HBA-MPM C.S.H.B. 1702 77(R) BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 1702 By: Green Public Health 5/3/2001 Committee Report (Substituted) BACKGROUND AND PURPOSE In 1997, the Texas Department of Health (TDH) established an immunization registry tracking system called ImmTrac for the purpose of monitoring immunization rates for children in Texas. This tracking system also serves as an information depository for providers, who are then able to determine if a child's immunization record is current. For children who do not regularly see the same care provider, ImmTrac serves to protect them from duplicate immunizations. However, the current system lacks data from the private sector, and therefore does not provide an adequate picture of immunization rates in Texas. C.S.H.B. 1702 requires a report on the immunization history of a person younger than 18 years to be in a format prescribed by TDH, changes ImmTrac from an opt-in to an opt-out system, and adds an exemption from immunization for reasons of personal belief. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas Board of Health in SECTION 6 (Section 161.007, Health and Safety Code), SECTION 10 (Section 161.008, Health and Safety Code) and SECTION 16 and the Texas Department of Health in SECTION 6 (Section 161.007, Health and Safety Code) of this bill. ANALYSIS C.S.H.B. 1702 amends the Health and Safety Code to provide that a person who administers or authorizes the administration of a vaccination or immunization is not liable for the failure to immunize a child because the child's parent, managing conservator, or guardian (parent) does not consent to the vaccination or immunization of that child for reasons of personal belief or religious belief. The bill prohibits a parent who fails or refuses to consent to the required vaccination or immunization or who refuses to consent to the immunization because of reasons of personal belief or religious belief from bringing a cause of action against any person for the other person's failure to immunize the child (Secs. 161.001). The bill provides that a child is exempt from an immunization required by the state if the child's parent states that the immunization is being declined for reasons of personal belief or religious belief, except that a personal exemption will no longer be available if the number of exemptions taken exceeds one percent of the total population of children eligible for vaccines under the age of five. The bill requires the Texas Department of Health (TDH) to develop and implement an outreach and education campaign to maximize the number of children who receive the required immunizations (Sec. 161.004). C.S.H.B. 1702 requires TDH to develop and provide an exemption affidavit form to a person subject to exclusion from a school or facility because the person declines a required immunization for reasons of personal belief or because of religious belief. The bill sets forth the contents of the affidavit form and requires TDH to provide the affidavit form on request by mail, facsimile, or electronic mail, and through TDH's Internet website in a printable format (Sec. 161.0045). The bill requires TDH by rule to develop guidelines to permit a parent to choose to have the patient excluded from TDH's childhood immunization registry (registry) rather than requiring the written consent of the parent to include the patient in the registry. TDH is also required to by rule develop guidelines to encourage schools to apply for a TDH ImmTrac user number to enable an authorized school employee to track the immunization records of students enrolled at the school and included in the registry and to verify whether a child has received the required vaccinations. The bill requires a report from an organization that pays or reimburses a claim for an immunization or a healthcare provider on the immunization history of a person younger than 18 years to contain the elements prescribed by TDH, which may include submission in writing, by electronic format, or by voice. The bill requires TDH to consult with such organizations and health care providers to determine the most efficient and cost-effective manner of reporting immunization histories. The bill provides that such an organization that submits or obtains in good faith an immunization history or data to or from TDH in compliance with immunization provisions and any rules adopted under those provisions is not liable for any civil damages. The bill provides that the notice to parents regarding a due or overdue immunization must contain instructions for the parent to request that future notices not be sent and to remove the child's immunization record from the registry and any other registry-related record that individually identifies the child. The notice must describe the procedure to report a violation if a child is included in the registry after requesting exclusion. The bill requires the Texas Board of Health (board) to adopt rules to implement immunization provisions, and specifies that to the extent that the confidentiality requirements imposed under those provisions are more stringent than those imposed under physician-patient communication, the requirements of the immunization provisions prevail (Sec. 161.007). C.S.H.B. 1702 requires TDH to send a written notification to the child's parent disclosing certain information relating to the registry the first time TDH receives registry data for a child. The bill requires TDH to delete all of a child's immunization records from the registry and any other registry-related TDH record that individually identifies the child not later than the 30th day after the date TDH receives from the parent of the child a written request that the child be excluded from the registry. TDH is required to maintain only those records related to the child necessary to ensure that the child continues to be excluded from the registry and is prohibited from releasing the identity of a child excluded from the registry. TDH commits a violation if TDH fails to exclude a child from the registry within 30 days of receiving the written request. The bill requires TDH to accept any written indication from a parent communicating to TDH that a child should be excluded from the registry including a statement on the child's birth certificate as a request for exclusion from the registry (Sec. 161.0071). The bill provides that information that individually identifies a child received by TDH for the immunization registry is confidential and is authorized for use by TDH for registry purposes only. The bill prohibits TDH from releasing registry information to any individual or entity without the consent of the person or the person's parent if the person is a minor. The bill prohibits a person required to report information to TDH for registry purposes from disclosing the individually identifiable information to any other person without written consent of a parent except as provided by physician-patient communication provisions. The bill provides that registry information cannot be brought before a court of law (Sec. 161.0072). The bill authorizes TDH to obtain and release data constituting an immunization record for a child to certain health care related organizations without requiring consent of a child's parent and to enter the child into the registry if TDH has not received a written request to exclude the child from the registry by the parent within a specified time period. The bill authorizes TDH to release nonidentifying summary statistics and prohibits TDH from releasing individually identifiable information to an entity outside of this state. TDH is required to develop a secure Internet-based system to allow a school with an ImmTrac user number to verify whether a child has received required vaccinations. Except as provided by board rules, a school that obtains an ImmTrac user number for this purpose is prohibited from requiring verification of vaccination of a child from the child's parent (Sec. 161.008). The bill requires TDH to report to the Legislative Budget Board, the governor, the lieutenant governor, the speaker of the house of representatives, and appropriate committees of the legislature on ways to increase immunization rates using state and federal resources and sets forth what the report must include (Sec. 161.0075). C.S.H.B. 1702 amends the Education Code to set forth provisions for the exemption from immunization requirements for admission to elementary or secondary schools or an institution of higher education due to the possibility of an injury being inflicted or for reasons of personal belief or religious beliefs. The bill prohibits an elementary or secondary school from providing a parent the exemption affidavit form and prohibits a notary from notarizing the form on school premises (Secs. 38.001 and 51.933). The bill requires each public school to keep a record of the number and type of exemptions from immunization for each student admitted. The bill requires each school to submit a report annually on a form prescribed by TDH stating the number and type of exemptions on file for children who are attending a school and exercising the exemption option. The bill prohibits the inclusion of individually identifiable information in the report and provides that the report must include the total student enrollment on campus (Sec. 38.002). The bill amends the Human Resources Code to authorize a child care facility to refuse admission to a child who has not received a required immunization unless proof is submitted of an exemption due to the possibility of an injury being inflicted on a child or for reasons of personal belief or for religious beliefs (Sec. 42.043). The bill requires the board to adopt rules necessary to implement procedures for excluding children from the immunization registry and to make available the form for requesting exclusion from the immunization registry as soon as practicable but no later than August 1, 2002. The board is required to make available for use the form for exemption from the required immunizations as soon as practicable but no later than November 1, 2001. The bill prohibits the report on immunization histories and the immunization record data from being accepted or released by TDH until TDH has adopted rules and prescribed the immunization exemption form (SECTION 16). EFFECTIVE DATE On passage, or if the Act does not receive the necessary vote, the Act takes effect September 1, 2001. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 1702 differs from the original by removing provisions that established the Texas immunization advisory committee (committee). The substitute provides for a parent, managing conservator, or guardian (parent) to refuse to consent to the immunization of a child as required by state law for reasons of personal belief rather than conscience. The substitute prohibits a parent who fails or refuses to consent to the vaccination or immunization from bringing a cause of action against any person for the other person's failure to immunize the child. The substitute deletes the provision in existing law that a person who fails to comply with provisions governing statewide immunization of children is not liable or responsible for that failure, and that failure does not create a cause of action (Sec. 161.001). The substitute provides that an exemption for personal or religious beliefs will no longer be available if the number of exemptions taken exceeds one percent of the total population of children eligible for vaccines under the age of five. The substitute requires the Texas Department of Health (TDH) to develop and implement an outreach and education campaign to maximize the number of children who receive the required immunizations (Sec. 161.004). The substitute modifies the contents of the exemption affidavit form (Sec. 161.0045). The substitute requires TDH to by rule develop guidelines to encourage schools to apply for a TDH ImmTrac user number. The substitute specifies that to the extent that the confidentiality requirements imposed under immunization provisions are more stringent than those imposed under physician-patient communication provisions, the requirements of immunization provisions prevail (Sec. 161.007). The substitute removes the requirement that TDH destroy all of a child's immunization records in the possession of TDH. The substitute prohibits TDH from releasing the identity of a child excluded from the registry. The substitute removes the provision authorizing a parent to request that the birth certificate of a child be excluded from the registry (Sec. 161.0071). The substitute differs from the original by prohibiting TDH from releasing individually identifiable information to an entity outside of this state. The substitute requires TDH to develop a secure Internet-based system to allow a school with an ImmTrac user number to verify whether a child has received required vaccinations. The substitute specifies that except as provided by board rules, a school that obtains an ImmTrac user number for this purpose is prohibited from requiring verification of vaccination of a child from the child's parent (Sec. 161.008). The substitute includes the lieutenant governor, the speaker of the house of representatives, and appropriate committees of the legislature among those entities to whom TDH is required to report on ways to increase immunization rates and modifies the contents of the report (Sec. 161.0075). The substitute prohibits an elementary or secondary school from providing a parent an exemption affidavit form and prohibits a notary from notarizing the form on school premises (Sec. 38.001, Education Code). The substitute specifies that the annual report submitted to TDH from a school regarding the number and type of exemptions from immunization must be in a format prescribed by TDH and may not include individually identifiable information and that it must include the total student enrollment on campus (Sec. 38.002). The substitute requires the board to make available for use the form for exemption from the required immunizations as soon as practicable but no later than November 1, 2001. (SECTION 16).