  The following provisions are repealed:
 (1)  Sections 38.001(a), (c), (c-1), (d), (e), and
 (f), Education Code;
 (2)  Section 38.001(b), Education Code, as amended by
 Chapters 43 (H.B. 1098) and 94 (H.B. 1059), Acts of the 80th
 Legislature, Regular Session, 2007;
 (3)  Section 38.019(a-1), Education Code;
 (4)  Section 51.9192, Education Code;
 (5)  Sections 51.933(b), (b-1), (d), (d-1), and (e),
 Education Code;
 (6)  Section 531.0335(c), Government Code;
 (7)  Section 81.023, Health and Safety Code;
 (8)  Section 161.001, Health and Safety Code;
 (9)  Section 161.004, Health and Safety Code;
 (10)  Section 161.0041, Health and Safety Code;
 (11)  Section 161.005, Health and Safety Code;
 (12)  Section 161.007(h), Health and Safety Code;
 (13)  Section 224.002(c), Health and Safety Code;
 (14)  Section 224.003, Health and Safety Code;
 (15)  Sections 31.031(d) and (e), Human Resources Code;
 (16)  Sections 42.043(c), (d-1), and (f), Human
 Resources Code; and
 (17)  Section 42.04305(d), Human Resources Code.
 ARTICLE 3. TRANSITION AND EFFECTIVE DATE
 SECTION 3.01.  Each facility subject to Chapter 224, Health
 and Safety Code, as amended by this Act, or Section 42.04305, Human
 Resources Code, as amended by this Act, shall modify the facility's
 vaccine-preventable disease policy to conform with the changes in
 law made by this Act not later than January 1, 2024.
 SECTION 3.02.  (a) Subchapter O, Chapter 544, Insurance
 Code, as added by this Act, applies only to a health benefit plan or
 insurance policy delivered, issued for delivery, or renewed on or
 after January 1, 2024.
 (b)  Section 544.705, Insurance Code, as added by this Act,
 applies only to a contract entered into on or after the effective
 date of this Act.
 SECTION 3.03.  (a) The changes in law made by this Act to
 Title 2, Education Code, apply starting with the 2023-2024 school
 year.
 (b)  The changes in law made by this Act to Title 3, Education
 Code, apply starting with the 2023-2024 academic year.
 SECTION 3.04.  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, 2023.