HOUSE DOCKET, NO. 4470        FILED ON: 9/4/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 4096

The Commonwealth of Massachusetts

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PRESENTED BY:

Paul J. Donato and Rebecca L. Rausch

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act promoting community immunity.

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PETITION OF:

HOUSE DOCKET, NO. 4470        FILED ON: 9/4/2019

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 4096

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-First General Court
(2019-2020)

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An Act promoting community immunity.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Chapter 76 of the General Laws is hereby amended by striking out section 15, as appearing in the 2018 Official Edition, and inserting in place thereof the following section:-

Section 15. All schools shall comply with the requirements set forth in section 238 of chapter 111.

SECTION 2. Said chapter 76 is hereby further amended by striking out section 15C, as so appearing, and inserting in place thereof the following section:-

Section 15C. All institutions of higher learning shall comply with the requirements established in sections 238 of chapter 111.

SECTION 3. Section 15D of said chapter 76 is hereby repealed.

SECTION 4. Section 24N of chapter 111 of the General Laws, as appearing in the 2018 Official Edition, is hereby amended by inserting after the word “24M”, in line 32, the following words:- , and to administer the Community Immunity Act, established in section 238.

SECTION 5. Said chapter 111 is hereby further amended by adding the following section:-

Section 238. (a) This section shall be known and may be cited as the Community Immunity Act.

(b) As used in this section, the following words shall have the following meanings unless the context clearly requires otherwise:-

“Covered program”, (i) a child care center, as defined in section 1A of chapter 15D; (ii) a school, whether public, private or charter, that provides education to students in any combination of grade levels from kindergarten to grade 12, inclusive, and including, but not limited to, any school activity open to children who are home schooled; (iii) a recreational camp; or (iv) an institution of higher education, whether public or private.

“Department”, the department of public health.

“Exemption”, written authorization from the department for a participant to be excused from the schedule.

“Herd immunity”, population-wide resistance to the spread of an infectious disease within that population, resulting from a sufficient percentage of people receiving one or more immunizations against the disease.

“Immunization”, an inoculation administered for the purpose of making a person resistant to an infectious disease.

“Participant”, a person who engages in 1 or more activities of a covered program through enrollment or other registration process.

“Provider”, a health care provider licensed by an agency, board or division of the commonwealth who, acting within their scope of practice, may lawfully administer an immunization.

“Responsible adult”, a parent or legal guardian of a participant, a participant who is an emancipated minor or a participant who has achieved the age of majority.

“Schedule”, the immunization administration schedule established by the department and consistent with generally accepted medical practice.

(c) No covered program shall enroll a participant whose records do not include: (i) documentation of immunizations in accordance with the schedule; (ii) an exemption approval letter issued by the department, consistent with subsections (d) to (l), inclusive; (iii) evidence that the participant is in the process of obtaining immunizations with the objective of compliance with the schedule; (iv) for public schools only, evidence that the participant moved into the commonwealth not more than 90 days before the date of enrollment and the responsible adult is making a good faith effort to obtain the necessary immunization documentation or exemption approval; or (v) evidence that more than 60 days have elapsed since a responsible adult applied to the department for an exemption and the department has not responded.

(d) The two types of immunization exemptions shall be: (i) medical, for a participant whose medical conditions or circumstances preclude the administration of immunizations, as determined in the best medical judgment of a provider; provided, however, that medical judgment may include, but shall not be limited to, immunization contraindications or guidelines established by the Centers for Disease Control and Prevention; and (ii) religious, for a participant who holds, or whose family holds, sincere religious beliefs prohibiting immunizations. There shall be no other type of exemption.

(e) The department shall prepare separate standardized exemption application forms for medical and religious exemptions. The department shall make the forms available to the public online and, as necessary, in hard copy; provided, however, that no covered program shall provide a form, whether in hard copy or electronically, to a responsible adult or a participant absent a specific request for a form from the responsible adult.

(f) The department shall include in the medical exemption application form the following required elements: (i) a statement of the medical condition or conditions substantiating the exemption, including a checklist of generally accepted contraindications to immunizations; provided, however, that the checklist shall contain an “other” category wherein a provider may describe 1 or more conditions within the totality of the participant’s medical circumstances; and provided further, that the medical conditions section shall be completed by a provider; (ii) a statement that the provider has an established primary care provider-patient relationship with the participant; (iii) the signature of the provider; (iv) a unique government-issued professional identification number assigned to the provider; (v) the signature of the responsible adult; and (vi) dates for all signatures.

(g) The department shall include in the religious exemption application form the following required elements: (i) statements that: (a) the participant or responsible adult has a sincere religious belief prohibiting immunizations; (b) refusing to immunize the participant may result in serious illness or death of the participant; and (c) refusing to immunize the participant is against public health policy and may result in serious illness or death of others; (ii) a certification that the responsible adult has provided a complete and accurate copy of the religious exemption application to the participant’s primary health care provider, including the name and contact information for the primary health care provider; and (iii) the dated signature of a provider on the participant’s primary health care team, indicating receipt of a copy of the exemption application form only. DPH may provide requirements as alternatives to elements (ii) and (iii) of this subsection in the event a participant does not have a primary health care provider.

(h) The department may add additional elements to the exemption application forms described in subsections (f) and (g).

(i) A responsible adult must submit a completed exemption application to the department for review. The department shall determine the method of submission, be it electronic, hard copy, or both.

(j) The department shall have the exclusive authority to approve or deny exemption applications. The department shall deny all applications submitted in a form other than the forms described in subsections (f) and (g). For religious exemption applications, the department shall approve all validly and accurately completed religious exemption application forms. For medical exemption applications, the department shall approve all validly and accurately completed medical exemption applications; provided, however, that a generally accepted contraindication is the medical condition justifying the exemption. If another medical condition or set of conditions is provided as justification for the exemption, the department may approve or deny the exemption application based on a review by an expert licensed provider of the stated justification, or request more information about the participant’s medical history in order to make its determination.

(k) The department shall issue a letter to each applicant setting forth the department’s determination to approve or deny the exemption application. Whenever practicable, the department shall issue a determination letter not more than 60 days after receipt of the application. For approved applications, the determination letter shall include the final signature date of the application or the expiration date of the approval pursuant to subsection (l) or both dates. For denied applications, the determination letter shall include the reason or reasons for the denial. The department shall establish a process for appeal or reconsideration for applicants who are denied.

(l) An exemption approved by the department shall be valid for a period of not more than 1 year from the final signature date of the application. The department may, in its sole discretion, require covered programs to exclude exempted participants during a declared public health emergency.

(m) A private covered program may implement immunization requirements more stringent than those set forth in this section; provided, however, that the program creates and maintains a written immunization policy, which shall be made available to all responsible adults.

(n) A minor may request and consent to preventive care when, in a provider’s best medical judgment, the minor is mature and capable of providing informed consent or if performance of the preventive care would be in the minor’s best interest. A provider shall not be subject to regulatory disciplinary action or liable for civil damages or subject to a criminal penalty for a decision under this subsection. All information and records kept in connection with the medical care of a minor who consents to treatment pursuant to this section shall be confidential and shall not be released except upon the written consent of the minor or proper judicial order.

(o) All covered programs shall annually report total numbers of immunizations and exemptions data, delineated by exemption type, as applicable, to the department and publish the data to all responsible adults. The department shall designate the methodology for reporting. Publication may be electronic or in hard copy. Publication shall not be required if it would result in disclosure of personally identifying information, as defined in chapter 93H, or otherwise violate applicable privacy laws.

(p) The department shall annually publish immunizations and exemptions data, delineated by exemption type, as applicable, for each covered program and school district. The department may also publish data by municipality, county, or other geographic designation, or otherwise in its discretion. Publication shall be electronic and may also be in hard copy. Publication shall not be required whenever doing so would result in disclosure of personally identifying information, as defined in chapter 93H, or otherwise violate applicable privacy laws.

(q) Any covered program that has not achieved herd immunity shall be designated as an elevated risk program. Any covered program that fails to report immunization and exemption rates consistent with this section shall be designated an elevated risk program. Elevated risk program designations shall remain in place for not less than 12 months or for whatever longer period may be necessary to improve immunization rates as determined by the department.

(r) The department shall maintain a public, online list of elevated risk programs.

(s) The department shall create a notice to responsible adults about an elevated risk designation. An elevated risk program shall issue the notice to all responsible adults for participants or those seeking enrollment in the program during the period in which the designation is in place not more than 10 days after receiving an elevated risk program designation. All elevated risk programs shall organize and invite all responsible adults to a presentation by the department about immunization safety, immunization efficacy and herd immunity. The presentation shall be conducted not more than 45 days after the designation is received.

(t) The department shall develop and make available online an informational pamphlet about immunization safety, immunization efficacy and herd immunity. The department shall distribute the informational pamphlet, either electronically or in hard copy, to every responsible adult who submits an exemption application pursuant to this section. All elevated risk programs shall distribute the informational pamphlet, either electronically or in hard copy, to all responsible adults for participants or those seeking enrollment in the program during the period in which the designation is in place.

(u) The department shall promulgate regulations to administer, implement, and enforce the act, including but not limited to establishing herd immunity rates consistent with established medical practice and public health research.

SECTION 6. Section 12F of chapter 112 of the general laws, as appearing in the 2018 Official Edition, is hereby amended by striking out, in lines 14 and 15, the words “have come in contact with” and inserting in place thereof the following words:- be at risk of contracting.

SECTION 7. Said section 12F of said chapter 112, as so appearing, is hereby further amended by inserting after the word “diagnosis”, in line 18, the following word:- , prevention.

SECTION 8. This act shall take effect on July 1, 2020.