BILL NUMBER: AB 576	CHAPTERED
	BILL TEXT

	CHAPTER  329
	FILED WITH SECRETARY OF STATE  SEPTEMBER 19, 2006
	APPROVED BY GOVERNOR  SEPTEMBER 19, 2006
	PASSED THE ASSEMBLY  AUGUST 21, 2006
	PASSED THE SENATE  AUGUST 17, 2006
	AMENDED IN SENATE  AUGUST 9, 2006
	AMENDED IN SENATE  JUNE 14, 2006
	AMENDED IN SENATE  FEBRUARY 14, 2006
	AMENDED IN SENATE  AUGUST 15, 2005
	AMENDED IN ASSEMBLY  MAY 26, 2005
	AMENDED IN ASSEMBLY  APRIL 4, 2005

INTRODUCED BY   Assembly Member Wolk

                        FEBRUARY 16, 2005

   An act to amend Section 120440 of, and to add Section 120476 to,
the Health and Safety Code, relating to immunizations.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 576, Wolk  Immunizations.
   Existing law regulates the sharing of a patient's or client's
immunization information between a health care provider, local health
department, the State Department of Health Services, and other
agencies. Existing law prescribes the process by which a patient or
client, or parent or guardian of a patient or client, may refuse to
allow the information to be shared.
   This bill would, after the patient or client, or parent or
guardian of a patient or client refuses the sharing of immunization
information, allow the patient's or client's physician to maintain
access to this information for the purpose of patient care or
protecting the public health, and would allow the local health
department and the department to maintain access to this information
for the purpose of protecting the public health, as specified. The
bill would also allow local health departments and the department to
share the name of a patient or client, or parent or guardian of a
patient or client, with a state, local health department, health care
provider, immunization information system, or any representative of
an entity designated by federal or state law to receive this
information, and would authorize the department to enter into written
agreements to share this information with other states for specified
purposes, unless the patient or client, or parent or guardian of the
patient or client, refuses to allow the information to be shared.
   Existing law requires the State Department of Health Services to
submit a biennial report to the Legislature on the immunization
levels of children in the state, steps taken to increase immunization
levels and immunization education, and recommendations of a strategy
and the funding that would be necessary to immunize all children in
the state.
   This bill would require the department to submit by January 31,
2008, a sustainability plan for full funding of a statewide
immunization information system, as specified.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 120440 of the Health and Safety Code is amended
to read:
   120440.  (a) For the purposes of this chapter, the following
definitions shall apply:
   (1) "Health care provider" means any person licensed pursuant to
Division 2 (commencing with Section 500) of the Business and
Professions Code or a clinic or health facility licensed pursuant to
Division 2 (commencing with Section 1200).
   (2) "Schools, child care facilities, and family child care homes"
means those institutions referred to in subdivision (b) of Section
120335, regardless of whether they directly provide immunizations to
patients or clients.
   (3) "WIC service provider" means any public or private nonprofit
agency contracting with the department to provide services under the
California Special Supplemental Food Program for Women, Infants, and
Children, as provided for in Article 2 (commencing with Section
123275) of Chapter 1 of Part 2 of Division 106.
   (4) "Health care plan" means a health care service plan as defined
in subdivision (f) of Section 1345, a government-funded program the
purpose of which is paying the costs of health care, or an insurer as
described in Sections 10123.5 and 10123.55 of the Insurance Code,
regardless of whether the plan directly provides immunizations to
patients or clients.
   (5) "County welfare department" means a county welfare agency
administering the California Work Opportunity and Responsibility to
Kids (CalWORKs) program, pursuant to Chapter 2 (commencing with
Section 11200.5) of Part 3 of Division 9 of the Welfare and
Institutions Code.
   (6) "Foster care agency" means any of the county and state social
services agencies providing foster care services in California.
   (b) (1) Local health officers may operate immunization information
systems pursuant to their authority under Section 120175, in
conjunction with the Immunization Branch of the State Department of
Health Services. Local health officers and the State Department of
Health Services may operate these systems in either or both of the
following manners:
   (A) Separately within their individual jurisdictions.
   (B) Jointly among more than one jurisdiction.
   (2) Nothing in this subdivision shall preclude local health
officers from sharing the information set forth in paragraphs (1) to
(9), inclusive, of subdivision (c) with other health officers jointly
operating the system.
   (c) Notwithstanding Sections 49075 and 49076 of the Education
Code, Chapter 5 (commencing with Section 10850) of Part 2 of Division
9 of the Welfare and Institutions Code, or any other provision of
law, unless a refusal to permit recordsharing is made pursuant to
subdivision (e), health care providers, and other agencies,
including, but not limited to, schools, child care facilities,
service providers for the California Special Supplemental Food
Program for Women, Infants, and Children (WIC), health care plans,
foster care agencies, and county welfare departments, may disclose
the information set forth in paragraphs (1) to (9), inclusive, from
the patient's medical record, or the client's record, to local health
departments operating countywide or regional immunization
information and reminder systems and the State Department of Health
Services. Local health departments and the State Department of Health
Services may disclose the information set forth in paragraphs (1) to
(9), inclusive, to each other, and upon a request for information
pertaining to a specific person, to health care providers taking care
of the patient. Local health departments and the State Department of
Health Services may disclose the information in paragraphs (1) to
(6), inclusive, and paragraphs (8) and (9), to schools, child care
facilities, county welfare departments, and family child care homes
to which the person is being admitted or in attendance, foster care
agencies in assessing and providing medical care for children in
foster care, and WIC service providers providing services to the
person, health care plans arranging for immunization services for the
patient, and county welfare departments assessing immunization
histories of dependents of CalWORKs participants, upon request for
information pertaining to a specific person. Determination of
benefits based upon immunization of a dependent CalWORKs participant
shall be made pursuant to Section 11265.8 of the Welfare and
Institutions Code. The following information shall be subject to this
subdivision:
   (1) The name of the patient or client and names of the parents or
guardians of the patient or client.
   (2) Date of birth of the patient or client.
   (3) Types and dates of immunizations received by the patient or
client.
   (4) Manufacturer and lot number for each immunization received.
   (5) Adverse reaction to immunizations received.
   (6) Other nonmedical information necessary to establish the
patient's or client's unique identity and record.
   (7) Current address and telephone number of the patient or client
and the parents or guardians of the patient or client.
   (8) Patient's or client's gender.
   (9) Patient's or client's place of birth.
   (d) (1) Health care providers, local health departments, and the
State Department of Health Services shall maintain the
confidentiality of information listed in subdivision (c) in the same
manner as other medical record information with patient
identification that they possess. These providers, departments, and
contracting agencies are subject to civil action and criminal
penalties for the wrongful disclosure of the information listed in
subdivision (c), in accordance with existing law. They shall use the
information listed in subdivision (c) only for the following
purposes:
   (A) To provide immunization services to the patient or client,
including issuing reminder notifications to patients or clients or
their parents or guardians when immunizations are due.
   (B) To provide or facilitate provision of third-party payer
payments for immunizations.
   (C) To compile and disseminate statistical information of
immunization status on groups of patients or clients or populations
in California, without identifying information for these patients or
clients included in these groups or populations.
   (D) In the case of health care providers only, as authorized by
Part 2.6 (commencing with Section 56) of Division 1 of the Civil
Code.
   (2) Schools, child care facilities, family child care homes, WIC
service providers, foster care agencies, county welfare departments,
and health care plans shall maintain the confidentiality of
information listed in subdivision (c) in the same manner as other
client, patient, and pupil information that they possess. These
institutions and providers are subject to civil action and criminal
penalties for the wrongful disclosure of the information listed in
subdivision (c), in accordance with existing law. They shall use the
information listed in subdivision (c) only for those purposes
provided in subparagraphs (A) to (D), inclusive, of paragraph (1) and
as follows:
   (A) In the case of schools, child care facilities, family child
care homes, and county welfare departments, to carry out their
responsibilities regarding required immunization for attendance or
participation benefits, or both, as described in Chapter 1
(commencing with Section 120325), and in Section 11265.8 of the
Welfare and Institutions Code.
   (B) In the case of WIC service providers, to perform immunization
status assessments of clients and to refer those clients found to be
due or overdue for immunizations to health care providers.
   (C) In the case of health care plans, to facilitate payments to
health care providers, to assess the immunization status of their
clients, and to tabulate statistical information on the immunization
status of groups of patients, without including patient-identifying
information in these tabulations.
   (D) In the case of foster care agencies, to perform immunization
status assessments of foster children and to assist those foster
children found to be due or overdue for immunization in obtaining
immunizations from health care providers.
   (e) A patient or a patient's parent or guardian may refuse to
permit recordsharing. The health care provider administering
immunization and any other agency possessing any patient or client
information listed in subdivision (c), if planning to provide patient
or client information to an immunization system, as described in
subdivision (b), shall inform the patient or client, or the parent or
guardian of the patient or client, of the following:
   (1) The information listed in subdivision (c) may be shared with
local health departments, and the State Department of Health
Services. The health care provider or other agency shall provide the
name and address of the State Department of Health Services or of the
immunization registry with which the provider or other agency will
share the information.
   (2) Any of the information shared with local health departments
and the State Department of Health Services shall be treated as
confidential medical information and shall be used only to share with
each other, and, upon request, with health care providers, schools,
child care facilities, family child care homes, WIC service
providers, county welfare departments, foster care agencies, and
health care plans. These providers, agencies, and institutions shall,
in turn, treat the shared information as confidential, and shall use
it only as described in subdivision (d).
   (3) The patient or client, or parent or guardian of the patient or
client, has the right to examine any immunization-related
information shared in this manner and to correct any errors in it.
   (4) The patient or client, or the parent or guardian of the
patient or client, may refuse to allow this information to be shared
in the manner described, or to receive immunization reminder
notifications at any time, or both. After refusal, the patient or
client's physician, may maintain access to this information for the
purposes of patient care or protecting the public health. After
refusal, the local health department and the State Department of
Health Services may maintain access to this information for the
purpose of protecting the public health pursuant to Sections 100325,
120140, and 120175, as well as Sections 2500 to 2643.20, inclusive,
of Title 17 of the California Code of Regulations.
   (f) (1) The health care provider administering the immunization
and any other agency possessing any patient or client information
listed in subdivision (c), may inform the patient or client, or the
parent or guardian of the patient or client, by ordinary mail, of the
information in paragraphs (1) to (4), inclusive, of subdivision (e).
The mailing must include a reasonable means for refusal, such as a
return form or contact telephone number.
   (2) The information in paragraphs (1) to (4), inclusive, of
subdivision (e) may also be presented to the parent or guardian of
the patient or client during any hospitalization of the patient or
client.
   (g) If the patient or client, or parent or guardian of the patient
or client, refuses to allow the information to be shared, pursuant
to paragraph (4) of subdivision (e), the health care provider or
other agency may not share this information in the manner described
in subdivision (c), except as provided in subparagraph (D) of
paragraph (1) of subdivision (d).
   (h) (1) Upon request of the patient or client, or the parent or
guardian of the patient or client, in writing or by other means
acceptable to the recipient, a local health department or the State
Department of Health Services that has received information about a
person pursuant to subdivision (c) shall do all of the following:
   (A) Provide the name and address of other persons or agencies with
whom the recipient has shared the information.
   (B) Stop sharing the information in its possession after the date
of the receipt of the request.
   (2) After refusal, the patient or client's physician, may maintain
access to this information for the purposes of patient care or
protecting the public health. After refusal, the local health
department and the State Department of Health Services may maintain
access to this information for the purpose of protecting the public
health pursuant to Sections 100325, 120140, and 120175, as well as
Sections 2500 to 2643.20, inclusive, of Title 17 of the California
Code of Regulations.
   (i) Upon notification, in writing or by other means acceptable to
the recipient, of an error in the information, a local health
department or the State Department of Health Services that has
information about a person pursuant to subdivision (c) shall correct
the error. If the recipient is aware of a disagreement about whether
an error exists, information to that effect may be included.
   (j) (1) Any party authorized to make medical decisions for a
patient or client, including, but not limited to, those authorized by
Section 6922, 6926, or 6927 of, Part 1.5 (commencing with Section
6550), Chapter 2 (commencing with Section 6910) of Part 4, or Chapter
1 (commencing with Section 7000) of Part 6, of Division 11 of, the
Family Code, Section 1530.6 of the Health and Safety Code, or
Sections 727 and 1755.3 of, and Article 6 (commencing with Section
300) of Chapter 2 of Part 1 of Division 2 of, the Welfare and
Institutions Code, may permit sharing of the patient's or client's
record with any of the immunization information systems authorized by
this section.
   (2) For a patient or client who is a dependent of a juvenile
court, the court or a person or agency designated by the court may
permit this recordsharing.
   (3) For a patient or client receiving foster care, a person or
persons licensed to provide residential foster care, or having legal
custody, may permit this recordsharing.
   (k) For purposes of supporting immunization information systems,
the State Department of Health Services shall assist the Immunization
Branch of the State Department of Health Services in both of the
following:
   (1) The provision of department records containing information
about publicly funded immunizations.
   (2) Supporting efforts for the reporting of publicly funded
immunizations into immunization information systems by health care
providers and health care plans.
   (l)  Subject to any other provisions of state and federal law or
regulation that limit the disclosure of health information and
protect the privacy and confidentiality of personal information,
local health departments and the State Department of Health Services
may share the information listed in subdivision (c) with a state,
local health departments, health care providers, immunization
information systems, or any representative of an entity designated by
federal or state law or regulation to receive this information. The
State Department of Health Services may enter into written agreements
to exchange confidential immunization information with other states
for the purposes of patient care, protecting the public health,
entrance into school, child care and other institutions requiring
immunization prior to entry, and the other purposes described in
subdivision (d). The written agreement shall provide that the state
that receives confidential immunization information must maintain its
confidentiality and may only use it for purposes of patient care,
protecting the public health, entrance into school, child care and
other institutions requiring immunization prior to entry, and the
other purposes described in subdivision (d). Information may not be
shared pursuant to this subdivision if a patient or client, or parent
or guardian of a patient or client, refuses to allow the sharing of
immunization information pursuant to subdivision (e).
  SEC. 2.  Section 120476 is added to the Health and Safety Code, to
read:
   120476.  The department shall submit to the Legislature, by
January 31, 2008, a sustainability plan for full funding of a
statewide immunization information system that integrates existing
immunization systems throughout the state. The plan shall demonstrate
how the department will fully populate and sustain the statewide
immunization information system over time.