Female First Responder Cancer Coverage — Will Campbell For Texas

By: ___________________

H.B. No. _____

A BILL TO BE ENTITLED

AN ACT

relating to presumptions for certain occupational diseases affecting firefighters and emergency medical technicians, the reprocessing of certain claims involving those diseases, and the establishment of a first responder health research program.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

ARTICLE 1. SHORT TITLE AND PURPOSE

SECTION 1.01. SHORT TITLE.

This Act may be cited as the Equal Cancer Protections for Female First Responders Act.

SECTION 1.02. PURPOSE.

The purposes of this Act are to:

(1) ensure that the statutory presumption for occupational cancer applies without regard to the sex of an eligible firefighter or emergency medical technician or whether a covered cancer predominantly or exclusively occurs in persons of a particular sex;

(2) modernize the list of cancers covered by the presumption;

(3) provide a limited post-service period for discovery of a covered cancer;

(4) provide a time-limited opportunity to request reprocessing of certain previously denied claims; and

(5) establish a continuing statewide program to study the occupational health of first responders and translate scientifically validated findings into improved training, equipment, screening, medical practices, and exposure controls.

ARTICLE 2. PRESUMPTIVE CANCER COVERAGE

SECTION 2.01.

Section 607.052, Government Code, is amended by adding Subsection (a-1) to read as follows:

(a-1) For purposes of Subsection (a)(3), a cancer described by Section 607.055 that is discovered not later than the third anniversary of the last date on which a firefighter or emergency medical technician was employed in the position for which the presumption is claimed is considered to have been discovered during that employment.

SECTION 2.02.

Section 607.055(b), Government Code, is amended by adding Subdivisions (6), (7), (8), and (9) and amending Subdivision (1) to read as follows:

Sec. 607.055. CANCER.

(b) This section applies only to:

(1) cancer that originates at the stomach, colon, rectum, skin, prostate, testis, bladder, breast, cervix, esophagus, fallopian tube, lung, ovary, pancreas, thyroid, uterus, including the endometrium, vagina, vulva, or brain;

(2) non-Hodgkin's lymphoma;

(3) multiple myeloma;

(4) malignant melanoma; [and]

(5) renal cell carcinoma;

(6) basal cell carcinoma;

(7) leukemia;

(8) mesothelioma; and

(9) primary peritoneal cancer.

SECTION 2.03.

Section 607.055, Government Code, is amended by adding Subsection (c) to read as follows:

(1) the sex of the firefighter or emergency medical technician; or

(2) whether a cancer described by Subsection (b) predominantly or exclusively occurs in persons of a particular sex.

ARTICLE 3. TEXAS FIRST RESPONDER HEALTH RESEARCH PROGRAM

SECTION 3.01.

Subtitle B, Title 2, Health and Safety Code, is amended by adding Chapter 55 to read as follows:

CHAPTER 55. TEXAS FIRST RESPONDER HEALTH RESEARCH PROGRAM

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 55.001. DEFINITIONS.

In this chapter:

(1) "Advisory council" means the Texas First Responder Health Research Advisory Council.

(2) "Coded data" means information concerning an individual that is assigned a unique program identifier and from which direct identifiers have been removed, but for which the department or a trusted linkage unit maintains a separately secured key that permits reidentification for a purpose authorized by this chapter.

(3) "Department" means the Department of State Health Services.

(4) "De-identified data" means information processed in accordance with applicable state and federal law and generally accepted statistical disclosure-control standards so that the information does not identify an individual and there is no reasonable basis to believe the information can be used to identify an individual.

(5) "First responder" means:

(A) a public safety employee as defined by Section 607.001, Government Code;

(B) a firefighter as defined by Section 607.051, Government Code, including a career, part-time, volunteer, industrial, airport, marine, or wildland firefighter and a fire investigator or fire-service instructor;

(D) a peace officer, county jailer, or telecommunicator licensed, certified, or otherwise regulated under Chapter 1701, Occupations Code;

(E) a detention officer or custodial officer as defined by Section 607.051, Government Code;

(F) an employee of the Texas Department of Criminal Justice, the Texas Juvenile Justice Department, a county, a municipality, or another governmental entity whose regular duties include the custody, supervision, transportation, or direct care of a person confined or detained in a correctional, detention, or juvenile facility;

(G) an employee or volunteer of the Texas A&M Forest Service, a political subdivision, a volunteer fire department, or another recognized organization whose regular duties include wildfire suppression, prescribed-fire operations, or emergency wildland response;

(H) a public safety telecommunicator, 9-1-1 call taker, or dispatcher employed by or serving a public safety answering point or public safety agency;

(I) emergency management or disaster-response personnel whose regular duties include field response during an emergency or declared disaster; or

(J) another occupational group designated by department rule whose members regularly perform substantially similar emergency-response duties and experience material occupational health exposures.

(6) "First responder entity" means a state agency, political subdivision, department, authority, public safety answering point, emergency medical services provider, volunteer organization, nonprofit organization, or other public or private entity that employs, appoints, certifies, credentials, supervises, or maintains service records for a first responder.

(7) "Institution of higher education" has the meaning assigned by Section 61.003, Education Code.

(8) "Participant" means a first responder or former first responder who voluntarily consents to participate in a research activity under this chapter that requires individual informed consent.

(9) "Program" means the Texas First Responder Health Research Program.

(10) "Protected linkage key" means the information maintained separately from coded data that permits an authorized person to associate a program identifier with a specific individual.

Sec. 55.002. ESTABLISHMENT AND PURPOSE.

(a) The department shall establish and administer the Texas First Responder Health Research Program.

(b) The purposes of the program are to:

(1) conduct continuing longitudinal surveillance of occupational exposures, diseases, injuries, disabilities, and mortality among first responders;

(2) identify health conditions and harmful exposures that occur disproportionately or demonstrate a scientifically concerning pattern among first responders, including differences associated with occupation, assignment, geography, type of service, and sex;

(3) support rigorous, reproducible occupational-health research;

(4) evaluate training, equipment, personal protective equipment, decontamination, station design, staffing practices, screening, medical surveillance, and other prevention measures;

(5) develop and evaluate practical interventions to reduce occupational disease, injury, disability, and death and to improve first-responder readiness and professional capability;

(6) coordinate state agencies, first responder entities, nonprofit organizations, professional associations, and institutions of higher education engaged in first-responder health research and prevention; and

(7) provide policymakers, first responders, employing entities, researchers, and the public with accurate, privacy-protected information concerning first-responder occupational health.

Sec. 55.003. ADMINISTRATION; INTERAGENCY COORDINATION.

(a) The department is the lead agency for the program and retains authority over program administration, rulemaking, contracting, appropriations, data custody, privacy, and publication.

(b) The department shall enter into memoranda of understanding as necessary with the Texas Commission on Fire Protection; Texas Department of Insurance, Division of Workers' Compensation; Texas Commission on Law Enforcement; State Fire Marshal's Office; Texas Department of Criminal Justice; Texas Juvenile Justice Department; Texas A&M Forest Service; Texas Division of Emergency Management; Commission on State Emergency Communications; the department's emergency medical services and registry programs; and other state agencies that collect information relevant to the program.

(c) A memorandum of understanding must address information sharing, transmission, data quality, privacy, security, access, retention, redisclosure, costs, and reduction of duplicative reporting.

(d) The department shall use existing state data systems and interoperable exchanges to the greatest extent practicable before requiring a new reporting system.

SUBCHAPTER B. DATA COLLECTION AND RESEARCH

Sec. 55.051. STATEWIDE DATA SYSTEM.

(a) The department shall maintain a statewide data system permitting longitudinal analysis of first-responder employment, service, exposure, prevention, health, claims, disability, and mortality information.

(b) The system must use a unique coded identifier; separate the protected linkage key; permit lawful record linkage; support occupation-, exposure-, geography-, and sex-specific analysis; distinguish relevant service categories; and include active, former, and retired first responders to the extent lawful information is available.

Sec. 55.052. REQUIRED ADMINISTRATIVE REPORTING.

(a) Each first responder entity shall submit the minimum information required by department rule to establish a reliable occupational denominator and evaluate occupational exposures and prevention practices.

(b) Required information may include dates of service; occupation and assignment; incident type, operational role, duration, and known or suspected exposures; respiratory protection and personal protective equipment use; fit testing, equipment condition and cleaning; decontamination practices; workplace conditions; and occupational-health training.

(c) A first responder entity shall report roster and service information annually; electronically available hires, separations, retirements, and deaths quarterly; incident and exposure information within 30 days or by approved quarterly batch; and prevention-practice information annually.

(d) The department may adjust frequency to reduce burden, improve quality, or address scientific or privacy needs but may not eliminate annual roster and prevention-practice reporting.

(e) The department shall provide standardized forms, specifications, technical assistance, and, from appropriated money, implementation grants, with priority for small, rural, and volunteer entities.

(f) No civil, administrative, licensing, certification, grant, or monetary penalty may be imposed for incomplete or untimely reporting. The department shall use technical assistance, confidential data-quality notices, and cooperative correction plans.

(g) The department may publish privacy-protected aggregate measures of data completeness.

Sec. 55.053. RECORD LINKAGE AND INTERAGENCY DATA.

(a) Subject to federal law, a state agency or first responder entity may disclose information necessary to carry out this chapter. Information confidential under other law remains confidential.

(b) The department shall conduct scientifically appropriate, lawful linkages at least annually.

(c) The Division of Workers' Compensation shall provide standardized information concerning first-responder claims, including claimed condition, use of a Chapter 607 presumption, status, denial basis, decision time, adjudication, and benefits paid.

Sec. 55.054. VOLUNTARY INDIVIDUAL PARTICIPATION.

(a) Participation in surveys, interviews, clinical examinations, imaging, genetic tests, biomarker assessments, biospecimen collection, or other direct research intervention is voluntary and requires informed consent.

(b) Participation may not be required as a condition of employment, certification, promotion, assignment, benefits, or employer participation in the program.

(d) The department and participating institutions shall obtain institutional review board approval when required.

(e) Consent must describe collection, purposes, risks, uses, linkages, return of findings, right not to know, withdrawal, retention, destruction, and confidentiality limits.

Sec. 55.055. RETURN OF INDIVIDUAL FINDINGS.

(a) The department shall establish a return-of-results protocol.

(b) The department or its designated clinical team may use the protected linkage key to contact a participant only if the participant consented; the finding is scientifically valid and clinically confirmed; a qualified health professional determines it concerns a serious condition or risk for which timely evaluation may benefit the participant; the institutional review board approved the procedure; and contact is not made by a researcher having only coded or de-identified data.

(c) The department shall offer referral information and may not present an unconfirmed research finding as a medical diagnosis.

(d) This section does not prohibit a disclosure otherwise authorized or required by law to prevent or lessen a serious and imminent threat.

Sec. 55.056. SCIENTIFIC STANDARDS.

Research must use accepted methods; use prospective longitudinal design when feasible; include healthy responders when needed; evaluate exposure-response and latency; perform valid occupation- and sex-specific analyses; address bias, missing data, confounding, and multiple comparisons; report denominators, uncertainty, methods, limitations, and revisions; register major protocols when appropriate; undergo independent review; publish methods and code when lawful; and distinguish hazard, association, causation, and individual adjudication.

Sec. 55.057. MINIMUM SUBJECT AREAS.

The program shall, subject to feasibility, study cancer; cardiovascular and cerebrovascular disease; pulmonary disease; reproductive and maternal health; neurological and renal disease; hearing loss; infectious disease; musculoskeletal injury; sleep, fatigue, and shift work; behavioral health, post-traumatic stress, substance-use disorders, and suicide; occupational injury, disability, and mortality; and other conditions designated by the department.

SUBCHAPTER C. UNIVERSITY RESEARCH CONSORTIUM

Sec. 55.101. TEXAS FIRST RESPONDER HEALTH RESEARCH CONSORTIUM.

(a) The department shall establish a consortium of qualified institutions of higher education and appropriate nonprofit research organizations.

(b) The department shall competitively select a coordinating center and provide qualified institutions across multiple Texas university systems and regions a reasonable opportunity to participate.

(c) Activities may include epidemiology, medicine, industrial hygiene, toxicology, behavioral health, engineering, equipment testing, data science, privacy, implementation science, screening, and medical surveillance.

(d) Institutions may integrate approved work into supervised educational programs subject to privacy, data-use, and institutional review requirements.

(e) A grant or contract must preserve scientific independence and publication rights. A funder may not control methods or suppress or materially alter findings.

Sec. 55.102. COMPETITIVE RESEARCH AND PREVENTION PROJECTS.

(a) From available money, the department may fund priority research, rapid investigation, equipment and training evaluation, risk-reduction pilots, and implementation evaluation.

(b) Selection must be competitive and merit based and consider scientific quality, operational relevance, responder participation, feasibility, privacy, and population inclusion.

SUBCHAPTER D. ADVISORY COUNCIL

Sec. 55.151. ADVISORY COUNCIL.

(a) The Texas First Responder Health Research Advisory Council is established to advise the department.

(b) The council consists of 24 members.

(c) The following officials, or their designees, serve: the commissioner of state health services; executive director of the Texas Commission on Fire Protection; commissioner of workers' compensation; executive director of the Texas Commission on Law Enforcement; state fire marshal; executive directors of the Texas Department of Criminal Justice and Texas Juvenile Justice Department; director of the Texas A&M Forest Service; executive director of the Commission on State Emergency Communications; and chief of the Texas Division of Emergency Management.

(d) The commissioner appoints 14 members: one career firefighter; one volunteer or wildland firefighter; one EMS professional; one peace officer; one detention, custodial, jail, or correctional officer; one telecommunicator; one emergency-management professional; one association or nonprofit representative; one occupational-medicine or oncology physician; one epidemiologist or biostatistician; one industrial-hygiene, toxicology, engineering, or protective-equipment expert; one behavioral-health, reproductive-health, or implementation-science expert; one privacy, cybersecurity, linkage, or ethics expert; and one additional relevant researcher.

(e) At least four scientific appointees must be affiliated with institutions representing at least three Texas public university systems.

(f) Appointments must seek meaningful representation of women, active and retired responders, geographic diversity, and varied forms of service.

Sec. 55.152. TERMS; MEETINGS.

(a) Agency members serve at the designating official's pleasure. Appointed members serve staggered four-year terms.

(b) The commissioner or designee presides. The council meets at least quarterly.

(d) Chapter 2110, Government Code, applies, except Section 2110.008 does not apply.

Sec. 55.153. DUTIES AND LIMITATIONS.

(a) The council advises on data standards, research priorities, scientific and privacy standards, public reporting, prevention recommendations, five-year reviews, and legislative recommendations.

(b) The council may not administer the program, direct a finding, decide a claim, receive the linkage key, or have unrestricted identifiable-data access.

SUBCHAPTER E. PRIVACY, ACCESS, AND PUBLICATION

Sec. 55.201. CONFIDENTIALITY AND SECURITY.

(a) Identifiable or reasonably identifiable information maintained under this chapter is confidential and excepted from Chapter 552, Government Code.

(b) The department shall separate the linkage key; use encryption, role-based access, multifactor authentication, audit logging, and minimum-necessary access; conduct assessments; establish retention and destruction schedules; maintain breach procedures; and comply with applicable law.

(c) Identifiable or coded research information may not be disclosed to an employer, prospective employer, licensing authority, insurer, carrier, or plan for employment, discipline, licensing, underwriting, or individual benefits unless specifically authorized by the individual, required by court order, or expressly required by law.

(d) Voluntary research information may not be used to rebut a Chapter 607 presumption unless the participant specifically authorizes that use in writing.

Sec. 55.202. RESEARCHER ACCESS.

The department may grant minimum-necessary coded-data access through a secure research environment only for an approved use, with required institutional review, a data-use agreement prohibiting reidentification and unauthorized contact or disclosure, audit logging, and disclosure-risk review.

Sec. 55.203. PUBLIC WEBSITE AND APPLICATION PROGRAMMING INTERFACE.

(a) The department shall maintain a public website using existing state open-data infrastructure to the greatest extent practicable.

(b) The department shall publish dashboards; downloadable CSV and JSON data; a documented, versioned API; dictionaries and codebooks; protocols, methods, quality statements, limitations, suppression rules, and revisions; annual and five-year reports; valid privacy-safe trends; publications; and prevention guidance.

(d) The public system may not publish the linkage key, a stable person identifier, direct identifiers, precise histories creating unreasonable identification risk, or another high-risk field.

(e) Non-sensitive operational information must be refreshed at least quarterly and validated health outcomes at least annually.

SUBCHAPTER F. PREVENTION, REPORTS, AND FUNDING

Sec. 55.251. PREVENTION AND IMPLEMENTATION CYCLE.

For a potentially preventable concern, the department shall validate the pattern; identify modifiable practices; support a pilot; evaluate adoption, exposure reduction, health, feasibility, capability, and unintended effects; publish results; issue guidance; recommend standards, appropriations, procurement, training, or legislation when warranted; and continue surveillance.

Sec. 55.252. REPORTS.

(a) By December 1 annually, the department shall publish program status, trends, research, evidence gaps, prevention results, expenditures, guidance, and recommendations.

(b) By December 1 of each even-numbered year, the department shall report costs, performance, and conditions warranting legislative consideration of presumptive or other occupational protection to statewide elected leadership, the Legislative Budget Board, and appropriate committees.

(c) At least every five years, the department shall publish an independently reviewed comprehensive epidemiological, exposure, prevention, privacy, and data-quality review.

(d) Reports may not identify a first responder.

Sec. 55.253. FUNDING.

(a) The program is funded from money appropriated to the department.

(b) The department shall include staffing, secure linkage, technology, public data, consortium, research, prevention pilots, and local assistance in its legislative appropriations request.

(c) The department may accept federal funds, grants, gifts, interagency transfers, and university cost sharing as supplements, not substitutes, for core appropriations.

(d) The department may not accept a condition allowing a funder to control methods, suppress or materially alter a finding, or unreasonably delay publication.

Sec. 55.254. RULES.

The executive commissioner shall adopt rules governing data elements and formats; reporting; consent and return of results; privacy and researcher access; grants and contracts; council procedures; and phased implementation.

ARTICLE 4. TRANSITION AND IMPLEMENTATION

SECTION 4.01. APPLICABILITY.

The changes made by Article 2 apply to claims filed on or after the effective date and pending claims without a final judgment. They do not affect a final judgment rendered before that date.

SECTION 4.02. REPROCESSING CERTAIN CANCER CLAIMS.

(a) A claimant whose claim was denied before the effective date wholly or partly because the cancer was not then listed in Section 607.055(b), Government Code, may, not later than September 1, 2028, submit a written reprocessing request with existing or supplemental evidence.

(b) The carrier shall reprocess the claim under amended law and, within 60 days, issue written acceptance or a denial stating every basis and the dispute procedure.

(c) A timely request is not barred by another claim-filing or notice deadline, but the claimant must otherwise establish eligibility.

(d) This section does not reopen a final court judgment.

(e) The commissioner of workers' compensation shall adopt necessary rules and forms.

SECTION 4.03. INITIAL PROGRAM IMPLEMENTATION.

(a) Initial rules and council designations and appointments are due March 1, 2028.

(b) DSHS shall begin roster reporting by September 1, 2028; achieve statewide exposure and prevention reporting by September 1, 2029; establish the public website and API by September 1, 2029; and publish the first annual report by December 1, 2029.

(c) Implementation shall prioritize existing systems, privacy, assistance to small and volunteer entities, and reliable denominator data before disease-rate comparisons.

SECTION 4.04. RULES FOR CANCER CLAIMS.

The commissioner of workers' compensation shall adopt necessary rules and forms by March 1, 2028.

ARTICLE 5. EFFECTIVE DATE

SECTION 5.01.

This Act takes effect September 1, 2027.