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Model Law Work Group Progress Report. Cathy Molchan Donald, MBA Karen Hampton, JD Linette Scott, MD June 7, 2010. Model Law Revision. Model State Vital Statistics Act and Regulations:
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Model Law Work GroupProgress Report Cathy Molchan Donald, MBA Karen Hampton, JD Linette Scott, MD June 7, 2010
Model Law Revision Model State Vital Statistics Act and Regulations: • Provides detailed guidance to States that are considering revision of their own State vital statistics laws and regulations. • Promotes uniformity among states in definitions, registration practices, disclosure and issuance procedures, and in the many other functions that comprise a state system of vital statistics. • Initially established in 1907, has been revised in 1941, 1959, 1977, 1992 http://www.cdc.gov/nchs/nvss/model_law_revision.htm
Chairperson Alvin T. Onaka, Ph.D.Hawaii Department of Health Members Catherine Molchan DonaldAlabama Department of Public Health Karen R. Hampton, J.D.Oregon Department of Human Services Ronald HymanColorado Department of Public Health and Environment Wilfredo Lopez, J.D.New York City Department of Health and Mental Hygiene Patricia W. Potrzebowski, Ph.D.Pennsylvania Department of Health Steven Schwartz, Ph.D.New York City Department of Healthand Mental Hygiene Linette T. Scott, M.D., M.P.H.California Department of Public Health Centers for Disease Control and Prevention National Center for Health Statistics, Division of Vital Statistics, Registration Methods Staff Judy M. Barnes Julia L. Kowaleski George C. Tolson Centers for Disease Control and Prevention Anthony Moulton, Ph.D.Public Health Law ProgramOffice of the Director/OSI Deborah Tress, J.D.Office of General Counsel Model Law Revision Work Group
Accomplishments To Date • Surveys of NAPHSIS Membership developed by the Workgroup • Model Law Survey – 32 states responded • Issuance Survey – 35 states responded • Other Surveys of NAPHSIS Membership used by the Workgroup: • Fees Charged • Fee Retention • Levying Fines • Verification Charges
Accomplishments To Date • Solicitation of Comments on NCHS web site • Received feedback from NAPHSIS Members • National Archives and Records Administration • CSTE Subcommittee on Tribal Epidemiology • US Department of Justice, Witness Security Division • Vermont Notary Public • West VA Funeral Directors Association • American College of Nurse Midwives • National Funeral Directors Association • Lambda Legal • ACLU LGBT Rights Project • National Center for Lesbian Rights • Gay and Lesbian Advocates and Defenders • and others
Accomplishments To Date • NAPHSIS Annual Meeting 2009 Inputs • Presentations • Roundtables • Town Hall • Workgroup Meetings began in 2009 • April, July, September, November 2009 • January, April 2010
Huge Thank You • NAPHSIS Committees have been critical to the development of the Model Law revision providing reviews and input to the Workgroup • Registration Committee • Statistics Committee • Security Committee • Inter-Jurisdictional Exchange Committee
Registration • Linda Loftus, MN • Shae Sutton, SC • Melissa Andrews, CA • Gary Thompson, WV • Ken Jones, FL • Stan Nyberg, MA • Colleen Fontana, RI • Relates to 16 of the 29 Sections of the Model Law • NAPHSIS Registration Committee • Important role in the process • Bi-weekly conference calls
Registration Topics Already Reviewed Still to Come • Birth Registration • Delayed Registration of Birth • Infants of Unknown Parentage • Judicial Procedures to Establish Birth • Reports of Adoption • Birth Certificates following Adoption • Etc. • Death Registration • Fetal Deaths • Marriage • Divorce • Delayed Registration of Death • Authorization for Final Disposition • Amendment of Vital Records
Registration – Clarification Needed Same-sex marriage as it relates to birth registration Allowing for “parent” labels on the birth certificate or something more? Assisted reproductive technology to include surrogacy Asking for clarification of who goes on the birth certificate and which medical information is gathered? Asking that Model Law indicate Gestational Agreements are acceptable at hospital to put parents on birth certificate? Change of parent outside adoption (divorce)
Registration – Additional Issues Duplicate registrations and Authority to void records Model Law allows registrar to void a record if fraud or misrepresentation is found Asking for specific language around duplicates accidentally filed by institution or something else? Gender reassignment Model Law allows for the birth certificate to be amended Asking about amending birth certificate or create new birth certificate; issues about requirement of court order, or other issues?
Registration – Additional Issues Cont. Segregation of births to unmarried mothers Delayed birth certificates More flexibility for older population; Model Law currently allows for “other evidence acceptable to State Registrar”
Registration – Additional Issues Cont. Who can pronounce death? Family Burials Model Law allows for “other person in charge of disposition” Do regulations need to clarify procedures when no established facility is involved? (Assistance from Local Registrar?) Mass Disasters Currently nothing in Model Law about handling of bodies and death certificates in the event of a mass disaster where there are bodies Issues around mass graves and temporary disposition
Issuance Our challenge is to anticipate technological changes and business needs for the next twenty years
Issuance Survey Highlights Eligibility to order records – 35 jurisdictions Four responding jurisdictions reported anyone can obtain a certified copy of a birth certificate Four additional jurisdictions reported anyone can obtain a certified copy of a death certificate Relationships that can order had a standard core of registrant (for birth), parents, spouse, legal representative, then expand by jurisdiction (siblings, children, government agencies, etc.)
Issuance Survey Highlights – Cont. Age limit for registrant Father not on the record – can’t get until age 16 Different criteria for identification Some states more restrictive on in person (photo id), some more restrictive on mail (notarized only) and internet (electronic check of identity) When identification requirement took effect 16 of the jurisdictions didn’t require ID for birth and death records until 2000 or later 14 didn’t require identification until 2002 or later
Establishing identity and confirming relationship Survey shows: ‘Open’ records – 4 for birth and 8 for death Do not require ID from the applicant – 7 for birth and 9 for death Do not require proof of relationship – 17 for birth and 25 for death
Issuance – still to come Apostilles and exemplifications some vital records offices have three steps, others issue apostilles on their own records History of applicants maintained on a central database Electronic certifications and verifications Minimum fields for certifications, including (or not) amendment history
Security – Is it a myth? Food for thought: • Does your jurisdiction have more breaches occurring on paper or electronically? • Is there such a thing as tamper-proof (paper or electronic)? • Implications of:HIPAA - Health Insurance Portability and Accountability Act HITECH - Health Information Technology for Economic and Clinical Health ActHCR – Health Care Reform …
Security Not a matter of “IF” but “WHEN” • Asking the “right question:” • Will Iknow if there is a breach? • How will Iknow if there is a breach? • What will / must I do if there is a breach? • What authority (Model Law) would help to accomplish the “right question”?
Security For Civil Purposes: • Fulfilling vital record role as prima facie evidence • Keeping records unaltered/safe/preserved into perpetuity • Preventing fraud – cross-matching birth and death records • Recording legal signatures: Ink vs. Electronic For Public Health Purposes: • Maintaining confidential data • Ensuring uses are appropriate and conducting follow-up
Data Flow Terminology • A Report is submitted to the Registrar • The Registrar accepts the Report and it becomes a Record • The Record is used for: • Certification – subset of the Record necessary for civil purposes • Verification – performed based on matching a Certification against the Registrar’s Records • Data File Provision – subset of the Records used for research, governmental purposes, etc.
Timeline for 2010-2011 • NAPHSIS Annual Meeting • Two Round Tables • Confidentiality and Disclosure • Registration • Town Hall • Workgroup Meetings • July, September, November 2010; March 2011 • Draft Model Law Revision for review by NAPHSIS Membership with online comments
Objectives • Implementation of revised Model Law and Regulations in jurisdictions • Improved uniformity of process • Use as a resource to support justifications for actions in the jurisdictions regarding the vital record system
Acknowledgments • Funding for this effort is supported by the National Center for Health Statistics • Support of Work Group and Committee meetings by the National Association for Public Health Statistics and Information Systems