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SB-276 Immunizations: medical exemptions.(2019-2020)

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Date Published: 05/17/2019 04:58 PM
SB276:v95#DOCUMENT

Amended  IN  Senate  May 17, 2019
Amended  IN  Senate  April 30, 2019
Amended  IN  Senate  April 09, 2019
Amended  IN  Senate  March 25, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill No. 276


Introduced by Senator Pan
(Principal coauthor: Assembly Member Gonzalez)
(Coauthor: Senator Wiener)
(Coauthor: Assembly Member Aguiar-Curry)

February 13, 2019


An act to amend Sections 120370 and 120375 of, and to add Section 120372 to, the Health and Safety Code, relating to public health.


LEGISLATIVE COUNSEL'S DIGEST


SB 276, as amended, Pan. Immunizations: medical exemptions.
Existing law prohibits the governing authority of a school or other institution from admitting for attendance any pupil who fails to obtain required immunizations within the time limits prescribed by the State Department of Public Health. Existing law exempts from those requirements a pupil whose parents have filed with the governing authority a written statement by a licensed physician to the effect that immunization is not considered safe for that child, indicating the specific nature and probable duration of their medical condition or circumstances, including, but not limited to, family medical history.
This bill would instead require the State Department of Public Health, by July 1, 2020, to develop and make available for use by licensed physicians and surgeons a statewide standardized medical exemption request form, which, commencing January 1, 2021, would be the only medical exemption documentation that a governing authority may accept. The bill would require the State Public Health Officer or the public health officer’s designee to approve or deny a medical exemption request, upon determining that the request provides sufficient medical evidence that the immunization is contraindicated or that a specific precaution regarding a particular immunization exists, based on guidelines of the federal Centers for Disease Control and Prevention (CDC). The bill would specify the information to be included in the medical exemption form. The bill would, commencing January 1, 2021, require a physician and surgeon to inform a parent or guardian of the bill’s requirements and to examine the child and submit a completed medical exemption request form to the department, as specified. The bill would require the State Public Health Officer or designee to review the completed exemption request form and notify the physician and surgeon of the approval or denial of the request. The bill would require the reason for denial of a request to be included in the notification, and would authorize the physician and surgeon to submit additional information to the department for further review for purposes of filing an appeal if an exemption request is denied.
This bill would require the department, by December 31, 2020, to create and maintain a database of approved medical exemption requests, and to make the database accessible to local health officers. The bill would require a copy of a medical exemption granted prior to the availability of the standardized form to be submitted to the department for inclusion in the database by December 31, 2021, 2020, in order for the medical exemption to remain valid after the statewide standardized form has been adopted. The bill would authorize the State Public Health Officer or a local public health officer to revoke a medical exemption if the State Public Health Officer or local public health officer determines that the medical exemption is fraudulent or inconsistent with applicable CDC guidelines. The bill would require the department, in consultation with local educational agencies and local public health officers, to develop a process for a parent or guardian to request a medical exemption and the department to approve or deny the request and communicate its decision to the school district and the parent or guardian, as specified. The bill would also make conforming changes to existing law.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 120370 of the Health and Safety Code is amended to read:

120370.
 (a) (1) If the parent or guardian files with the governing authority a written statement by a licensed physician and surgeon to the effect that the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances, including, but not limited to, family medical history, for which the physician and surgeon does not recommend immunization, that child shall be exempt from the requirements of this chapter, except for Section 120380, and exempt from Sections 120400, 120405, 120410, and 120415 to the extent indicated by the physician and surgeon’s statement.
(2)  Commencing January 1, 2021, an exemption issued before January 1, 2021, pursuant to this subdivision is valid only if the parent or guardian has complied with paragraph (2) of subdivision (c) of Section 120372.
(b) If there is good cause to believe that a child has been exposed to a disease listed in subdivision (b) of Section 120335 and the child’s documentary proof of immunization status does not show proof of immunization against that disease, that child may be temporarily excluded from the school or institution until the local health officer is satisfied that the child is no longer at risk of developing or transmitting the disease.

SEC. 2.

 Section 120372 is added to the Health and Safety Code, to read:

120372.
 (a) (1) By July 1, 2020, the department shall develop and make available for use by licensed physicians and surgeons a statewide standardized medical exemption request form. Notwithstanding Section 120370, commencing January 1, 2021, it shall be the only medical exemption documentation that a governing authority may accept, except as provided in paragraph (2) of subdivision (c). A medical exemption request form shall be approved or denied only by the State Public Health Officer or the public health officer’s designee, upon a determination that the request provides sufficient medical evidence that the immunization is contraindicated or there exists a specific precaution regarding a particular immunization, based on guidelines of the federal Centers for Disease Control and Prevention (CDC).
(2) At a minimum, the form shall require all of the following information:
(A) The name, medical license number, and business address and telephone number, of the licensed physician and surgeon.
(B) The name of the child for whom the exemption is sought and the name of the child’s parent or guardian.
(C) A statement certifying that the licensed physician and surgeon has personally examined the child.
(D) A description of the medical reason for which the exemption is sought.
(E) An authorization for the release of records related to the medical exemption by the physician and surgeon to the department and the California Medical Board.
(b) (1) Commencing January 1, 2021, if a parent or guardian requests a licensed physician and surgeon to request a medical exemption for the parent’s or guardian’s child, the physician and surgeon shall inform the parent or guardian of the requirements of this section. If the parent or guardian consents, the physician and surgeon shall examine the child and submit a completed medical exemption request form to the department. A medical exemption request form may be submitted to the department at any time.
(2) The State Public Health Officer or designee shall review the completed request form and provide the physician and surgeon with notification approving or denying the medical exemption request. If the medical exemption request is denied, the reason for the denial shall be included in the notification.
(3) The denial of a request for a medical exemption may be appealed to the State Public Health Officer.
(4) For purposes of filing an appeal, the physician and surgeon may submit additional information to the department within 30 days from the notification for further review by the State Public Health Officer or designee.
(c) (1) By December 31, 2020, the department shall create and maintain a database of medical exemption requests approved pursuant to this section. The department shall make the information in the database accessible to local public health officers.
(2) If a medical exemption has been authorized pursuant to Section 120370 prior to the adoption of the statewide standardized form, the parent or guardian shall submit, by December 31, 2020, a copy of that medical exemption to the department for inclusion in the database in order for the medical exemption to remain valid.
(d) If the State Public Health Officer or a local public health officer determines that a medical exemption submitted to the department is fraudulent or inconsistent with applicable CDC guidelines, as specified in paragraph (1) of subdivision (a), the State Public Health Officer or local public health officer may revoke the medical exemption.
(e) The department, in consultation with local educational agencies and local public health officers, shall develop a process for a parent or guardian to request a medical exemption and the department to expeditiously approve or deny the request and communicate its decision in a timely manner to the school district and the parent or guardian.
(f) In administering this section, the department shall comply with all applicable state and federal privacy laws, including, but not limited to, the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191), and Sections 827, 5328, and 10850 of the Welfare and Institutions Code.
(g) This section does not require the department to review or approve any medical exemption that is granted by a physician and surgeon before January 1, 2021.

SEC. 3.

 Section 120375 of the Health and Safety Code is amended to read:

120375.
 (a) The governing authority of each school or institution included in Section 120335 shall require documentary proof of each entrant’s immunization status. The governing authority shall record the immunizations of each new entrant in the entrant’s permanent enrollment and scholarship record on a form provided by the department. The immunization record of each new entrant admitted conditionally shall be reviewed periodically by the governing authority to ensure that within the time periods designated by regulation of the department the entrant has been fully immunized against all of the diseases listed in Section 120335, and immunizations received after entry shall be added to the pupil’s immunization record.
(b) The governing authority of each school or institution included in Section 120335 shall prohibit from further attendance any pupil admitted conditionally who failed to obtain the required immunizations within the time limits allowed in the regulations of the department until that pupil has been fully immunized against all of the diseases listed in Section 120335, unless the pupil is exempted under Section 120370 or 120372.
(c) The governing authority shall file a written report on the immunization status of new entrants to the school or institution under their jurisdiction with the department and the local health department at times and on forms prescribed by the department. As provided in paragraph (4) of subdivision (a) of Section 49076 of the Education Code, the local health department shall have access to the complete health information as it relates to immunization of each student in the schools or other institutions listed in Section 120335 in order to determine immunization deficiencies.
(d) The governing authority shall cooperate with the county health officer in carrying out programs for the immunization of persons applying for admission to any school or institution under its jurisdiction. The governing board of any school district may use funds, property, and personnel of the district for that purpose. The governing authority of any school or other institution may permit any licensed physician or any qualified registered nurse to administer immunizing agents to any person seeking admission to any school or institution under its jurisdiction.