1     
PUBLIC HEALTH IN SCHOOLS

2     
2017 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Norman K Thurston

5     
Senate Sponsor: Margaret Dayton

6     

7     LONG TITLE
8     General Description:
9          This bill amends the vaccination requirements for school attendance.
10     Highlighted Provisions:
11          This bill:
12          ▸     defines terms;
13          ▸     amends the Utah Health Code regarding vaccinations and records of student
14     vaccinations;
15          ▸     subject to certain exceptions, continues the requirement that a student receive
16     certain vaccinations in order to attend school;
17          ▸     requires the renewal of a student's vaccination exemption before the student begins
18     grade 7;
19          ▸     continues the practice of preventing a local education agency from receiving
20     weighted pupil unit money for a student who does not comply with vaccination
21     requirements;
22          ▸     amends rulemaking authority of the Department of Health;
23          ▸     addresses policies and procedures relating to vaccinations, recordkeeping, and
24     disease outbreaks;
25          ▸     continues the practice of allowing local health departments to vaccinate students
26     and recover costs; and
27          ▸     makes technical changes.
28     Money Appropriated in this Bill:
29          None
30     Other Special Clauses:
31          This bill provides a special effective date.
32     Utah Code Sections Affected:
33     AMENDS:
34          26-1-17.5, as last amended by Laws of Utah 2008, Chapter 382
35          26-10-9, as enacted by Laws of Utah 2011, Chapter 147
36          26-39-402, as renumbered and amended by Laws of Utah 2008, Chapter 111
37     ENACTS:
38          53A-11-300.5, Utah Code Annotated 1953
39          53A-11-307, Utah Code Annotated 1953
40     REPEALS AND REENACTS:
41          53A-11-301, as last amended by Laws of Utah 1992, Chapter 53
42          53A-11-302, as last amended by Laws of Utah 2010, Chapter 395
43          53A-11-302.5, as enacted by Laws of Utah 1992, Chapter 129
44          53A-11-303, as enacted by Laws of Utah 1988, Chapter 2
45          53A-11-304, as enacted by Laws of Utah 1988, Chapter 2
46          53A-11-305, as last amended by Laws of Utah 1988, Chapter 202
47          53A-11-306, as enacted by Laws of Utah 1988, Chapter 2
48     

49     Be it enacted by the Legislature of the state of Utah:
50          Section 1. Section 26-1-17.5 is amended to read:
51          26-1-17.5. Confidential records.
52          (1) A record classified as confidential under this title shall remain confidential, and be
53     released according to the provisions of this title, notwithstanding Section 63G-2-310.
54          (2) In addition to those persons granted access to [records] a private record described in
55     Subsection 63G-2-302(1)(b), [immunization records may be shared among] schools, school
56     districts, and local and state health departments and the state Department of Human Services
57     may share an immunization record as defined in Section 53A-11-300.5 or any other record
58     relating to a vaccination or immunization as necessary to [assure] ensure compliance with
59     [Section 53A-11-301] Title 53A, Chapter 11, Part 3, Immunization of Students, and to prevent,
60     investigate, and control the causes of epidemic, infectious, communicable, and other diseases
61     affecting the public health.
62          Section 2. Section 26-10-9 is amended to read:
63          26-10-9. Vaccinations -- Consent of minor to treatment.
64          (1) This section:
65          (a) is not intended to interfere with the integrity of the family or to minimize the rights
66     of parents or children; and
67          (b) applies to a minor, who at the time care is sought is:
68          (i) married or has been married;
69          (ii) emancipated as provided for in Section 78A-6-805;
70          (iii) a parent with custody of a minor child; or
71          (iv) pregnant.
72          (2) (a) A minor described in Subsections (1)(b)(i) and (ii) may consent to:
73          (i) [immunizations] vaccinations against epidemic infections and communicable
74     diseases as defined in Section 26-6-2; and
75          (ii) examinations and [immunizations] vaccinations required to attend school as
76     provided in Title 53A, Chapter 11, Students in Public Schools.
77          (b) A minor described in Subsections (1)(b)(iii) and (iv) may consent to the
78     [immunizations] vaccinations described in Subsections (2)(a)(i) and (ii), and the vaccine for
79     human papillomavirus only if:
80          (i) the minor represents to the health care provider that the minor is an abandoned
81     minor as defined in Section 76-5-109; and
82          (ii) the health care provider makes a notation in the minor's chart that the minor
83     represented to the health care provider that the minor is an abandoned minor under Section
84     76-5-109.
85          (c) Nothing in Subsection (2)(a) or (b) requires a health care provider to immunize a
86     minor.
87          (3) The consent of the minor pursuant to this section:
88          (a) is not subject to later disaffirmance because of the minority of the person receiving
89     the medical services;
90          (b) is not voidable because of minority at the time the medical services were provided;
91          (c) has the same legal effect upon the minor and the same legal obligations with regard
92     to the giving of consent as consent given by a person of full age and capacity; and
93          (d) does not require the consent of any other person or persons to authorize the medical
94     services described in Subsections (2)(a) and (b).
95          (4) A health care provider who provides medical services to a minor in accordance
96     with the provisions of this section is not subject to civil or criminal liability for providing the
97     services described in Subsections (2)(a) and (b) without obtaining the consent of another
98     person prior to rendering the medical services.
99          (5) This section does not remove the requirement for parental consent or notice when
100     required by Section 76-7-304 or 76-7-304.5.
101          (6) The parents, parent, or legal guardian of a minor who receives medical services
102     pursuant to Subsections (2)(a) and (b) are not liable for the payment for those services unless
103     the parents, parent, or legal guardian consented to the medical services.
104          Section 3. Section 26-39-402 is amended to read:
105          26-39-402. Residential child care certificate.
106          (1) [(a)] A residential child care provider of five to eight qualifying children shall
107     obtain a Residential Child Care Certificate from the department, unless Section 26-39-403
108     applies.
109          [(b)] (2) The minimum qualifications for a Residential Child Care Certificate are:
110          [(i)] (a) the submission of:
111          [(A)] (i) an application in the form prescribed by the department;
112          [(B)] (ii) a certification and criminal background fee established in accordance with
113     Section 26-1-6; and
114          [(C)] (iii) in accordance with Section 26-39-404, identifying information for each adult
115     person and each juvenile age 12 through 17 years of age who resides in the provider's home:
116          [(I)] (A) for processing by the Department of Public Safety to determine whether any
117     such person has been convicted of a crime;
118          [(II)] (B) to screen for a substantiated finding of child abuse or neglect by a juvenile
119     court; and
120          [(III)] (C) to discover whether the person is listed in the Licensing Information System
121     described in Section 62A-4a-1006;
122          [(ii)] (b) an initial and annual inspection of the provider's home within 90 days of
123     sending an intent to inspect notice to:
124          [(A)] (i) check the immunization record, as defined in Section 53A-11-300.5, of each
125     qualifying child who receives child care in the provider's home;
126          [(B)] (ii) identify serious sanitation, fire, and health hazards to qualifying children; and
127          [(C)] (iii) make appropriate recommendations; and
128          [(iii)] (c) annual training consisting of 10 hours of department-approved training as
129     specified by the department by administrative rule, including a current department-approved
130     CPR and first aid course.
131          [(c)] (3) If a serious sanitation, fire, or health hazard has been found during an
132     inspection conducted pursuant to Subsection [(1)(b)(ii)] (2)(b), the department shall require
133     corrective action for the serious hazards found and make an unannounced follow up inspection
134     to determine compliance.
135          [(d)] (4) In addition to an inspection conducted pursuant to Subsection [(1)(b)(ii)]
136     (2)(b), the department may inspect the home of a residential care provider of five to eight
137     qualifying children in response to a complaint of:
138          [(i)] (a) child abuse or neglect;
139          [(ii)] (b) serious health hazards in or around the provider's home; or
140          [(iii)] (c) providing residential child care without the appropriate certificate or license.
141          [(2)] (5) Notwithstanding this section:
142          (a) a license under Section 26-39-401 is required of a residential child care provider
143     who cares for nine or more qualifying children;
144          (b) a certified residential child care provider may not provide care to more than two
145     qualifying children under the age of two; and
146          (c) an inspection may be required of a residential child care provider in connection
147     with a federal child care program.
148          [(3)] (6) With respect to residential child care, the department may only make and
149     enforce rules necessary to implement this section.
150          Section 4. Section 53A-11-300.5 is enacted to read:
151          53A-11-300.5. Definitions.
152          As used in this part:
153          (1) "Department" means the Department of Health, created in Section 26-1-4.
154          (2) "Health official" means an individual designated by a local health department from
155     within the local health department to consult and counsel parents and licensed health care
156     providers, in accordance with Subsection 53A-11-302.5(2)(a).
157          (3) "Health official designee" means a licensed health care provider designated by a
158     local health department, in accordance with Subsection 53A-11-302.5(2)(b), to consult with
159     parents, licensed health care professionals, and school officials.
160          (4) "Immunization" or "immunize" means a process through which an individual
161     develops an immunity to a disease, through vaccination or natural exposure to the disease.
162          (5) "Immunization record" means a record relating to a student that includes:
163          (a) information regarding each required vaccination that the student has received,
164     including the date each vaccine was administered, verified by:
165          (i) a licensed health care provider;
166          (ii) an authorized representative of a local health department;
167          (iii) an authorized representative of the department;
168          (iv) a registered nurse; or
169          (v) a pharmacist;
170          (b) information regarding each disease against which the student has been immunized
171     by previously contracting the disease; and
172          (c) an exemption form identifying each required vaccination from which the student is
173     exempt, including all required supporting documentation described in Section 53A-11-302.
174          (6) "Legally responsible individual" means:
175          (a) a student's parent;
176          (b) the student's legal guardian;
177          (c) an adult brother or sister of a student who has no legal guardian; or
178          (d) the student, if the student:
179          (i) is an adult; or
180          (ii) is a minor who may consent to treatment under Section 26-10-9.
181          (7) "Licensed health care provider" means a health care provider who is licensed under
182     Title 58, Occupations and Professions, as:
183          (a) a medical doctor;
184          (b) an osteopathic doctor;
185          (c) a physician assistant; or
186          (d) an advanced practice registered nurse.
187          (8) "Local education agency" or "LEA" means:
188          (a) a school district;
189          (b) a charter school; or
190          (c) the Utah Schools for the Deaf and the Blind.
191          (9) "Local health department" means the same as that term is defined in Section
192     26A-1-102.
193          (10) "Required vaccines" means vaccines required by department rule described in
194     Section 53A-11-303.
195          (11) "School" means any public or private:
196          (a) elementary or secondary school;
197          (b) preschool;
198          (c) child care center or program;
199          (d) nursery school; or
200          (e) business that receives compensation for supervising or educating a child.
201          (12) "Student" means an individual who attends a school.
202          (13) "Vaccinating" or "vaccination" means the administration of a vaccine.
203          (14) "Vaccination exemption form" means a form, described in Section 53A-11-302.5,
204     that documents and verifies that a student is exempt from the requirement to receive one or
205     more required vaccines.
206          (15) "Vaccine" means the substance licensed for use by the United States Food and
207     Drug Administration that is injected into or otherwise administered to an individual to
208     immunize the individual against a communicable disease.
209          Section 5. Section 53A-11-301 is repealed and reenacted to read:
210          53A-11-301. Immunization required -- Exception -- Weighted pupil unit funding.
211          (1) A student may not attend a school unless:
212          (a) the school receives an immunization record from the legally responsible individual
213     of the student, the student's former school, or a statewide registry that shows:
214          (i) that the student has received each vaccination required by the department under
215     Section 53A-11-303; or
216          (ii) for any required vaccination that the student has not received, that the student:
217          (A) has immunity against the disease for which the vaccination is required, because the
218     student previously contracted the disease as documented by a health care provider, as that term
219     is defined in Section 78B-3-103; or
220          (B) is exempt from receiving the vaccination under Section 53A-11-302;
221          (b) the student qualifies for conditional enrollment under Section 53A-11-306; or
222          (c) the student:
223          (i) is a student, as defined in Section 53A-1-1001; and
224          (ii) complies with the immunization requirements for military children under Section
225     53A-1-1001.
226          (2) An LEA may not receive weighted pupil unit money for a student who is not
227     permitted to attend school under Subsection (1).
228          Section 6. Section 53A-11-302 is repealed and reenacted to read:
229          53A-11-302. Grounds for exemption from required vaccines -- Renewal.
230          (1) A student is exempt from the requirement to receive a vaccine required under
231     Section 53A-11-303 if the student qualifies for a medical or personal exemption from the
232     vaccination under Subsection (2) or (3).
233          (2) A student qualifies for a medical exemption from a vaccination required under
234     Section 53A-11-303 if the student's legally responsible individual provides to the student's
235     school:
236          (a) a completed vaccination exemption form; and
237          (b) a written notice signed by a licensed health care provider stating that, due to the
238     physical condition of the student, administration of the vaccine would endanger the student's
239     life or health.
240          (3) A student qualifies for a personal exemption from a vaccination required under
241     Section 53A-11-303 if the student's legally responsible individual provides to the student's
242     school a completed vaccination exemption form, stating that the student is exempt from the
243     vaccination because of a personal or religious belief.
244          (4) (a) A vaccination exemption form submitted under this section is valid for as long
245     as the student remains at the school to which the form first is presented.
246          (b) If the student changes schools before the student is old enough to enroll in
247     kindergarten, the vaccination exemption form accepted as valid at the student's previous school
248     is valid until the earlier of the day on which:
249          (i) the student enrolls in kindergarten; or
250          (ii) the student turns six years old.
251          (c) If the student changes schools after the student is old enough to enroll in
252     kindergarten but before the student is eligible to enroll in grade 7, the vaccination exemption
253     form accepted as valid at the student's previous school is valid until the earlier of the day on
254     which:
255          (i) the student enrolls in grade 7; or
256          (ii) the student turns 12 years old.
257          (d) If the student changes schools after the student is old enough to enroll in grade 7,
258     the vaccination exemption form accepted as valid at the student's previous school is valid until
259     the student completes grade 12.
260          Section 7. Section 53A-11-302.5 is repealed and reenacted to read:
261          53A-11-302.5. Vaccination exemption form.
262          (1) The department shall:
263          (a) develop a vaccination exemption form that includes only the following information:
264          (i) identifying information regarding:
265          (A) the student to whom an exemption applies; and
266          (B) the legally responsible individual who claims the exemption for the student and
267     signs the vaccination exemption form;
268          (ii) an indication regarding the vaccines to which the exemption relates;
269          (iii) a statement that the claimed exemption is for:
270          (A) a medical reason; or
271          (B) a personal or religious belief; and
272          (iv) an explanation of the requirements, in the event of an outbreak of a disease for
273     which a required vaccine exists, for a student who:
274          (A) has not received the required vaccine; and
275          (B) is not otherwise immune from the disease;
276          (b) provide the vaccination exemption form created in this Subsection (1) to local
277     health departments; and
278          (c) make the vaccination exemption form created in this Subsection (1) available to the
279     public upon request.
280          (2) (a) Each local health department shall designate one or more individuals from
281     within the local health department as a health official to consult, regarding the requirements of
282     this part, with:
283          (i) parents, upon the request of parents;
284          (ii) school principals and administrators; and
285          (iii) licensed health care providers.
286          (b) A local health department may designate a licensed health care provider as a health
287     official designee to provide the services described in Subsection (2)(a).
288          Section 8. Section 53A-11-303 is repealed and reenacted to read:
289          53A-11-303. Regulations of department.
290          (1) In accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, the
291     department shall make rules regarding:
292          (a) which vaccines are required as a condition of attending school;
293          (b) the manner and frequency of the vaccinations; and
294          (c) the vaccination exemption form described in Section 53A-11-302.5.
295          (2) The department shall ensure that the rules described in Subsection (1):
296          (a) conform to recognized standard medical practices; and
297          (b) require schools to report to the department statistical information and names of
298     students who are not in compliance with Section 53A-11-301.
299          Section 9. Section 53A-11-304 is repealed and reenacted to read:
300          53A-11-304. Immunization record part of student's record -- School review
301     process at enrollment -- Transfer.
302          (1) Each school:
303          (a) shall request an immunization record for each student at the time the student enrolls
304     in the school;
305          (b) may not charge a fee related to receiving or reviewing an immunization record or a
306     vaccination exemption form; and
307          (c) shall retain an immunization record for each enrolled student as part of the student's
308     permanent school record.
309          (2) (a) Within five business days after the day on which a student enrolls in a school,
310     an individual designated by the school principal or administrator shall:
311          (i) determine whether the school has received an immunization record for the student;
312          (ii) review the student's immunization record to determine whether the record complies
313     with Subsection 53A-11-301(1); and
314          (iii) identify any deficiencies in the student's immunization record.
315          (b) If the school has not received a student's immunization record or there are
316     deficiencies in the immunization record, the school shall:
317          (i) place the student on conditional enrollment, in accordance with Section
318     53A-11-306; and
319          (ii) within five days after the day on which the school places the student on conditional
320     enrollment, provide the written notice described in Subsection 53A-11-306(2).
321          (3) A school from which a student transfers shall provide the student's immunization
322     record to the student's new school upon request of the student's legally responsible individual.
323          Section 10. Section 53A-11-305 is repealed and reenacted to read:
324          53A-11-305. Immunization by local health departments -- Fees.
325          (1) (a) If a student has not been immunized against a disease specified by the
326     department, the local health department may vaccinate the student upon the request of the
327     student's legally responsible individual.
328          (b) The local health department may charge a fee to cover the cost of the vaccine and
329     administration of the vaccine described in Subsection (1)(a).
330          (2) (a) The department shall provide to each local health department the vaccines
331     necessary for vaccinations required under Sections 53A-11-301 and 53A-11-303.
332          (b) The department may recover all or part of the cost of vaccines purchased with state
333     funds by charging local health departments a fee for those vaccines.
334          (c) A local health department may not refuse to vaccinate a student who resides in the
335     jurisdiction of the local health department because of the inability of the student or another
336     legally responsible individual party to pay for the vaccine or the administration of the vaccine.
337          (3) In accordance with Section 63J-1-504, the department shall establish fees for the
338     vaccines and for the administration of vaccines described in this section.
339          Section 11. Section 53A-11-306 is repealed and reenacted to read:
340          53A-11-306. Conditional enrollment -- Suspension for noncompliance --
341     Procedure.
342          (1) A student for whom a school has not received a complete immunization record may
343     attend the school on a conditional enrollment:
344          (a) during the period in which the student's immunization record is under review by the
345     school; or
346          (b) for 21 calendar days after the day on which the school provides the notice described
347     in Subsection (2).
348          (2) (a) Within five days after the day on which a school places a student on conditional
349     enrollment, the school shall provide written notice to the student's legally responsible
350     individual, in person or by mail, that:
351          (i) the school has placed the student on conditional enrollment for failure to
352     comply with the requirements of Subsection 53A-11-301(1);
353          (ii) describes the identified deficiencies in the student's immunization record or states
354     that the school has not received an immunization record for the student;
355          (iii) gives notice that the student will not be allowed to attend school unless the legally
356     responsible individual cures the deficiencies, or provides an immunization record that complies
357     with Subsection 53A-11-301(1), within the conditional enrollment period described in
358     Subsection (1)(b); and
359          (iv) describes the process for obtaining a required vaccination.
360          (b) A school shall remove the conditional enrollment status from a student after the
361     school receives an immunization record for the student that complies with Subsection
362     53A-11-301(1).
363          (c) Except as provided in Subsection (2)(d), at the end of the conditional enrollment
364     period, a school shall prohibit a student who does not comply with Subsection 53A-11-301(1)
365     from attending the school until the student complies with Subsection 53A-11-301(1).
366          (d) A school principal or administrator:
367          (i) shall grant an additional extension of the conditional enrollment period, if the
368     extension is necessary to complete all required vaccination dosages, for a time period medically
369     recommended to complete all required vaccination dosages; and
370          (ii) may grant an additional extension of the conditional enrollment period in cases of
371     extenuating circumstances, if the school principal or administrator and a school nurse, a health
372     official, or a health official designee agree that an additional extension will likely lead to
373     compliance with Subsection 53A-11-301(1) during the additional extension period.
374          Section 12. Section 53A-11-307 is enacted to read:
375          53A-11-307. School record of students' immunization status -- Confidentiality.
376          (1) Each school shall maintain a current list of all enrolled students, noting each
377     student:
378          (a) for whom the school has received a valid and complete immunization record;
379          (b) who is exempt from receiving a required vaccine; and
380          (c) who is allowed to attend school under Section 53A-11-306.
381          (2) Each school shall ensure that the list described in Subsection (1) specifically
382     identifies each disease against which a student is not immunized.
383          (3) Upon the request of an official from a local health department in the case of a
384     disease outbreak, a school principal or administrator shall:
385          (a) notify the legally responsible individual of any student who is not immune to the
386     outbreak disease, providing information regarding steps the legally responsible individual may
387     take to protect students;
388          (b) identify each student who is not immune to the outbreak disease; and
389          (c) for a period determined by the local health department not to exceed the duration of
390     the disease outbreak, do one of the following at the discretion of the school principal or
391     administrator:
392          (i) provide a separate educational environment for the students described in Subsection
393     (3)(b) that ensures protection of the remainder of the student body; or
394          (ii) prevent each student described in Subsection (3)(b) from attending school.
395          (4) A name appearing on the list described in Subsection (1) is subject to
396     confidentiality requirements described in Section 26-1-17.5 and Section 53A-13-301.
397          Section 13. Effective date.
398          This bill takes effect on July 1, 2018.




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