HOUSE Amended 2nd Reading March 10, 2016Second Regular Session Seventieth General Assembly STATE OF COLORADO ENGROSSED This Version Includes All Amendments Adopted on Second Reading in the House of Introduction LLS NO. 16-0769.01 Christy Chase x2008 HOUSE BILL 16-1164 HOUSE SPONSORSHIP Pabon, SENATE SPONSORSHIP Aguilar and Martinez Humenik, House Committees Senate Committees Health, Insurance, & Environment A BILL FOR AN ACT Concerning the transfer of responsibilities related to exemptions from immunization requirements from schools to the department of public health and environment. Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://www.leg.state.co.us/billsummaries.) Under current law, parents or students seeking an exemption from immunization requirements are to submit the required documentation in support of the exemption to the student's school. The bill will require parents or students to submit the documentation to the department of public health and environment instead of the school. The department is responsible for determining the form by which the exemption is to be submitted and for posting on its website exemption rates for each school. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. In Colorado Revised Statutes, 25-4-901, amend (2) (b) (II); and add (1.7) and (2.5) as follows: 25-4-901. Definitions. As used in this part 9, unless the context otherwise requires: (1.7) "Department" means the department of public health and environment created in section 25-1-102. (2) (b) "School" does not include: (II) College or university courses of study that are offered: (A) Off-campus; or are offered (B) To nontraditional adult students, as defined by the governing board of the institution state board of health; or are offered (C) At colleges or universities that do not have residence hall facilities. (2.5) "State board of health" means the state board of health created in section 25-1-103. SECTION 2. In Colorado Revised Statutes, 25-4-902, amend (1) introductory portion, (1) (a), (3), (4) introductory portion, and (4) (b) as follows: 25-4-902. Immunization prior to attending school - standardized immunization information. (1) Except as provided in section 25-4-903, no a child shall not attend any school in the state of Colorado on or after the dates specified in section 25-4-906 (4) unless he or she has presented the following to the appropriate school official: (a) An up-to-date certificate of immunization from a licensed physician, a licensed advanced practice nurse, or authorized representative of the department of public health and environment or county, district, or municipal public health agency stating that the child has received immunization against communicable diseases as specified by the state board of health, based on recommendations of the advisory committee on immunization practices of in the centers for disease control and prevention in the United States department of health and human services; or the American academy of pediatrics; or (3) Notwithstanding the provisions of subsection (1) of this section, a school shall enroll a student who is in out-of-home placement within five school days after receiving the student's education information and records as required in section 22-32-138, C.R.S., regardless of whether the school has received the items specified in subsection (1) of this section. Upon enrolling the student, the school shall notify the student's legal guardian that, unless the school receives the student's certificate of immunization or a written authorization for administration of immunizations within fourteen days after the student enrolls, the school shall will suspend the student until such time as the school receives the certificate of immunization or the authorization. (4) On or before March 1, 2011, The department of public health and environment shall develop and provide to the department of education a standardized document regarding childhood immunizations. The department of education shall post the standardized immunization document on its website. on or before January 15, 2011, and each year thereafter. The department shall update the standardized document shall be updated annually and shall include but need not be limited to in the standardized document at least the following: (b) A list of immunizations currently recommended for children by the center for disease control advisory committee on immunization practices in the centers for disease control and prevention in the United States department of health and human services and the recommended age at which each immunization should be given. SECTION 3. In Colorado Revised Statutes, 25-4-902.5, amend (1) and (3) (a) as follows: 25-4-902.5. Immunization prior to attending a college or university - tuberculosis screening process development. (1) Except as provided in section 25-4-903, no a student shall not attend any college or university in the state of Colorado on or after the dates specified in section 25-4-906 (4) unless such the student can present to the appropriate official of the school: (a) A certificate of immunization from a licensed physician, a licensed advanced practice nurse, or authorized representative of the department of public health and environment or county, district, or municipal public health agency stating that the student has received immunization against communicable diseases as specified by the state board of health; or (b) A written authorization signed by one parent or guardian, or the emancipated student, or the student eighteen years of age or older requesting that local health officials administer the immunizations; or (c) A plan signed by one parent or guardian, or the emancipated student, or the student eighteen years of age or older for receipt by the student of the required inoculation or the first or the next required of a series of inoculations within thirty days. (3) (a) Each college and university in Colorado may work to create a tuberculosis screening process with the goal of making the process as uniform as possible for all colleges and universities in the state. The department of public health and environment may attend and participate in any meetings held by the universities and colleges regarding the screening process. The screening process may include a tuberculosis risk questionnaire, a tuberculosis education policy, a clinical review process for each completed questionnaire, and follow-up testing procedures for students who are determined to be at risk for tuberculosis. On or before January 1, 2009, the colleges and universities that work to create a tuberculosis screening process pursuant to this subsection (3) shall report to the health and human services committees of the senate and the house of representatives, or their successor committees, regarding any legislative recommendations necessary regarding a tuberculosis screening process. SECTION 4. In Colorado Revised Statutes, 25-4-903, amend (2) and (5) as follows: 25-4-903. Exemptions from immunization - rules. (2) (a) It is the responsibility of the parent or legal guardian to have his or her child immunized unless the child is exempted pursuant to this section. A To be exempt from the required immunizations, the parent or guardian of the student or, if emancipated or at least eighteen years of age, the student shall be exempted from receiving the required immunizations in the following manner submit to the department, on a form prescribed by the department: (a) (I) By submitting to the student's school A certification from a licensed physician or advanced practice nurse that, the based on the student's physical condition, of the student is such that receipt of one or more specified immunizations would endanger his or her the student's life or health or is medically contraindicated due to other medical conditions; or (b) (II) By submitting to the student's school A statement of exemption signed by one parent or guardian or, the if emancipated student, or student or at least eighteen years of age or older, by the student that the parent, guardian, or student is an adherent adheres to a religious belief whose teachings are opposed to immunizations or that the parent, or guardian, or the emancipated student or student eighteen years of age or older has a personal belief that is opposed to immunizations. (b) Notwithstanding paragraph (a) of this subsection (2), a child participating in a nonpublic home-based educational program, as defined in section 22-33-104.5, C.R.S., whose parent or guardian chooses not to disclose immunization records required to be maintained under section 22-33-104.5 (3) (g), C.R.S., is presumed exempt from immunization pursuant to this subsection (2) and need not submit to the department a certification or statement of exemption. (5) Each school The department shall make the immunization and exemption rates of their the enrolled student population for each school publicly available upon request by posting the information on its website. SECTION 5. In Colorado Revised Statutes, 25-4-904, amend (1) as follows: 25-4-904. Rules - immunization rules - rule-making authority of state board of health. (1) The state board of health shall establish adopt rules and regulations for administering this part 9. Such The rules and regulations shall establish which immunizations shall be are required and the manner and frequency of their administration and shall conform to recognized standard medical practices. Such The rules and regulations may also require the reporting of schools to report statistical information and names of noncompliers. by the schools. The department of public health and environment shall administer and enforce the immunization requirements. SECTION 6. In Colorado Revised Statutes, 25-4-905, amend (1) as follows: 25-4-905. Immunization of indigent children. (1) (a) The county, district, or municipal public health agency or a public health or school nurse under the supervision of a licensed physician or the department, of public health and environment in the absence of a county, district, or municipal public health agency or public health or school nurse shall provide, at public expense to the extent that funds are available, immunizations required by this part 9 to each child who has not been exempted under section 25-4-903 and whose parents or guardians cannot afford to have the child immunized or, if emancipated, who cannot himself or herself afford immunization. and who has not been exempted. (b) In the absence of a county, district, or municipal public health agency or public health or school nurse, the department shall provide immunizations in accordance with paragraph (a) of this subsection (1). (c) (I) The department of public health and environment shall provide all vaccines necessary to comply with this section as far as funds will permit. (II) Nothing in this section shall preclude precludes the department of public health and environment from distributing vaccines to physicians, advanced practice nurses, or others as required by law or the rules of the department. (d) No An indigent child shall not be excluded, suspended, or expelled from school unless the immunizations have been available and readily accessible to the child at public expense. SECTION 7. In Colorado Revised Statutes, 25-4-906, amend (1) and (3) as follows: 25-4-906. Certificate of immunization - forms. (1) The department of public health and environment shall provide official certificates of immunization to the schools, private physicians, and county, district, and municipal public health agencies. Upon the commencement of the gathering of epidemiological information Pursuant to section 25-4-2403, to implement the immunization tracking system, such form the department shall include on the certificate of immunization form a notice that informs a parent or legal guardian that he or she has the option to exclude include his or her infant's, child's, or student's immunization information from in the immunization tracking system created in section 25-4-2403. Any immunization record provided by a licensed physician, registered nurse, or public health official may be accepted by the school official as certification of immunization if the information is transferred to the official certificate of immunization and verified by the school official. (3) The department of public health and environment may examine, audit, and verify the records of immunizations maintained by each school. SECTION 8. In Colorado Revised Statutes, 25-4-907, amend (2) as follows: 25-4-907. Noncompliance. (2) In the event of suspension or expulsion of If a student is suspended or expelled from school under subsection (1) of this section, school officials shall notify the state department of public health and environment or the county, district, and or municipal public health agency. An agent of said the department shall then contact the parent or guardian or, if the student is emancipated student or student at least eighteen years of age, or older the student in an effort to secure compliance with this part 9 in order that the student may be reenrolled in school. SECTION 9. In Colorado Revised Statutes, amend 25-4-908 as follows: 25-4-908. When exemption from immunization not recognized. If at any time there is, in the opinion of the state department of public health and environment or the county, district, or municipal public health agency, danger of an epidemic from any of the communicable diseases for which an immunization is required pursuant to the rules and regulations promulgated pursuant to section 25-4-904, no an exemption or exception from immunization against such the disease shall not be recognized. Quarantine by the state department of public health and environment or the county, district, or municipal public health agency is hereby authorized as a legal alternative to immunization. SECTION 10. In Colorado Revised Statutes, 25-4-2403, amend (3) introductory portion as follows: 25-4-2403. Department of public health and environment - powers and duties - immunization tracking system - definitions. (3) Records in the immunization tracking system shall be and exemption records maintained by the department under part 9 of this article are strictly confidential, and the department shall not be released, shared release the records, share the records with any agency or institution, or made make the records public upon subpoena, search warrant, discovery proceedings, or otherwise, except under the following circumstances: SECTION 11. Effective date. This act takes effect July 1, 2016. SECTION 12. Safety clause. The general assembly hereby finds, determines, and declares that this act is necessary for the immediate preservation of the public peace, health, and safety.