1     
PUBLIC HEALTH AND SCHOOLS

2     
2017 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Norman K Thurston

5     
Senate Sponsor: Margaret Dayton

6     Cosponsors:
7     Brad M. Daw
Carol Spackman Moss

8     

9     LONG TITLE
10     General Description:
11          This bill requires the Department of Health to create an online education module
12     regarding certain preventable diseases.
13     Highlighted Provisions:
14          This bill:
15          ▸     defines terms;
16          ▸     requires the Department of Health to:
17               •     create an online education module regarding certain preventable diseases; and
18               •     create a new vaccination exemption form;     
19          ▸     amends the Utah Health Code regarding student vaccinations and records of student
20     vaccinations;
21          ▸     subject to certain exceptions, continues the requirement that a student receive
22     certain vaccinations in order to attend school;
23          ▸     requires the renewal of a student's vaccination exemption under certain conditions;
24          ▸     allows for the vaccination exemption form to be completed online in conjunction
25     with the education module;
26          ▸     continues the practice of preventing a local education agency from receiving
27     weighted pupil unit money for a student who does not comply with vaccination
28     requirements;

29          ▸     addresses policies and procedures relating to vaccinations, recordkeeping, and
30     disease outbreaks; and
31          ▸     makes technical changes.
32     Money Appropriated in this Bill:
33          None
34     Other Special Clauses:
35          This bill provides a special effective date.
36     Utah Code Sections Affected:
37     AMENDS:
38          26-1-17.5, as last amended by Laws of Utah 2008, Chapter 382
39          26-10-9, as enacted by Laws of Utah 2011, Chapter 147
40          26-39-402, as renumbered and amended by Laws of Utah 2008, Chapter 111
41     ENACTS:
42          26-7-9, Utah Code Annotated 1953
43          53A-11-300.5, Utah Code Annotated 1953
44          53A-11-307, Utah Code Annotated 1953
45     REPEALS AND REENACTS:
46          53A-11-301, as last amended by Laws of Utah 1992, Chapter 53
47          53A-11-302, as last amended by Laws of Utah 2010, Chapter 395
48          53A-11-302.5, as enacted by Laws of Utah 1992, Chapter 129
49          53A-11-303, as enacted by Laws of Utah 1988, Chapter 2
50          53A-11-304, as enacted by Laws of Utah 1988, Chapter 2
51          53A-11-306, as enacted by Laws of Utah 1988, Chapter 2
52     REPEALS:
53          53A-11-305, as last amended by Laws of Utah 1988, Chapter 202
54     

55     Be it enacted by the Legislature of the state of Utah:
56          Section 1. Section 26-1-17.5 is amended to read:

57          26-1-17.5. Confidential records.
58          (1) A record classified as confidential under this title shall remain confidential, and be
59     released according to the provisions of this title, notwithstanding Section 63G-2-310.
60          (2) In addition to those persons granted access to [records] a private record described in
61     Subsection 63G-2-302(1)(b), [immunization records may be shared among] schools, school
62     districts, and local and state health departments and the state Department of Human Services
63     may share an immunization record as defined in Section 53A-11-300.5 or any other record
64     relating to a vaccination or immunization as necessary to [assure] ensure compliance with
65     [Section 53A-11-301] Title 53A, Chapter 11, Part 3, Immunization of Students, and to prevent,
66     investigate, and control the causes of epidemic, infectious, communicable, and other diseases
67     affecting the public health.
68          Section 2. Section 26-7-9 is enacted to read:
69          26-7-9. Online public health education module.
70          (1) As used in this section:
71          (a) "Health care provider" means the same as that term is defined in Section
72     78B-3-403.
73          (b) "Nonimmune" means that a child or an individual:
74          (i) has not received each vaccine required in Section 53A-11-303 and has not
75     developed a natural immunity through previous illness to a vaccine-preventable disease, as
76     documented by a health care provider;
77          (ii) cannot receive each vaccine required in Section 53A-11-303; or
78          (iii) is otherwise known to not be immune to a vaccine-preventable disease.
79          (c) "Vaccine-preventable disease" means an infectious disease that can be prevented by
80     a vaccination required in Section 53A-11-303.
81          (2) The department shall develop an online education module regarding
82     vaccine-preventable diseases:
83          (a) to assist a parent of a nonimmune child to:
84          (i) recognize the symptoms of vaccine-preventable diseases;

85          (ii) respond in the case of an outbreak of a vaccine-preventable disease;
86          (iii) protect children who contract a vaccine-preventable disease; and
87          (iv) prevent the spread of vaccine-preventable diseases;
88          (b) that contains only the following:
89          (i) information about vaccine-preventable diseases necessary to achieve the goals
90     stated in Subsection (2)(a), including the best practices to prevent the spread of
91     vaccine-preventable diseases;
92          (ii) recommendations to reduce the likelihood of a nonimmune individual contracting
93     or transmitting a vaccine-preventable disease; and
94          (iii) information about additional available resources related to vaccine-preventable
95     diseases and the availability of low-cost vaccines;
96          (c) that includes interactive questions or activities; and
97          (d) that is expected to take an average user 20 minutes or less to complete, based on
98     user testing.
99          (3) In developing the online education module described in Subsection (2), the
100     department shall consult with individuals interested in vaccination or vaccine-preventable
101     diseases, including:
102          (a) representatives from organizations of health care professionals; and
103          (b) parents of nonimmune children.
104          (4) The department shall make the online education module described in Subsection
105     (2) publicly available to parents through:
106          (a) a link on the department's website;
107          (b) county health departments, as that term is defined in Section 26A-1-102;
108          (c) local health departments, as that term is defined in Section 26A-1-102;
109          (d) local education agencies, as that term is defined in Section 53A-1-401; and
110          (e) other public health programs or organizations.
111          (5) The department shall report to the Health and Human Services Interim Committee
112     before November 30, 2018, regarding compliance with this section.

113          Section 3. Section 26-10-9 is amended to read:
114          26-10-9. Immunizations -- Consent of minor to treatment.
115          (1) This section:
116          (a) is not intended to interfere with the integrity of the family or to minimize the rights
117     of parents or children; and
118          (b) applies to a minor, who at the time care is sought is:
119          (i) married or has been married;
120          (ii) emancipated as provided for in Section 78A-6-805;
121          (iii) a parent with custody of a minor child; or
122          (iv) pregnant.
123          (2) (a) A minor described in Subsections (1)(b)(i) and (ii) may consent to:
124          (i) [immunizations] vaccinations against epidemic infections and communicable
125     diseases as defined in Section 26-6-2; and
126          (ii) examinations and [immunizations] vaccinations required to attend school as
127     provided in Title 53A, Chapter 11, Students in Public Schools.
128          (b) A minor described in Subsections (1)(b)(iii) and (iv) may consent to the
129     [immunizations] vaccinations described in Subsections (2)(a)(i) and (ii), and the vaccine for
130     human papillomavirus only if:
131          (i) the minor represents to the health care provider that the minor is an abandoned
132     minor as defined in Section 76-5-109; and
133          (ii) the health care provider makes a notation in the minor's chart that the minor
134     represented to the health care provider that the minor is an abandoned minor under Section
135     76-5-109.
136          (c) Nothing in Subsection (2)(a) or (b) requires a health care provider to immunize a
137     minor.
138          (3) The consent of the minor pursuant to this section:
139          (a) is not subject to later disaffirmance because of the minority of the person receiving
140     the medical services;

141          (b) is not voidable because of minority at the time the medical services were provided;
142          (c) has the same legal effect upon the minor and the same legal obligations with regard
143     to the giving of consent as consent given by a person of full age and capacity; and
144          (d) does not require the consent of any other person or persons to authorize the medical
145     services described in Subsections (2)(a) and (b).
146          (4) A health care provider who provides medical services to a minor in accordance
147     with the provisions of this section is not subject to civil or criminal liability for providing the
148     services described in Subsections (2)(a) and (b) without obtaining the consent of another
149     person prior to rendering the medical services.
150          (5) This section does not remove the requirement for parental consent or notice when
151     required by Section 76-7-304 or 76-7-304.5.
152          (6) The parents, parent, or legal guardian of a minor who receives medical services
153     pursuant to Subsections (2)(a) and (b) are not liable for the payment for those services unless
154     the parents, parent, or legal guardian consented to the medical services.
155          Section 4. Section 26-39-402 is amended to read:
156          26-39-402. Residential child care certificate.
157          (1) [(a)] A residential child care provider of five to eight qualifying children shall
158     obtain a Residential Child Care Certificate from the department, unless Section 26-39-403
159     applies.
160          [(b)] (2) The minimum qualifications for a Residential Child Care Certificate are:
161          [(i)] (a) the submission of:
162          [(A)] (i) an application in the form prescribed by the department;
163          [(B)] (ii) a certification and criminal background fee established in accordance with
164     Section 26-1-6; and
165          [(C)] (iii) in accordance with Section 26-39-404, identifying information for each adult
166     person and each juvenile age 12 through 17 years of age who resides in the provider's home:
167          [(I)] (A) for processing by the Department of Public Safety to determine whether any
168     such person has been convicted of a crime;

169          [(II)] (B) to screen for a substantiated finding of child abuse or neglect by a juvenile
170     court; and
171          [(III)] (C) to discover whether the person is listed in the Licensing Information System
172     described in Section 62A-4a-1006;
173          [(ii)] (b) an initial and annual inspection of the provider's home within 90 days of
174     sending an intent to inspect notice to:
175          [(A)] (i) check the immunization record, as defined in Section 53A-11-300.5, of each
176     qualifying child who receives child care in the provider's home;
177          [(B)] (ii) identify serious sanitation, fire, and health hazards to qualifying children; and
178          [(C)] (iii) make appropriate recommendations; and
179          [(iii)] (c) annual training consisting of 10 hours of department-approved training as
180     specified by the department by administrative rule, including a current department-approved
181     CPR and first aid course.
182          [(c)] (3) If a serious sanitation, fire, or health hazard has been found during an
183     inspection conducted pursuant to Subsection [(1)(b)(ii)] (2)(b), the department shall require
184     corrective action for the serious hazards found and make an unannounced follow up inspection
185     to determine compliance.
186          [(d)] (4) In addition to an inspection conducted pursuant to Subsection [(1)(b)(ii)]
187     (2)(b), the department may inspect the home of a residential care provider of five to eight
188     qualifying children in response to a complaint of:
189          [(i)] (a) child abuse or neglect;
190          [(ii)] (b) serious health hazards in or around the provider's home; or
191          [(iii)] (c) providing residential child care without the appropriate certificate or license.
192          [(2)] (5) Notwithstanding this section:
193          (a) a license under Section 26-39-401 is required of a residential child care provider
194     who cares for nine or more qualifying children;
195          (b) a certified residential child care provider may not provide care to more than two
196     qualifying children under the age of two; and

197          (c) an inspection may be required of a residential child care provider in connection
198     with a federal child care program.
199          [(3)] (6) With respect to residential child care, the department may only make and
200     enforce rules necessary to implement this section.
201          Section 5. Section 53A-11-300.5 is enacted to read:
202          53A-11-300.5. Definitions.
203          As used in this part:
204          (1) "Department" means the Department of Health, created in Section 26-1-4.
205          (2) "Health official" means an individual designated by a local health department from
206     within the local health department to consult and counsel parents and licensed health care
207     providers, in accordance with Subsection 53A-11-302.5(2)(a).
208          (3) "Health official designee" means a licensed health care provider designated by a
209     local health department, in accordance with Subsection 53A-11-302.5(2)(b), to consult with
210     parents, licensed health care professionals, and school officials.
211          (4) "Immunization" or "immunize" means a process through which an individual
212     develops an immunity to a disease, through vaccination or natural exposure to the disease.
213          (5) "Immunization record" means a record relating to a student that includes:
214          (a) information regarding each required vaccination that the student has received,
215     including the date each vaccine was administered, verified by:
216          (i) a licensed health care provider;
217          (ii) an authorized representative of a local health department;
218          (iii) an authorized representative of the department;
219          (iv) a registered nurse; or
220          (v) a pharmacist;
221          (b) information regarding each disease against which the student has been immunized
222     by previously contracting the disease; and
223          (c) an exemption form identifying each required vaccination from which the student is
224     exempt, including all required supporting documentation described in Section 53A-11-302.

225          (6) "Legally responsible individual" means:
226          (a) a student's parent;
227          (b) the student's legal guardian;
228          (c) an adult brother or sister of a student who has no legal guardian; or
229          (d) the student, if the student:
230          (i) is an adult; or
231          (ii) is a minor who may consent to treatment under Section 26-10-9.
232          (7) "Licensed health care provider" means a health care provider who is licensed under
233     Title 58, Occupations and Professions, as:
234          (a) a medical doctor;
235          (b) an osteopathic doctor;
236          (c) a physician assistant; or
237          (d) an advanced practice registered nurse.
238          (8) "Local education agency" or "LEA" means:
239          (a) a school district;
240          (b) a charter school; or
241          (c) the Utah Schools for the Deaf and the Blind.
242          (9) "Local health department" means the same as that term is defined in Section
243     26A-1-102.
244          (10) "Required vaccines" means vaccines required by department rule described in
245     Section 53A-11-303.
246          (11) "School" means any public or private:
247          (a) elementary or secondary school through grade 12;
248          (b) preschool;
249          (c) child care program, as that term is defined in Section 26-39-102;
250          (d) nursery school; or
251          (e) kindergarten.
252          (12) "Student" means an individual who attends a school.

253          (13) "Vaccinating" or "vaccination" means the administration of a vaccine.
254          (14) "Vaccination exemption form" means a form, described in Section 53A-11-302.5,
255     that documents and verifies that a student is exempt from the requirement to receive one or
256     more required vaccines.
257          (15) "Vaccine" means the substance licensed for use by the United States Food and
258     Drug Administration that is injected into or otherwise administered to an individual to
259     immunize the individual against a communicable disease.
260          Section 6. Section 53A-11-301 is repealed and reenacted to read:
261          53A-11-301. Immunization required -- Exception -- Weighted pupil unit funding.
262          (1) A student may not attend a school unless:
263          (a) the school receives an immunization record from the legally responsible individual
264     of the student, the student's former school, or a statewide registry that shows:
265          (i) that the student has received each vaccination required by the department under
266     Section 53A-11-303; or
267          (ii) for any required vaccination that the student has not received, that the student:
268          (A) has immunity against the disease for which the vaccination is required, because the
269     student previously contracted the disease as documented by a health care provider, as that term
270     is defined in Section 78B-3-103; or
271          (B) is exempt from receiving the vaccination under Section 53A-11-302;
272          (b) the student qualifies for conditional enrollment under Section 53A-11-306; or
273          (c) the student:
274          (i) is a student, as defined in Section 53A-1-1001; and
275          (ii) complies with the immunization requirements for military children under Section
276     53A-1-1001.
277          (2) An LEA may not receive weighted pupil unit money for a student who is not
278     permitted to attend school under Subsection (1).
279          Section 7. Section 53A-11-302 is repealed and reenacted to read:
280          53A-11-302. Grounds for exemption from required vaccines -- Renewal.

281          (1) A student is exempt from the requirement to receive a vaccine required under
282     Section 53A-11-303 if the student qualifies for a medical or personal exemption from the
283     vaccination under Subsection (2) or (3).
284          (2) A student qualifies for a medical exemption from a vaccination required under
285     Section 53A-11-303 if the student's legally responsible individual provides to the student's
286     school:
287          (a) a completed vaccination exemption form; and
288          (b) a written notice signed by a licensed health care provider stating that, due to the
289     physical condition of the student, administration of the vaccine would endanger the student's
290     life or health.
291          (3) A student qualifies for a personal exemption from a vaccination required under
292     Section 53A-11-303 if the student's legally responsible individual provides to the student's
293     school a completed vaccination exemption form, stating that the student is exempt from the
294     vaccination because of a personal or religious belief.
295          (4) (a) A vaccination exemption form submitted under this section is valid for as long
296     as the student remains at the school to which the form first is presented.
297          (b) If the student changes schools before the student is old enough to enroll in
298     kindergarten, the vaccination exemption form accepted as valid at the student's previous school
299     is valid until the earlier of the day on which:
300          (i) the student enrolls in kindergarten; or
301          (ii) the student turns six years old.
302          (c) If the student changes schools after the student is old enough to enroll in
303     kindergarten but before the student is eligible to enroll in grade 7, the vaccination exemption
304     form accepted as valid at the student's previous school is valid until the earlier of the day on
305     which:
306          (i) the student enrolls in grade 7; or
307          (ii) the student turns 12 years old.
308          (d) If the student changes schools after the student is old enough to enroll in grade 7,

309     the vaccination exemption form accepted as valid at the student's previous school is valid until
310     the student completes grade 12.
311          (e) Notwithstanding Subsections (4)(b) and (c), a vaccination exemption form obtained
312     through completion of the online education module created in Section 26-7-9 is valid for at
313     least two years.
314          Section 8. Section 53A-11-302.5 is repealed and reenacted to read:
315          53A-11-302.5. Vaccination exemption form.
316          (1) The department shall:
317          (a) develop a vaccination exemption form that includes only the following information:
318          (i) identifying information regarding:
319          (A) the student to whom an exemption applies; and
320          (B) the legally responsible individual who claims the exemption for the student and
321     signs the vaccination exemption form;
322          (ii) an indication regarding the vaccines to which the exemption relates;
323          (iii) a statement that the claimed exemption is for:
324          (A) a medical reason; or
325          (B) a personal or religious belief; and
326          (iv) an explanation of the requirements, in the event of an outbreak of a disease for
327     which a required vaccine exists, for a student who:
328          (A) has not received the required vaccine; and
329          (B) is not otherwise immune from the disease; and
330          (b) provide the vaccination exemption form created in this Subsection (1) to local
331     health departments.
332          (2) (a) Each local health department shall designate one or more individuals from
333     within the local health department as a health official to consult, regarding the requirements of
334     this part, with:
335          (i) parents, upon the request of parents;
336          (ii) school principals and administrators; and

337          (iii) licensed health care providers.
338          (b) A local health department may designate a licensed health care provider as a health
339     official designee to provide the services described in Subsection (2)(a).
340          (3) (a) To receive a vaccination exemption form described in Subsection (1), a legally
341     responsible individual shall complete the online education module described in Section 26-7-9,
342     permitting an individual to:
343          (i) complete any requirements online; and
344          (ii) download and print the vaccine exemption form immediately upon completion of
345     the requirements.
346          (b) A legally responsible individual may decline to take the online education module
347     and obtain a vaccination exemption form from a local health department if the individual:
348          (i) requests and receives an in-person consultation at a local health department from a
349     health official or a health official designee regarding the requirements of this part; and
350          (ii) pays any fees established under Subsection (4)(b).
351          (4) (a) Neither the department nor any other person may charge a fee for the exemption
352     form offered through the online education module in Subsection (3)(a).
353          (b) A local health department may establish a fee of up to $25 to cover the costs of
354     providing an in-person consultation.
355          Section 9. Section 53A-11-303 is repealed and reenacted to read:
356          53A-11-303. Regulations of department.
357          (1) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the
358     department shall make rules regarding:
359          (a) which vaccines are required as a condition of attending school;
360          (b) the manner and frequency of the vaccinations; and
361          (c) the vaccination exemption form described in Section 53A-11-302.5.
362          (2) The department shall ensure that the rules described in Subsection (1):
363          (a) conform to recognized standard medical practices; and
364          (b) require schools to report to the department statistical information and names of

365     students who are not in compliance with Section 53A-11-301.
366          Section 10. Section 53A-11-304 is repealed and reenacted to read:
367          53A-11-304. Immunization record part of student's record -- School review
368     process at enrollment -- Transfer.
369          (1) Each school:
370          (a) shall request an immunization record for each student at the time the student enrolls
371     in the school;
372          (b) may not charge a fee related to receiving or reviewing an immunization record or a
373     vaccination exemption form; and
374          (c) shall retain an immunization record for each enrolled student as part of the student's
375     permanent school record.
376          (2) (a) Within five business days after the day on which a student enrolls in a school,
377     an individual designated by the school principal or administrator shall:
378          (i) determine whether the school has received an immunization record for the student;
379          (ii) review the student's immunization record to determine whether the record complies
380     with Subsection 53A-11-301(1); and
381          (iii) identify any deficiencies in the student's immunization record.
382          (b) If the school has not received a student's immunization record or there are
383     deficiencies in the immunization record, the school shall:
384          (i) place the student on conditional enrollment, in accordance with Section
385     53A-11-306; and
386          (ii) within five days after the day on which the school places the student on conditional
387     enrollment, provide the written notice described in Subsection 53A-11-306(2).
388          (3) A school from which a student transfers shall provide the student's immunization
389     record to the student's new school upon request of the student's legally responsible individual.
390          Section 11. Section 53A-11-306 is repealed and reenacted to read:
391          53A-11-306. Conditional enrollment -- Suspension for noncompliance --
392     Procedure.

393          (1) A student for whom a school has not received a complete immunization record may
394     attend the school on a conditional enrollment:
395          (a) during the period in which the student's immunization record is under review by the
396     school; or
397          (b) for 21 calendar days after the day on which the school provides the notice described
398     in Subsection (2).
399          (2) (a) Within five days after the day on which a school places a student on conditional
400     enrollment, the school shall provide written notice to the student's legally responsible
401     individual, in person or by mail, that:
402          (i) the school has placed the student on conditional enrollment for failure to
403          comply with the requirements of Subsection 53A-11-301(1);
404          (ii) describes the identified deficiencies in the student's immunization record or states
405     that the school has not received an immunization record for the student;
406          (iii) gives notice that the student will not be allowed to attend school unless the legally
407     responsible individual cures the deficiencies, or provides an immunization record that complies
408     with Subsection 53A-11-301(1), within the conditional enrollment period described in
409     Subsection (1)(b); and
410          (iv) describes the process for obtaining a required vaccination.
411          (b) A school shall remove the conditional enrollment status from a student after the
412     school receives an immunization record for the student that complies with Subsection
413     53A-11-301(1).
414          (c) Except as provided in Subsection (2)(d), at the end of the conditional enrollment
415     period, a school shall prohibit a student who does not comply with Subsection 53A-11-301(1)
416     from attending the school until the student complies with Subsection 53A-11-301(1).
417          (d) A school principal or administrator:
418          (i) shall grant an additional extension of the conditional enrollment period, if the
419     extension is necessary to complete all required vaccination dosages, for a time period medically
420     recommended to complete all required vaccination dosages; and

421          (ii) may grant an additional extension of the conditional enrollment period in cases of
422     extenuating circumstances, if the school principal or administrator and a school nurse, a health
423     official, or a health official designee agree that an additional extension will likely lead to
424     compliance with Subsection 53A-11-301(1) during the additional extension period.
425          Section 12. Section 53A-11-307 is enacted to read:
426          53A-11-307. School record of students' immunization status -- Confidentiality.
427          (1) Each school shall maintain a current list of all enrolled students, noting each
428     student:
429          (a) for whom the school has received a valid and complete immunization record;
430          (b) who is exempt from receiving a required vaccine; and
431          (c) who is allowed to attend school under Section 53A-11-306.
432          (2) Each school shall ensure that the list described in Subsection (1) specifically
433     identifies each disease against which a student is not immunized.
434          (3) Upon the request of an official from a local health department in the case of a
435     disease outbreak, a school principal or administrator shall:
436          (a) notify the legally responsible individual of any student who is not immune to the
437     outbreak disease, providing information regarding steps the legally responsible individual may
438     take to protect students;
439          (b) identify each student who is not immune to the outbreak disease; and
440          (c) for a period determined by the local health department not to exceed the duration of
441     the disease outbreak, do one of the following at the discretion of the school principal or
442     administrator after obtaining approval from the local health department:
443          (i) provide a separate educational environment for the students described in Subsection
444     (3)(b) that ensures the protection of the students described in Subsection (3)(b) as well as the
445     protection of the remainder of the student body; or
446          (ii) prevent each student described in Subsection (3)(b) from attending school.
447          (4) A name appearing on the list described in Subsection (1) is subject to
448     confidentiality requirements described in Section 26-1-17.5 and Section 53A-13-301.

449          Section 13. Repealer.
450          This bill repeals:
451          Section 53A-11-305, Immunization by local health departments -- Fees.
452          Section 14. Effective date.
453          This bill takes effect on July 1, 2018.