Senate Bill No. 370

Introduced by Senator Wolk

February 24, 2015

An act to amend Section 120440 of the Health and Safety Code, relating to public health.

LEGISLATIVE COUNSEL’S DIGEST

SB 370, as introduced, Wolk. Immunizations: disclosure of information: tuberculosis screening.

Existing law regulates the sharing of a patient’s or client’s immunization information between a health care provider, a local health department, the State Department of Public Health, 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 and requires the health care provider administering the immunization to provide the patient with a designated notice. Existing law permits 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 authorizes 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. Under existing law, the patient or client, or parent or guardian of the patient or client, has the right to examine shared immunization-related information and to correct errors in it.

Under existing law, unless the patient or client or patient’s or client’s parent or guardian, refuses the recordsharing of information, 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, to local health departments operating countywide or regional immunization information and reminder systems and the department, specified information, including, but not limited to, the name, date of birth, gender, and birthplace of a patient or client.

This bill would include the patient’s or client’s height, weight, and body mass index, and other patient or client information of public health importance as determined by the department, in consultation with the California Conference of Local Health Officers, in the list of information that may be shared.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

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.

(7) “Tuberculosis screening” means an approved intradermal
tuberculin test or any other test for tuberculosis infection that is
recommended by the federal Centers for Disease Control and
Prevention and licensed by the federal Food and Drug
Administration.

(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 Public Health. Local health officers and the State
Department of Public Health 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 begin delete (10), end delete begin insert (12), end insert 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 begin delete (10), end delete begin insert (12), end insert
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 Public Health. Local health departments and the
State Department of Public Health may disclose the information
set forth in paragraphs (1) to begin delete (10), end delete begin insert (12), end insert 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 Public Health may
disclose the information in paragraphs (1) to (7), inclusive, and
paragraphs (9) begin delete and (10) end delete begin insert to (12), inclusive end insert , 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) Results of tuberculosis screening.

(8) Current address and telephone number of the patient or client
and the parents or guardians of the patient or client.

(9) Patient’s or client’s gender.

(10) Patient’s or client’s place of birth.

begin insert

(11) Patient’s height, weight, and body mass index.

end insert begin insert

(12) Other patient or client information of public health
importance as determined by the State Department of Public Health
in consultation with the California Conference of Local Health
Officers.

end insert

(d) (1) Health care providers, local health departments, and the
State Department of Public Health 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 Public Health.
The health care provider or other agency shall provide the name
and address of the State Department of Public Health 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 Public Health 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 or tuberculosis screening results 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’s 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
Public Health 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
or tuberculosis screening 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 Public Health 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’s 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 Public Health 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 Public Health 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 Public Health shall assist the
Immunization Branch of the State Department of Public Health in
both of the following:

(1) Providing 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 Public Health 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 Public Health 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).