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�	S.B.�No.�346

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�	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.
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�	______________________________	______________________________
�	���President of the Senate	Speaker of the House�����
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�	�������I hereby certify that S.B.�No.�346 passed the Senate on
�	April�2, 2009, by the following vote:��Yeas�31, Nays�0.
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�	______________________________
�	Secretary of the Senate����
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�	�������I hereby certify that S.B.�No.�346 passed the House on
�	April�24, 2009, by the following vote:��Yeas�134, Nays�0, one
�	present not voting.
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�	______________________________
�	Chief Clerk of the House���
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�	Approved:
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�	______________________________�
�	������������Date
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�	______________________________�
�	����������Governor