BILL NUMBER: AB 1748 CHAPTERED 09/24/00 CHAPTER 593 FILED WITH SECRETARY OF STATE SEPTEMBER 24, 2000 APPROVED BY GOVERNOR SEPTEMBER 22, 2000 PASSED THE ASSEMBLY AUGUST 31, 2000 PASSED THE SENATE AUGUST 30, 2000 AMENDED IN SENATE AUGUST 25, 2000 AMENDED IN SENATE AUGUST 7, 2000 AMENDED IN SENATE JUNE 14, 2000 AMENDED IN ASSEMBLY APRIL 27, 2000 AMENDED IN ASSEMBLY MARCH 29, 2000 INTRODUCED BY Assembly Member Zettel (Coauthor: Assembly Members Cunneen and Robert Pacheco) (Coauthor: Senator Rainey) JANUARY 12, 2000 An act to amend Section 120440 of the Health and Safety Code, relating to disease prevention and control. LEGISLATIVE COUNSEL'S DIGEST AB 1748, Zettel. Immunizations: disclosure of information. Existing law governing communicable disease prevention and immunization authorizes local health officers to operate immunization information systems. Existing law provides that certain health care providers, as defined, local health departments operating countywide immunization information and reminder systems, and the State Department of Health Services may disclose or share certain prescribed immunization-related information concerning individual patients, unless the patient refuses to consent to the sharing of this information. Existing law authorizes disclosure of patient information under specific circumstances, and also requires the health care provider administering the immunization to provide the patient with designated notice. This bill would authorize local health officers and the state department to contract with an outside agency to perform immunization information system functions. The bill would revise the conditions under which immunization information may be disclosed, including authorizing local health officers and the state department to disclose specified information to county welfare departments, as defined. The bill would also apply certain provisions identifying the types of information subject to disclosure, and authorizing refusal of permission for recordsharing, to clients of county welfare departments, and their parents or guardians, where appropriate. This bill would incorporate amendments to Section 120440 of the Health and Safety Code made by AB 2013, which would become operative only if both bills are chaptered and this bill is chaptered after AB 2013. 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 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. (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 6 (commencing with Section 10850), 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, 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 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, 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, 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. (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 department or departments 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, 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. (f) 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). (g) 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: (1) Provide the name and address of other persons or agencies with whom the recipient has shared the information. (2) Stop sharing the information in its possession after the date of the receipt of the request. (h) 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. (i) Section 120330 shall not apply to this section. SEC. 2. 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 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) "Local registry" means an immunization information system operated by a city or county health department. (6) "Regional registry" means an immunization information system operated on a multicounty or multicity health department basis. (7) "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) of Part 3 of Division 9 of the Welfare and Institutions Code. (b) (1) Local health departments may operate local or regional registries pursuant to their authority under Section 120175, in conjunction with the Immunization Branch of the State Department of Health Services. (2) Health care providers providing immunizations to persons 18 years of age and younger shall be required to participate in a local or regional registry, either directly or through the Statewide Immunization Information System, when the department has certified that the local or regional registry is functional and able to accommodate participation by all providers in the registry's service area. Department certification shall include, but shall not be limited to, consultation with health care providers and the ability of the registry to provide technical support. Local or regional registries may not charge health care providers for any training that is necessary for the health care registry provider to participate in the registry. However, with respect to information concerning a specific patient or client, information shall not be included in the local or regional registry if consent has been withheld by the patient or client, or, in the case of a patient or client under 18 years of age who is not legally emancipated, by the patient's or client's parent or legal guardian. (3) Nothing in this section 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 6 (commencing with Section 10850), 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, 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 local or regional registries 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, 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 patient's 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) and any information contained in a local or regional registry or in the Statewide Immunization Information System in the same manner as other medical record information with patient identification that they possess. These providers, departments and contracting agencies shall be 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, and 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, and 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. (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 clients, 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 department or departments 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, 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 the client, or 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. (f) 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). (g) Upon request of the patient or the 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: (1) Provide the name and address of other persons or agencies with whom the recipient has shared the information. (2) Stop sharing the information in its possession after the date of the receipt of the request. (h) 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. (i) Section 120330 shall not apply to this section. SEC. 3. Section 2 of this bill incorporates amendments to Section 120440 of the Health and Safety Code proposed by both this bill and AB 2013. It shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2001, (2) each bill amends Section 120440 of the Health and Safety Code, and (3) this bill is enacted after AB 2013, in which case Section 1 of this bill shall not become operative.