State Immunization Laws for Healthcare
Workers and Patients
Immunization Administration Requirements For
Any Immunization
** Click on each result to read the abridged text of the state immunization law.
**Please note the requirements below may apply to specific vaccines (e.g. influenza) or to general requirements for up-to-date vaccination. Please read footnotes for detailed requirements.
| [25] For Alabama requirements, see Ala. Admin. Code r. 580-5-32-.17(4), relating to all facilities of the Alabama Department of Mental Health and Mental Retardation, Mental Retardation Division. Ala. Admin. Code r. 580-5-32-.17(4) requires facilities of the Alabama Department of Mental Health and Mental Retardation, Mental Retardation Division to assist people in obtaining immunizations “consistent with their age and risk factors.” See also Ala. Admin. Code r. 580-5-30K-.10(2)(f), which requires facilities to obtain “needed immunizations”. Note however that Ala. Admin. Code r. 580-5-30K was repealed on November 5, 2001. | |
| [28] For Alaska requirements, see Alaska Admin. Code tit. 7 § 50.455 , relating to “full-time care facilities.” Alaska Admin. Code tit. 7 § 50.455 requires facilities to ensure that the following age-appropriate immunizations are administered to residents: diphtheria, tetanus, polio, measles, and rubella; if the child is less than 7 years old, pertussis; and starting July 1, 2001, mumps, hepatitis A, chickenpox and Haemophilus influenzae type b. “Full-time care facilities” are defined in Alaska Admin. Code tit. 7 § 50.990 as a type of “residential child care facility.” While the definition of “residential child care facilities” set forth in Alaska Stat. § 47.35.900 does not specifically mention juvenile detention centers, this chart assumes juvenile detention centers are a type of “residential child care facility” for the foregoing reasons. First, a plain reading of the broad definition of “residential child care facility” as a place, staffed by employees, where 1 or more children who are apart from their parents receive 24 hour care on an ongoing basis would suggest that juvenile detention centers are a type of “residential child care facility.” Second, the section relating to “full-time care facilities” is located in the part relating to ‘Family and Youth Services and Juvenile Justice.’ | |
| [29] For Alaska requirements, see Alaska Admin. Code tit. 7 § 50.455, relating to “full-time care facilities.” Alaska Admin. Code tit. 7 § 50.455 requires that facilities ensure the administration of the following age appropriate immunizations to their residents: diphtheria, tetanus, polio, measles, and rubella; if the child is less than 7 years old, pertussis; and starting July 1, 2001, mumps, hepatitis A, chickenpox and Haemophilus influenzae type b. “Full-time care facilities” are defined in Alaska Admin. Code § 50.990 as a type of “residential child care facility.” While the definition of “residential child care facilities” set forth in Alaska Stat. § 47.35.900 does not specifically mention residential facilities for the developmentally disabled and mentally retarded, the service provided by “full-time care facilities” includes the provision of developmental opportunities, indicating that the definition of “full-time care facilities” covers those facilities serving individuals with developmental disabilities. Note, however, that while “residential child care facilities” may provide incidental services to the mentally disabled or mentally retarded, if a facility is designed to provide for such clients on a regular basis, it must be licensed as a medical facility under Alaska Stat. § 18.20, and does not need a license issued pursuant to Alaska Stat. § 47.35.015(c)(2). | |
| [31] For Arizona requirements, see Ariz. Admin. Code R20-5-602 and Ariz. Admin. Code R9-6-331, relating to all occupational exposures. Ariz. Admin. Code R20-5-602 and Ariz. Admin. Code R9-6-331 incorporate the requirements of 29 CFR § 1910.1030. 29 CFR § 1910.1030 provides that employers must make available the hepatitis B vaccine and vaccine series to all employees who have occupational exposure. If the employee initially declines vaccination but changes their mind while still covered under the standard, the employer shall make the hepatitis B vaccine available. If a routine booster dose(s) is recommended by the U.S. Public Health Service, the dose(s) shall be made available to the employee free of charge. | |
| [32] For Arizona requirements, see Ariz. Admin. Code R6-5-7452, relating to “residential group care facilities.” Ariz. Admin. Code R6-5-7452 requires residential group care facilities to arrange for a child to receive any routine immunizations and booster shots within 30 days of admission. “Residential group care facilities” are defined in Ariz. Admin. Code R6-5-7401 as a living environment operated by a child welfare agency, where children are in the care of adults unrelated to the children on a 24 hour a day basis. “Child welfare agencies” are further defined to include any agency or institution maintained by a person, firm, corporation, association, or organization which receives children for care who have been adjudicated as a delinquent or dependent child. Therefore, this chart assumes that juvenile detention centers are a type of “residential group care facilities”. | Top of Page |
| [33] For Arizona requirements, see Ariz. Admin. Code R6-5-7452, relating to “residential group care facilities.” Admin. Code R6-5-7452 requires residential group care facilities to arrange for a child to receive any routine immunizations and booster shots within 30 days of admission. “Residential group care facilities” are defined in Ariz. Admin. Code R6-5-7401 as a living environment operated by a child welfare agency, where children are in the care of adults unrelated to the children on a 24 hour a day basis. “Child welfare agencies” are defined to include any agency or institution maintained by a person, firm, corporation, association, or organization to receive children for care and maintenance or for 24-hour social, emotional, or educational supervised care or to receive children for care who have been adjudicated as a delinquent or dependent child. This chart assumes that that the definition of “residential group care facilities” includes residential facilities for the developmentally disabled and mentally retarded for the foregoing reasons. First, a plain reading of the definition of “child welfare agencies” would suggest that residential facilities for the developmentally disabled or mentally retarded are one type of “child welfare agency.” Second, the article in which these requirements are found includes provisions relating to the placement of developmentally disabled children. | |
| [35]For Arkansas requirements, see 007 05 CARR 002.18, referring to “public health centers,” 007 05 CARR 010.12, referring to “freestanding birthing centers”, and 007 05 CARR 004.10, relating to “abortion facilities.” 007 05 CARR 002.18, 007 05 CARR 010.12 and 007 05 CARR 004.10 provide that there shall be a plan for ensuring that all health care workers who are frequently exposed to blood and other potentially infectious bodily fluids are offered hepatitis B immunization. While 007 05 CARR 002.18 is applicable to “hospitals and related facilities,” Ark. Code Ann. § 20-9-201 defines “hospital” as including public health centers. “Abortion facilities” are defined in 007 005 CARR 004 as any facility maintained for the primary purpose of providing care in the purposeful termination of human pregnancies with an intention other than to provide a live birth, and thus fall within the scope of this chart’s definition of “ambulatory care facility.” | |
| [36] For Arkansas requirements, see 016 15 CARR 005.160, relating to “child welfare agencies.” 016 15 CARR 005.160 requires that age-appropriate immunizations of children shall be current or scheduled within 1 week. This chart interprets “child welfare agencies” as including juvenile detention centers, based on the location of regulations relating to “child welfare agencies” within the greater regulatory scheme, as read in conjunction with the regulatory definition of “child welfare agencies.” First, regulations relating to child welfare agencies are located within the chapter of the Arkansas Administrative Code governing ‘placement’ and ‘detention.’ Second, child welfare agencies are broadly defined in 016 15 CARR 005 as any facility receiving a total number of 6 or more unrelated minors for care on a 24-hour basis for the purpose of ensuring the minors receive care, training, education, custody, or supervision, whether or not there are 6 or more children cared for at any single physical location. | |
| [37] For Arkansas requirements, see Ark. Code Ann. § 20-78-206, 005 15 CARR 010, 007 15 CARR 001, 007 26 CARR 001, and 016 22 CARR 003, relating to “child care facilities.” Ark. Code Ann. § 20-78-206 provides that no child care facility shall continue to accept children who have not been age-appropriately immunized against poliomyelitis, diphtheria, tetanus, pertussis, rubeola, rubella, and any other diseases designated by the Board of Health within 15 program days of the child’s original admission. Certain certification requirements apply. 005 15 CARR 010 provides that no child shall be admitted to a child care facility who has not been adequately immunized or is not in the process of becoming adequately immunized. 007 15 CARR 001 provides that, except as otherwise provided in the Arkansas rules, no child or infant shall be admitted to enter a child care facility in this state who has not been age-appropriately immunized against poliomyelitis, diphtheria, tetanus, pertussis, rubeola, rubella, Haemophilus influenzae type b, hepatitis B, and varicella, as evidenced by certain specified forms of documentation. If the child does not meet the immunization requirements for entrance, then the childcare facility must refer the child to a medical authority for immunization or consultation. 007 26 CARR 001 provides that no child will be admitted to a child care facility who has not been immunized or is not in the process of becoming immunized. 016 22 CARR 003 requires child care facilities to verify that a child has been immunized as required by the Arkansas Department of Health, or the child cannot remain in care. “Child care facilities” are defined in Ark. Code Ann. § 20-78-202 as any facility which provides care, training, education, or supervision to any unrelated minor child. Therefore, this chart assumes that residential facilities housing developmentally disabled minors are a type of “child care facility”. | Top of Page |
| [42] For California requirements, see Cal. Health & Safety Code § 1760.8(b)(3), relating to “pediatric day health care facilities.” Cal. Health & Safety Code § 1760.8(b)(3) requires that children accepted for care must have current immunization records. | |
| [44] For California requirements, see Cal. Code Regs. tit. 15, § 1432(a)(1), relating to “juvenile detention centers.” Cal. Code Regs. tit. 15, § 1432(a)(1) requires the health administrator/responsible physician to develop policies and procedures for a health appraisal/medical examination of minors, and shall include a health evaluation. Immunizations shall be verified and a program shall be started to bring minors up to date within 2 weeks of the evaluation in accordance with current public health guidelines. | |
| [45] For California requirements, see Cal. Code Regs., tit. 22, § 51343.2(1), relating to “intermediate care facilities for the developmentally disabled (nursing),” Cal. Code Regs. tit. 22, § 51343.1(j), relating to “intermediate care facilities for the developmentally disabled (habilitative),” and Cal. Code Regs. tit. 22, § 76341(b) and Cal. Code Regs. tit. 22, § 76874(a), relating to “intermediate care facilities for the developmentally disabled.” Cal. Code Regs. tit. 22, § 51343.2(1) provides that beneficiaries in intermediate care facilities for the developmentally disabled shall receive immunizations, using as a guide the recommendations of the U.S. Public Health Service Advisory Committee on Immunization Practices and the Committee on the Control of Infectious Diseases of the American Academy of Pediatrics. Cal. Code Regs. tit. 22, § 51343.1(j) provides that physician services to residents of intermediate care facilities for the developmentally disabled (habilitative) shall include immunizations in accordance with Cal. Code Regs. tit. 42, 442.477. (Note that 442.477 does not exist.) While the language of this regulation is too vague to accurately characterize as an “ensure” requirement,” such a requirement could be inferred. Cal. Code Regs. tit. 22, § 76341(b) provides that physician services to clients must include immunizations, using a guide the recommendations of the U.S. Public Health Service Advisory Committee on Immunization Practices and the Committee on the Control of Infectious Disease and the American Academy of Pediatrics. While the language of this regulation is too vague to accurately characterize as an “ensure” requirement,” such a requirement could be inferred. Cal. Code Regs. tit. 22, § 76874(a) provides that physician services to clients in intermediate care facilities for the developmentally disabled include immunizations, using as a guide the recommendations of the U.S. Public Health Service Advisory Committee on Immunization Practices and the Committee on the Control of Infectious Disease and the American Academy of Pediatrics. Also, California statutes and regulations do not provide explicitly that any residential facilities for the developmentally disabled and mentally retarded must “offer” immunizations to any resident; however, an “offer” requirement could be inferred from Cal. Code Regs. tit. 22, § 51343.1(j), relating to “intermediate care facilities for the developmentally disabled (habilitative),” and Cal. Code Regs. tit. 22, § 76341(b), relating to “intermediate care facilities for the developmentally disabled.” | |
| [46] For Colorado requirements, see Colo. Rev. Stat. § 26-6-106, relating to “child care centers.” Colo. Rev. Stat. § 26-6-106 provides that the department shall prescribe and publish standards for licensing. Standards prescribed by such rules shall include provisions that ensure that verification in accordance with part 9 of article 4 of title 25, C.R.S., is undertaken by family child care homes, foster care homes, and child care centers ensuring that each child has received appropriate immunizations against contagious diseases as follows: (1) children up to twenty-four months of age shall be required to be immunized in accordance with the “Infant Immunization Act”, part 17 of article 4 of title 25, C.R.S.; and (2) children over twenty-four months of age shall be required to be immunized in accordance with part 9 of article 4 of title 25, C.R.S. Part 9 of article 4 of title 25, pertaining to school-entry requirements, provides that no child shall attend any school unless he/she has presented to the appropriate school official: (1) an up-to-date certificate of immunization from a licensed physician or authorized representative of the department of public health and environment or local health department stating that such 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 the United States Department of Health and Human Services or the American Academy of Pediatrics; or (2) a written authorization signed by one parent or guardian or an authorization signed by the emancipated child requesting that local health officials administer the immunizations. Conditional admission is permissible under certain specified circumstances. Part 17 of article 4 of title 25, pertaining to the infant immunization program, provides that every person vested with legal custody or decision-making responsibility for the medical care of a minor, or person otherwise responsible for the care of an infant residing in this state shall be responsible for having such infant vaccinated in compliance with the schedule of vaccinations established by the Board of Health. A “child care center” is defined in as Colo. Rev. Stat. § 26-6-102 as facility, by whatever name known, that is maintained for the whole or part of a day for the care of five or more children who are eighteen years of age or younger and who are not related to the owner, operator, or manager thereof, whether such facility is operated with or without compensation for such care and with or without stated educational purposes. The term includes, but is not limited to, facilities commonly known as day care centers, school-age child care centers, before and after school programs, nursery schools, kindergartens, preschools, day camps, summer camps, and centers for developmentally disabled children. | Top of Page |
| [55] For Connecticut requirements, see Regs., Conn. State Agencies § 31-372-101-1910, relating to all occupational exposure to bloodborne pathogens or other potentially infectious materials. Regs., Conn. State Agencies § 31-372-101-1910 adopts by reference Subpart Z of 29 CFR § 1910. Subpart Z requires all employers to make available the hepatitis B vaccine and vaccine series to all employees who have occupational exposure. If the employee initially declines vaccination but changes their mind while still covered under the standard, the employer shall make the hepatitis B vaccine available. If a routine booster dose(s) is recommended by the U.S. Public Health Service, the dose(s) shall be made available to the employee free of charge. | |
| [56] For Connecticut requirements, see Regs., Conn. State Agencies § 19-13-D8t, relating to “infirmaries” and “industrial health facilities.” Regs., Conn. State Agencies § 19-13-D8t requires the following: (1) tetanus-diphtheria toxoid immunization for patients who have completed the initial series, or the initiation of the initial series for those who have not completed the initial series, shall be performed and results recorded in the patient’s medical record within 20 days after the patient’s admission; and (2) professional services provided to each patient by the facility shall include, but not necessarily be limited to, immunizations against influenza and pneumococcal disease in accordance with the recommendations of the Advisory Committee on Immunization Practices. Note that Regs., Conn. State Agencies § 19-31-D8t does not make specific reference to an “ensure” requirement; however, this chart construes § 19-13-D8t as imposing an “ensure” requirement because exemptions exist to the immunization administration requirements of § 19-13-D8t, indicating that administration of the vaccine is mandatory. “Industrial health facilities” are defined in Regs., Conn. State Agencies § 19-13-D1 as facilities established, conducted, operated or maintained by a commercial or industrial establishment primarily for the ambulatory care of its employees where health services in addition to first aid are provided. “Industrial health facilities” are thereby covered by the chart’s definition of “ambulatory care center.” | |
| [59] For Connecticut requirements, see Regs., Conn. State Agencies § 19-13-D8t, relating to “residential care homes.” Regs., Conn. State Agencies § 19-13-D8t requires the following: (1) tetanus-diphtheria toxoid immunization for patients who have completed the initial series, or the initiation of the initial series for those who have not completed the initial series, shall be performed and results recorded in the patient’s medical record within 20 days after the patient’s admission; and (2) professional services provided to each patient by the facility shall include, but not necessarily be limited to, immunizations against influenza and pneumococcal disease in accordance with the recommendations of the Advisory Committee on Immunization Practices. Note that Regs., Conn. State Agencies § 19-31-D8t does not make specific reference to an “ensure” requirement; however, this chart construes § 19-13-D8t as imposing an “ensure” requirement because exemptions exist to the immunization administration requirements of Regs., Conn. State Agencies § 19-13-D8t, indicating that administration of the vaccine is mandatory. “Residential care homes” are defined in Regs., Conn. State Agencies § 19-13-D1 as a institution having facilities and all necessary personnel to furnish food, shelter and laundry for two or more persons unrelated to the proprietor and in addition, providing services of a personal nature which do not require the training or skills of a licensed nurse. Additional services of a personal nature may include assistance with bathing, help with dressing, preparation of special diets and supervision over medications which are self-administered. | |
| [67] For D.C. requirements, see 29 DCMR § 6262, relating to “youth group homes.” 29 DCMR § 6262 requires the facility to cooperate with the contracting entity and, where applicable, the CSSD to meet the resident’s preventative, routine, and emergency health needs, including maintenance of required immunizations and booster shots recommended by the American Academy of Pediatrics. “Youth group homes” are defined in 29 DCMR § 6299 as facilities that provide 24-hour care for residents, and which maintain staff to provide supervision, guidance and recreation to their residents. 29 DCMR § 6299 identifies children in need of supervision as those children falling into 1 of the following 3 categories: (1) children who are subject to compulsory school attendance and who are habitually truant from school without justification; (2) a child who has committed an offense committable only by children; or, (3) a child who is habitually disobedient of the reasonable and lawful commands of his parent(s), guardian(s), or other custodian and is ungovernable. Based on the identity of those children served, this chart assumes that the definition of “youth group homes” includes juvenile detention centers. | Top of Page |
| [68] For D.C. requirements, see 29 DCMR § 6262, relating to “youth group homes.” 29 DCMR § 6262 requires the facility to cooperate with the contracting entity and, where applicable, the CSSD to meet the resident’s preventative, routine, and emergency health needs, including maintenance of required immunizations and booster shots recommended by the American Academy of Pediatrics. “Youth group homes” are a type of “youth residential facility”; “youth residential facilities” are defined in D.C. Code Ann. § 7-2101 as a residential placement providing adult supervision and care for 1 or more children unrelated to the operator or to any of the facility caregivers, and who were found to be in need of a special living arrangement as a result of a mental or physical handicap that requires more services than can be provided in a nonresidential program. Based on the characteristics of those individuals served by “youth residential facilities,” the chart assumes that the definition of “youth residential facilities,” and, by extension, “youth group homes,” includes residential facilities for the developmentally disabled and mentally retarded. | |
| [69] For Delaware requirements, see Code Del. Regs. 24-2500 § 14.2.1 and Code Del. Regs. 10-522-001, Regulation XIV, relating to “pharmacists.” Both regulations require the pharmacist to maintain a manual with policies consistent with OSHA ‘Occupational Exposure to Bloodborne Pathogens’ standards. OSHA Standards 29 CFR §1910.1030, as amended and supplemented, is incorporated by reference, and requires the following: Employers must make available the hepatitis B vaccine and vaccine series to all employees who have occupational exposure. The employer shall ensure that the hepatitis B vaccine and vaccination series and follow-up is made available at no cost to the employee. Additional time, place and manner requirements apply to vaccine administration. If the employee initially declines vaccination but changes their mind while still covered under the standard, the employer shall make the hepatitis B vaccine available. If a routine booster dose(s) is recommended by the U.S. Public Health Service, the dose(s) shall be made available to the employee free of charge. | |
| [70] For Delaware requirements, see Code Del. Regs. 9-100-105 § 3.5.2.1 and § 3.5.2.2, relating to “residential child care facilities.” Code Del. Regs. 9-100-105 § 3.5.2.1 and § 3.5.2.2 require residential child care facilities to coordinate with the child’s parent(s), legal guardian, or referring agency for the provision of required immunizations, and to ensure the child is immunized within 30 consecutive calendar days of admission. “Residential child care facilities” are defined in Code Del. Regs. 9-100-105 § 1.3 to include “secure residential facilities”. “Secure residential facilities” are further defined as a residential child care facility that is authorized to use locked doors, both exterior and interior, as the means of preventing a child from leaving the building(s) without authorization. | |
| [72] For Delaware requirements, see Code Del. Regs. 40-625-301, Part V, relating to all facilities of the Department of Mental Retardation. Code Del. Regs. 40-625-301, Part V requires clients to be protected against contracting communicable disease by the availability of prophylactic immunization. | Top of Page |
| [73] For Delaware requirements, see Code Del. Regs. 40-625-301, Part V, relating to all facilities of the Department of Mental Retardation. Code Del. Regs. 40-625-301, Part V requires that all facilities have on file evidence of annual vaccination against influenza for all residents as recommended by the Immunization Practice Advisory Committee of the Centers for Disease Control. | |
| [77] For Florida requirements, see Fla. Stat. § 409.912(35)(d), requiring that all entities providing health care services to Medicaid recipients make available, and encourage all pregnant women and mothers with infants to receive, immunizations in accordance with the recommendations of the Advisory Committee on Immunization Practices of the United States Public Health Service and the American Academy of Pediatrics, as appropriate. | |
| [79] For Georgia, no statute or regulation requires any correctional centers or juvenile detention centers to offer any vaccines to any inmates/juveniles or to ensure that any inmates/juveniles are vaccinated with any vaccines. However, note Ga. Comp. R. & Regs. r. 125-4-4-.04, relating to Board of Corrections institutions, centers, and program services. Ga. Comp. R. & Regs. r. 125-4-4-.04 provides that Health Services will be furnished to provide immunizations and vaccinations, as recommended by the institutional physician. | |
| [80] For Georgia requirements, see Ga. Comp. R. & Regs. r. 290-2-5-.12, relating to “child caring institutions.” Ga. Comp. R. & Regs. r. 290-2-5-.12 provides that each child shall have current immunizations as outlined in Chapter 290-5-4 of the Rules and Regulations of the State of Georgia. Under Chapter 290-5-4-.02, immunization against varicella, diphtheria, pertussis (before the 7th birthday), tetanus, poliomyelitis, measles, mumps, rubella, hepatitis B, and Haemophilus influenzae type b (before the 5th birthday) is required in order for entrance into a facility. Requirements for hepatitis B, measles, mumps, rubella, and varicella vaccines may be waived with serologic proof of immunity. Certain certification requirements apply to show a child has been immunized (see Ga. Comp. R. & Regs. r. 290-5-4-.04). “Child caring institutions” are defined in Ga. Comp. R. & Regs. r. 290-2-7-.01 as any institution, society, agency, or facility which either primarily or incidentally provides full-time care for children under 17 years of age outside of their own homes. This chart assumes that the definition of “child caring institution” covers residential facilities for the developmentally disabled or mentally retarded, based on a plain reading of the definitional language. | Top of Page |
| [83] For Hawaii requirements, see Weil’s Code of Hawaii Rules § 12-205.1, incorporating 29 CFR § 1910.1030 into the Code of Hawaii Rules. 29 CFR § 1910.1030 provides that employers must make available the hepatitis B vaccine and vaccine series to all employees who have occupational exposure. The employer shall ensure that the hepatitis B vaccine and vaccination series is made available at no cost to the employee. Additional time, place and manner requirements apply to vaccine administration. If the employee initially declines immunization but changes their mind while still covered under the standard, the employer shall make the hepatitis B vaccine available. If routine booster dose(s) are recommended by the U.S. Public Health Service, the dose(s) shall be made available to the employee free of charge. | |
| [89] For Illinois requirements, see Ill. Admin. Code tit. 56, § 350.280, incorporating the requirements of 29 CFR § 1910.1030. 29 CFR § 1910.1030 requires employers to make available the hepatitis B vaccine and vaccine series to all employees who have occupational exposure. The employer must ensure that the hepatitis B vaccine and vaccination series and follow-up is made available at no cost to the employee. Additional time, place and manner requirements apply to vaccine administration. If the employee initially declines vaccination but changes their mind while still covered under the standard, the employer shall make the hepatitis B vaccine available. If a routine booster dose(s) is recommended by the U.S. Public Health Service, the dose(s) shall be made available to the employee free of charge.See also Ill. Admin. Code tit. 77, § 956.30 relating to “influenza vaccination”. Ill. Admin. Code tit. 77, § 956.30 provides that beginning with the 2010 to 2011 influenza season, each health care setting shall ensure that all health care employees are offered the opportunity to receive seasonal, novel, and pandemic influenza vaccine during the influenza seasons (between September 1 and March 1 of each year), unless the vaccine is unavailable. Healthcare employees who decline vaccination for any reason shall sign a statement declining vaccination and certifying that he or she received education about the benefits of influenza vaccine. Ill. Admin. Code tit. 77, § 956.10 defines a “health care setting” as including, among others, an ambulatory surgical treatment center, as defined in the Ambulatory Surgical Treatment Center Act, and an end stage renal disease facility, as defined in the End Stage Renal Disease Facility Act. | |
| [90] For Illinois requirements, see Ill. Admin. Code tit. 20, § 415.30, requiring that each committed person shall be immunized as prescribed by the physician. | |
| [91] For Illinois requirements, see 210 Ill. Comp. Stat. Ann. § 47/2-213, relating to “facilities” regulated under the ID/DD Community Care Act. 210 Ill. Comp. Stat. Ann. § 47/2-213 states that facilities shall annually administer or arrange for administration of a vaccination against influenza to each resident in accordance with the recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention that are most recent to the time of vaccination unless the vaccination is medically contraindicated or the resident has refused the vaccine. Influenza vaccinations for all residents aged 65 and over shall be completed by November 30 of each year or as soon as practicable if vaccine supplies are not available before November 1. 210 Ill. Comp. Stat. Ann. § 47/2-213 further states that facilities shall administer or arrange for administration of a pneumococcal vaccination to each resident in accordance with the recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, who has not received this immunization prior to or upon admission to the facility, unless the resident refuses the offer for vaccination or the vaccination is medically contraindicated. 210 Ill. Comp. Stat. Ann. § 47/1-113 defines a “facility” as an intermediate care facility for the developmentally disabled or a long-term care for under age 22 facility, whether operated for profit or not, which provides, through its ownership or management, personal care or nursing for 3 or more persons not related to the applicant or owner by blood or marriage. It includes intermediate care facilities for the intellectually disabled as the term is defined in Title XVIII and Title XIX of the federal Social Security Act. | Top of Page |
| [93] For Indiana, no statute or regulation requires any correctional centers or juvenile detention centers to offer any vaccines to any inmates/juveniles or to ensure that any inmates/juveniles are vaccinated with any vaccines. However, note Ind. Admin. Code tit. 470, r. 3-11-75, relating to “child caring institutions.” Ind. Admin. Code tit. 470, r. 3-11-75 requires that the child caring institution shall ensure that each child has received immunizations and boosters required by the State Board of Health, and that every child must be immunized against routine childhood illnesses. “Child caring institutions” are defined in Ind. Admin. Code tit. 470, r. 3-15-5 as a place engaged in (among other things) receiving and caring for delinquent children. However, according to Indiana state counsel, child caring institutions operated by the Department of Corrections, county jails, and detention centers are not covered by the statute affected, Ind. Code 12-17.4. Communication from Catherine Wolter, September 13, 2005. | |
| [94] For Indiana requirements, see Ind. Admin. Code tit. 470, r. 3-11-75, relating to “child caring institutions.” Ind. Admin. Code tit. 470, r. 3-11-75 requires that the child caring institution, after attempting to determine the child’s immunization status, ensures that each child has received immunizations and boosters required by the State Board of Health, and that every child must be immunized against routine childhood disease. “Child caring institutions” are defined in Ind. Admin. Code tit. 470, r. 3-15-5 as place engaged in (among other things) receiving and caring for dependent children, children in need of services, or delinquent children. Based on the identity of those children served, this chart assumes that the definition of “child caring institutions” includes facilities serving developmentally disabled or mentally retarded children. | |
| [97] For Iowa requirements, see Iowa Admin. Code r. 441-82.2(249A)(2005), relating to “intermediate care facilities for the mentally retarded.” Iowa Admin. Code r. 441-82.2(249A)(2005) requires the facility to provide or obtain immunizations for each client, using as a guide recommendations of the Public Health Service Advisory Committee on Immunization Practices or of the Committee on the Control of Infectious Diseases of the American Academy of Pediatrics. | |
| [98] For Kansas requirements, see Kan. Admin. Regs. 28-4-608, relating to facilities providing hearing screening for newborns and infants. Kan. Admin. Regs. 28-4-608 provides that each person who screens the hearing of newborns and infants and who is not licensed in Kansas for hearing screening shall be current with immunizations required by the medical care facility and be free of infectious diseases transmittable to newborns and infants. | Top of Page |
| [99] For Kansas requirements, see Kan. Stat. Ann. § 65-508, relating to “child care facilities.” Kan. Stat. Ann. § 65-508 requires that child cared for in a child care facility shall be required to have current immunizations as the secretary of health and the environment considers necessary. “Child care facilities” are defined in Kan. Stat. Ann. § 65-503 to include (among other settings) any receiving or detention home for children under 16 years of age provided or maintained by, or receiving aid from, any city or county or the state. | |
| [102] For Kansas requirements, see Kan. Stat. Ann. § 65-508, relating to “child care facilities,” and Kan. Admin. Regs. 28-4-275, relating to “group boarding homes” and “residential centers.” Kan. Stat. Ann. § 65-508 requires that each child cared for in a child care facility shall be required to have current immunizations as the secretary of health and the environment considers necessary. “Child care facilities” are defined in Kan. Stat. Ann. § 65-503 to include (among other settings) a facility maintained by a person who has control or custody of one or more children under 16 years old, unattended by parent or guardian, for the purpose of providing the children with food or lodging, or both, except children related by blood marriage or legal adoption, and a children’s home, maternity home, day care facility, or other facility of a type determined by the secretary to require regulation under the provisions of this act. Based on a plain reading of the text of the definition, this chart assumes that the definition of “child care facilities” covers residential facilities for the developmentally disabled or mentally retarded. Kan. Admin. Regs. 28-4-275 provides that each person under 16 years of age living in “residential centers’ and “group boarding homes” shall have current immunizations according to the schedule recommended by the Centers for Disease Control. “Group boarding homes” are defined in Kan. Admin. Regs. 28-4-268 to include a non-secure facility providing residential care for not less than five nor more than ten persons unrelated to the caregivers, and includes emergency shelters and maternity homes. “Residential centers” are defined in Kan. Admin. Regs. 28-4-268 to include a non-secure facility which provides residential care for more than 10 residents unrelated to the caregivers, and includes emergency shelters and maternity homes. Based on a plain reading of the text of these definitions, this chart assumes that the definitions of “residential centers” and “group boarding homes” cover residential facilities for the developmentally disabled or mentally retarded. | |
| [105] For Kentucky requirements, see KY Rev. Stat. Ann. § 214.034 and 902 KY. Admin. Regs. 2:060, relating to “licensed facilities which care for children”. KY Rev. Stat. Ann. § 214.034 requires that for each child cared for in a licensed facility which provides care for children, a current immunization certificate, as provided by administrative regulation of the Cabinet for Health Services, promulgated under KY Rev. Stat. Ann., Chapter 13A, shall be on file in the center, home or facility within 30 days of admission into the facility. 902 KY. Admin. Regs. 2:060 requires that children 3 months or older without a current immunization certificate shall not attend facilities licensed to provide care for children. For certificates to be considered current, children must receive certain vaccines according to age. Based on a plain reading of the text, this chart assumes that juvenile detention centers are a type of “licensed facility which cares for children”. | |
| [108] For Kentucky requirements, see KY Rev. Stat. Ann. § 214.034 and 902 KY. Admin. Regs. 2:060, relating to “licensed facilities which care for children,” and 922 KY. Admin. Regs. 2:110 and 922 KY. Admin. Regs. 1:300, relating to “child caring facilities.” KY Rev. Stat. Ann. § 214.034 requires that for each child cared for in a licensed facility which provides care for children, a current immunization certificate, as provided by administrative regulation of the Cabinet for Health Services, promulgated under KY Rev. Stat. Ann., Chapter 13A, shall be on file in the center, home or facility within 30 days of admission into the facility. 902 KY. Admin. Regs. 2:060 requires that children 3 months or older without a current immunization certificate shall not attend facilities licensed to provide care for children. For certificates to be considered current, children must receive certain vaccines according to age. 922 KY. Admin. Regs. 2:110 provides that a current immunization certificate showing that the child is immunized pursuant to 902 KY. Admin. Regs. 2:060 shall be on file within 30 days of enrollment. 922 KY. Admin. Regs. 1:300 provides that the facility shall also keep an immunization record for each child, in accordance with KY Rev. Stat. Ann. § 214.034(4). KY Rev. Stat. Ann. § 214.034 provides that all public or private primary schools shall require a current immunization certificate for hepatitis B for any child enrolled as a regular attendee in the sixth grade, as provided by administrative regulation of the Cabinet for Health Services, promulgated under KY Rev. Stat. Ann., Chapter 13A, to be on file within two (2) weeks of the child's attendance. “Child caring facilities” are defined in KY Rev. Stat. Ann. § 199.011(6) as any institution or group home, including institutions and group homes that are publicly operated, providing residential care on a 24-hour basis to children, not related by blood, adoption, or marriage to the person maintaining the facility, other than an institution or group home certified by an appropriate agency as operated primarily for educational or medical purposes, or a residential program operated or contracted by the Department of Juvenile Justice that maintains accreditation, or obtains accreditation within 2 years of opening from a nationally recognized accrediting organization. Based on a plain reading of the definitional language, this chart assumes that the definition of “child caring facility” includes residential facilities for the developmentally disabled or mentally retarded. | Top of Page |
| [111] For Louisiana requirements, see La. Rev. Stat. Ann. § 46:1906, relating to juvenile detention facilities, and La. Admin. Code tit. 51, § 701, relating to “residential facilities.” La. Rev. Stat. Ann. § 46:1906 requires that each child between 12 and 19 who has been placed in the custody of the local juvenile detention facility shall be immunized with hepatitis B vaccine during the intake process at any state or non-state owned facility. Detainees released before completion of the series shall be referred to health units or other providers for completion. La. Admin. Code tit. 51, § 701 requires that each child 18 years of age or under admitted to any residential facility, shall have verification that the child had all age-appropriate immunizations according to the Office of Public Health Schedule. | |
| [113] For Louisiana requirements, see La. Admin. Code tit. 51, § 701, relating to “residential facilities.” La. Admin. Code tit. 51, § 701 requires that each child 18 years of age or under, admitted to any residential facility, shall have verification that the child had all age-appropriate immunizations according to the Office of Public Health Schedule. Based on a plain reading of the text, this chart assumes that residential facilities for the developmentally disabled and mentally retarded are a type of “residential facility”. | |
| [122] For Maine, no statute or regulation specifically requires residential facilities for the developmentally disabled and mentally retarded to offer any vaccines to any residents or ensure that any residents are vaccinated with any vaccines. However, note Code Me. R. § 10-148-018 and Code Me. R. § 14-153-018, both requiring facilities to adopt a written plan for ensuring the availability and provision of a comprehensive program of preventative, routine, and emergency medical, mental health, and dental care for each child, which shall include establishment of an ongoing immunization program. | |
| [126] For Maryland requirements, see MD. Regs. Code tit. 10, § 06.01.12-1, relating to physicians. MD. Regs. Code tit. 10, § 06.01.12-1 provides that a physician in attendance on an individual at increased risk of pneumococcal disease shall educate the individual or individual’s legal guardian on the availability of pneumococcal vaccine and administer pneumococcal vaccine to a consenting individual who has no contraindications and who is at increased risk of pneumococcal disease, or refer the individual to a health care provider who has agreed to administer pneumococcal vaccine. | Top of Page |
| [128] For Maryland, no statute or regulation requires any correctional centers or juvenile detention centers to offer any vaccines to any inmates/juveniles or to ensure that any inmates/juveniles are vaccinated with any vaccines. Note MD. Regs. Code tit. 01, § 04.07.13, relating to “residential child care programs”, requires the licensee to, within 30 days after admission and subject to the provisions of State law, provide for the immunization of any child who has not been immunized in accordance with the immunization schedules of the American Academy of Pediatrics, and maintain a record of immunizations in the child’s individual case record. However, Md. Regs. Code tit. 14. § 31.06.02, which replaced tit. 01, §04.07.02, does not list juvenile detention centers as covered entities. Juvenile detention centers are exempt from the requirements of this chapter, and it is incorrect to assume that definitional language indicates that a juvenile detention center is a residential child care program. The program running juvenile detention centers in Maryland states there are no immunization requirements for juvenile detention centers. Communication from Jenny Bowlus, July 21, 2005. | |
| [129] For Maryland requirements, see MD. Regs. Code tit. 01, § 04.07.13, relating to “residential child care programs.” MD. Regs. Code tit. 01, § 04.07.13 requires the licensee to, within 30 days after admission and subject to the provisions of State law, provide for the immunization of any child who has not been immunized in accordance with the immunization schedules of the American Academy of Pediatrics, and maintain a record of immunizations in the child’s individual case record. MD. Regs. Code tit. 01, § 04.02.03 defines a “residential child care program” as a program of care provided in a residential setting by a provider on a 24-hour basis for longer than 24 hours to a child or children unless otherwise provided by state law. Based on a plain reading of the definitional language, this chart assumes that the definition of “residential child care programs” covers residential facilities for the developmentally disabled or mentally retarded. | |
| [131] For Massachusetts requirements, see Mass. Regs. Code tit. 105, § 130.626, relating to hospital personnel assigned to maternal-newborn areas. Mass. Regs. Code tit. 105, § 130.626 requires that personnel assigned to maternal-newborn areas shall have: (1) demonstrated immunity to rubeola either via measles titer, physician-diagnosed disease or physician-documented live measles vaccine received on or after 12 months of age; and (2) demonstrated immunity to rubella either via rubella titer or physician-documented rubella vaccine received on or after 12 months of age. Note that, while this requirement applies to “hospitals,” Massachusetts’ definition includes facilities covered under this chart’s definition of “ambulatory care facility.” “Hospital” is defined in Mass. Regs. Code tit. 105, § 130.020 as any institution in the Commonwealth of Massachusetts, however named, whether conducted for charity or for profit, which is advertised, announced, established, or maintained for the purpose of caring for persons admitted thereto for diagnosis or medical, surgical or restorative treatment which is rendered within said institution. This definition shall not include any hospital operated by the Commonwealth of Massachusetts or by the United States. Because this definition of “hospital” is not limited to facilities providing 24-hour care, and the definition otherwise appears on its face to cover those facilities also covered by this chart’s definition of ambulatory care facilities, this chart assumes that the requirements applying to “hospitals” would also apply to ambulatory care facilities. | |
| [132] For Massachusetts requirements, see Mass. Regs. Code tit. 103, § 932.10, relating to “county correctional facilities,” and Mass. Regs. Code tit. 102, § 3.06, relating to “programs serving children and teen parents.” Mass. Regs. Code tit. 103, § 932.10 provides that county correctional facilities’ written policy and procedure shall provide, at a minimum, medical preventative maintenance including medical services provided to take advance measures against disease, such as inoculations and immunizations. Mass. Regs. Code tit. 102, § 3.06 provides that preventative health services for residents shall include immunizations and TB testing as required by the Department of Public Health. | |
| [133] For Massachusetts requirements, see Mass. Regs. Code tit. 102, § 3.06, relating to “programs serving children and teen parents.” Mass. Regs. Code tit. 102, § 3.06 provides that preventative health services for residents shall include immunizations and TB testing as required by the Department of Public Health. | |
| [135] For Michigan requirements, see Mich. Admin. Code r. 325.70013, requiring that, within a specified time frame, an employer shall make available hepatitis B vaccine to category A employees. If an employee initially declines vaccination, but at a later date, while still covered under these rules, decides to accept hepatitis B vaccine, the employer shall provide the vaccine at the later date. If booster dose(s) are recommended by the United States Public Health Service, they shall be made available. However, if an employee has previously received the complete hepatitis B vaccine series, is found to be immune to hepatitis B virus by adequate antibody titer, or the vaccine is contraindicated for medical reasons, the employer is not required to offer the vaccine to the employee. Category A is defined in Mich. Admin. Code r. 325.70003 as consisting of occupations that require procedures or other occupation-related tasks that involve exposure or reasonably anticipated exposure to blood or other potentially infectious material, or that involves a likelihood for spills or splashes blood or other potentially infectious material. | |
| [136] For Michigan requirements, see Mich. Admin. Code r. 400.4334 and Mich. Admin. Code r. 400.10307, relating to “residential treatment facilities,” and Mich. Admin. Code r. 325. 176, relating to “programs of group care or group residence.” Mich. Admin. Code r. 400.4334 requires that, if documentation of immunization for a resident is unavailable, immunizations shall begin within 30 days of admission to a residential treatment institution. Mich. Admin. Code r. 400.10307 requires that a resident in a facility shall have current immunizations as required by the department of health. If documentation of immunization is unavailable, then immunization shall begin within 30 days of admission to the facility. Mich. Admin. Code r. 400.4101 defines a “residential treatment facility” as an institution whose primary purpose is to provide habilitative or rehabilitative services. Mich. Admin. Code § 400.4302 clarifies the definition of “residential treatment facilities,” providing that the “rules in this part relate to all residential treatment child caring institutions.” Although the title in this part is ‘Residential Treatment Institutions,’ the rules in this section only apply to child caring institutions meeting the criteria established in the definition of “residential treatment institution.” A “child caring institution” is defined as having the same definition set forth in Mich. Comp. Laws § 722.111, which states that a “child caring institution” is a child care facility that is organized for the purpose of receiving minor children for care, maintenance, and supervision, usually on a 24-hour basis, in buildings maintained by the child caring institution for that purpose, and operates throughout the year. “Child caring institution” includes maternity homes for the care of unmarried mothers who are minors, agency group homes, defined as a small child caring institution owned, leased or rented by a licensed agency providing care for more than 4 but less than 13 children, and institutions for mentally retarded minor children. “Child caring institution” does not include hospitals, nursing homes, or homes for the aged licensed under article 17 of the public health code, 1978 PA 368, MCL 333.20101 to 333.22260, a boarding school licensed under section 1335 of the revised school code, 1976 PA 451, MCL 380.1335, a hospital or facility operated by the state or licensed under the mental health code, 1974 PA 258, MCL 330.1001 to 330.2106, or an adult foster care family home or an adult foster care small group home licensed under the adult foster care facility licensing act, 1979 PA 218, MCL 400.701 to 400.737, in which a child has been placed pursuant to section 5(6). Thus, the requirements of Mich. Admin. Code r. 400.4334 and Mich. Admin. Code r. 400.10307 would only apply to those residential homes for the developmentally disabled and mentally retarded that are not state operated and are not licensed under the mental health code. With respect to “programs of group care or group residence,” see Mich. Admin. Code r. 325.176. Mich. Admin. Code r. 325.176 provides the following: (1) children between 2 months and 3 months shall have received all of the following vaccines, in specified quantities: diphtheria vaccine, tetanus vaccine, pertussis vaccine, poliovirus vaccine, Haemophilus influenzae type b vaccine, and hepatitis B vaccine; (2) children between 4 months and 5 months of age shall have received all the following vaccines, in specified quantities: diphtheria vaccine, tetanus vaccine, pertussis vaccine, poliovirus vaccine, Haemophilus influenzae type b vaccine, and hepatitis B vaccine; (3) children between 6 months and 14 months of age registered in a program of group residence or care shall have received all of the following vaccines, in specified quantities: diphtheria vaccine, tetanus vaccine, pertussis vaccine, poliovirus vaccine, Haemophilus influenzae type b vaccine, and hepatitis B vaccine; (4) children between 15 months and 4 years shall have received all of the following vaccines, in specified quantities: diphtheria vaccine, tetanus vaccine, pertussis vaccine, poliovirus vaccine, Haemophilus influenzae type b vaccine, hepatitis B vaccine, live measles vaccine at or after 12 months, live mumps vaccine at or after 12 months, rubella vaccine. Effective Jan. 1, 2000, children in this age group must also show, according to specified criteria, evidence of varicella immunity. If a child cannot complete immunization requirements for medical reasons, within 4 months of admittance, a child shall be permitted to remain enrolled in the program for a time consistent with good medical practice. A statement requesting enrollment of the child beyond the exclusion date shall be signed by a physician or local health officer and shall certify that the child is in the process of complying with immunization requirements, and this medical exemption shall be filed with the group program. This chart assumes that the definition of “group program” covers residential facilities for the developmentally disabled and mentally retarded for the foregoing reasons. Mich. Comp. Laws § 333.9211 limits the application of “group program” to pre-school aged children, and makes “group program” synonymous with “a program of group residence care or camping.” These general classifications would fit under the definition of “child care organizations” within Mich. Comp. Laws § 722.111 of the Child Care Organizations Act. Mich. Comp. Laws § 722.111 defines “child care organization” as an organization having as its principal function the receiving of minor children for care, maintenance, training and supervision. “Child caring institutions” are one organization subject to the requirements of the Child Care Organizations Act and, as described above, the definition of “child caring institutions” includes residential facilities for the developmentally disabled and mentally retarded which are not state operated and which are not licensed under the mental health code. Thus, the requirements of Mich. Admin. Code r. 325.176 would only apply to those residential facilities for the developmentally disabled and mentally retarded which are not operated by the state or licensed under the mental health code. (Interpretation of application of “group program” based on interview w/ counsel for Michigan Department of Community Health, results received 4/1/05.) | |
| [140] For Missouri requirements, see Mo. Rev. Stat. § 210.030, relating to every licensed physician, midwife, registered nurse, and all persons who may undertake, in a professional way, the obstetrical and gynecological care of a pregnant woman. Mo. Rev. Stat. § 210.030 provides that, should a mother test positive for hepatitis B, the person who professionally undertakes the pediatric care of a newborn shall also administer the appropriate doses of hepatitis B vaccine and hepatitis B immune globulin (HBIG) in accordance with the current recommendations of the Advisory Committee on Immunization Practices (ACIP). If a mother’s hepatitis B status is unknown, the appropriate doses of hepatitis B vaccine shall be administered to the newborn in accordance with the current ACIP recommendations. If a mother consents, a sample of her venous blood shall be taken. If she tests positive for hepatitis B, hepatitis B vaccine and HBIG shall be administered to the newborn in accordance with the current ACIP recommendations. An approved and standard serological test for hepatitis B shall mean a test made in a laboratory approved by the department of health and senior services. | |
| [141] For Missouri requirements, see Mo. Code Regs. Ann. tit. 19, § 20-20.092 (relating to all public employees), incorporating the requirements of 29 CFR § 1910.1030. 29 CFR § 1910.1030 requires employers to make available the hepatitis B vaccine and vaccine series to all employees who have occupational exposure. The employer shall ensure that the hepatitis B vaccine and vaccination series and follow-up is made available at no cost to the employee. Additional time, place and manner requirements apply to vaccine administration. The employer shall not make participation in a pre-screening program a prerequisite for receiving hepatitis B vaccination. If the employee initially declines vaccination but changes their mind while still covered under the standard, the employer shall make the hepatitis B vaccine available. If a routine booster dose(s) is recommended by the U.S. Public Health Service, the dose(s) shall be made available to the employee free of charge. | |
| [142] For Missouri requirements, see Mo. Code Regs. Ann. tit. 9, § 40-40.4.115, relating to “community residential facilities not licensed by the Division of Aging and psychiatric group homes II,” and Mo. Code Regs. Ann. tit. 9, § 40-5.035, relating to “group homes” and “residential centers.” Mo. Code Regs. Ann. tit. 9, § 40-40.4.115 provides that, within 30 days of admission, each resident of a community residential facility not licensed by the Division of Aging and psychiatric group homes II who is mentally retarded or developmentally disabled shall be screened for hepatitis unless his/her medical record indicates one of the following: (1) she/he has been previously immunized against hepatitis B; or (2) she/he has been found to be immune by previous screening. “Community residential facilities” are defined in Mo. Code Regs. Ann. tit. 9, § 40-1.015 as any premises where residential prevention, evaluation, care, treatment or habilitation are provided for persons affected by mental retardation, developmental disabilities, mental illness or mental disorders, except for a person's dwelling. Mo. Code Regs. Ann. tit. 9, § 40-5.035 provides that immunizations shall be kept current in accordance with the recommendations of the Missouri Department of Health. “Group homes” are defined in Mo. Code Regs. Ann. tit. 9, § 40-1.015 as a residential facility serving 9 or fewer residents, similar in appearance to a single-family dwelling and providing basic health supervision, habilitation training in skills of daily and independent living and community integration, and social support. Group homes do not include family living arrangements or individualized supported living. “Residential centers” are defined in Mo. Code Regs. Ann. tit. 9, § 40-1.015 as a residential facility serving 10 or more residents and providing social support, health supervision and habilitation training in skills of daily living. | |
| [143] For Montana requirements, see Mont. Admin. R. 37.106.2150, relating to “intermediate care facilities for the developmentally disabled.” Mont. Admin. R. 37.106.2150 requires the facility to provide or obtain immunizations, using as a guide the recommendations of the Public Health Service Advisory Committee on Immunization Practices or of the Committee on the Control of Infectious Diseases of the American Academy of Pediatrics. | |
| [144] For Nebraska, no statute or regulation requires any correctional centers or juvenile detention centers to offer any vaccines to any inmates/juveniles or to ensure that any inmates/juveniles are vaccinated with any vaccines. However, note Neb. Rev. Stat. § 83-4,161, providing that, in developing and implementing medical treatment of communicable diseases, the medical director of a correctional or penal institution shall ensure that the medical treatment protocols include provisions allowing for routine immunizations against communicable diseases of all inmates upon entering the custody of departments. | |
| [145] For Nebraska requirements, see 175 NAC 17-006, concerning Intermediate Care Facilities for the Mentally Retarded. 175 NAC 17 adopts by reference 42 CFR 483.410 through 483.480. At 42 CFR 483.460 (a) (3) this requirement is found: “(3) The facility must provide or obtain preventive and general medical care as well as annual physical examinations of each client that at a minimum include the following: … (ii) Immunizations, using as a guide the recommendations of the Public Health Service Advisory Committee on Immunization Practices or of the Committee on the Control of Infectious Diseases of the American Academy of Pediatrics.” See also Neb. Rev. Stat. §71-468, requiring that each general acute hospital, intermediate care facility, nursing facility, and skilled nursing facility annually offer onsite vaccinations for influenza and pneumococcal disease to all residents and to all inpatients prior to discharge, and Neb. Rev. Stat. §71-469, requiring that each general acute hospital, intermediate care facility, nursing facility, and skilled nursing facility offer onsite vaccinations for diphtheria, tetanus, and pertussis to all residents and inpatients prior to discharge. Because “intermediate care facility for the mentally retarded” is defined separately from “intermediate care facility” in Nebraska law, the requirements of Neb. Rev. Stat. §71-468 and §71-469 were interpreted as not applying to residents of facilities for the developmentally disabled for purposes of this database. | |
| [154] For New Hampshire requirements, see N.H. Code Admin. R. Ann., Mid 502.07, relating to midwives. N.H. Code Admin. R. Ann., Mid 502.07 provides that, by 6 weeks postpartum, a midwife shall provide referral for rubella vaccination if the client showed no immunity to rubella when tested at the time of her initial visit with the midwife. | |
| [155] For New Hampshire requirements, see N.H. Code Admin. R. Ann. He-P 301.06, relating to medical providers. N.H. Code Admin. R. Ann. He-P 301.06 provides that for infants born to hepatitis B surface antigen positive women, the birthing facility shall administer hepatitis B immune globulin (HBIG) and the first hepatitis B vaccine dose within 12 hours of birth, and for infants born to women of unknown hepatitis B surface antigen status, the birthing facility shall administer the first hepatitis B vaccine dose within 12 hours of birth; and, if the mother tests positive for hepatitis B surface antigen, the birthing facility or medical provider shall administer HBIG to the infant within 7 days of birth. | |
| [156] For New Hampshire, no statute or regulation requires any ambulatory care facility to ensure that any employees are vaccinated with any vaccine. However, for New Hampshire, see N.H. Code Admin. R. Ann. He-P 301.05, relating to “health care facilities.” N.H. Code Admin. R. Ann. He-P 301.05 requires that if a case or suspect case of measles occurs in a health care facility, the facility shall ensure that vulnerable employees are given a dose of the measles vaccine. Vulnerable employees are those employees born after 1956, who cannot provide either: (1) documentation of 2 doses of measles vaccine on or after their first birthday, the second dose a minimum of 30 days after the first; or; (2) serologic evidence of immunity. N.H. Code Admin. R. Ann. He-P 301.01 defines “health care facilities” as facilities required to be licensed pursuant to RSA 151:2, I and those facilities exempt from licensing pursuant to RSA 151:2, II. RSA 151:2, I identifies (among other types of facilities) hospitals, as defined in RSA 151-C:2;…facilities or portions of a facility operating as an outpatient rehabilitation clinic, ambulatory surgical center, hospice, emergency medical care center, drop-in or walk-in care center, dialysis center, birthing center, or other entity where health care associated with illness, injury, deformity, infirmity, or other physical disability is provided, whether operated for profit or for free or at a reduced cost, however named, and whether owned by a hospital or hospital holding corporation or operated as part of a hospital's services, as facilities required to be licensed pursuant to RSA 151:2, I. | |
| [157] For New Hampshire requirements, see N.H. Rev. Stat. Ann. § 141-C:20-a, relating to “child care agencies.” N.H. Rev. Stat. Ann. § 141-C:20-a provides that no child shall be admitted or enrolled in any school or child care agency, public or private, unless the following is demonstrated: (1) immunizations including, but not limited to, diphtheria, mumps, pertussis, poliomyelitis, rubella, rubeola, and tetanus; (2) partial immunization relative to the age of the child as specified in rules adopted by the Commissioner; or (3) exemption under N.H. Rev. Stat. Ann. § 141-C:20-c. N.H. Code Admin. R. Ann. He-P 301.14 provides that the following vaccines are required for admission/enrollment in a “child care agency”: diphtheria, tetanus, pertussis, poliomyelitis, measles, rubella, mumps, Haemophilus influenzae type b conjugate, hepatitis B vaccine, and varicella vaccine. The number of doses, dosage, and route of administration of each vaccine that is appropriate for a child’s age shall be defined by the July-December 2004, United States Recommended Childhood Immunization Schedule as published by the Centers for Disease Control and Prevention and as approved by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians. “Child care agencies” are defined in N.H. Rev. Stat. Ann. § 170-E:25 as including “specialized care.” “Specialized care” is further defined as a child care agency which regularly provides general care for children who are diagnosed as mentally ill, mentally retarded, or physically disabled and who are determined to be in need of special mental treatment or nursing care, or both. | |
| [163] For New Jersey requirements, see N.J. Admin. Code tit. 10, § 10:58A-1.4, relating to nurse midwives. N.J. Admin. Code tit. 10, § 10:58-1.4 provides that for all periodic health maintenance examinations for individuals under 21 years of age, the assessment and administration of immunizations appropriate for age and need shall be performed and documented in the beneficiary’s record by the nurse midwife. | |
| [164] For New Jersey requirements, see N.J. Admin. Code tit. 8, § 8:43A-24.6, relating to “chronic dialysis facilities,” N.J. Admin. Code tit. 8, § 8:43F-7.2(a) and N.J. Admin. Code tit. 8, § 8:43F-7.3(c), relating to “adult and pediatric day health services facilities,” and N.J. Admin. Code tit. 8, § 8:43A-14.2, relating to “ambulatory care facilities.” N.J. Admin. Code tit. 8, § 8:43A-24.6 requires facilities which provide chronic dialysis services to comply with OSHA Rule 29 CFR § 1910.1030, incorporated by reference into the New Jersey Administrative Code, as it pertains to hepatitis B vaccine and vaccine series. The OSHA regulation requires employers to make available the hepatitis B vaccine and vaccine series to all employees who have occupational exposure. If the employee initially declines vaccination but changes their mind while still covered under the standard, the employer shall make available the hepatitis B vaccine. If a routine booster dose(s) is recommended by the U.S. Public Health Service, the dose(s) shall be made available to the employee. N.J. Admin. Code tit. 8, § 8:43F-7.2(a) requires adult and pediatric day health services facilities to comply with OSHA Rule 29 CFR § 1910.1030, incorporated by reference into the New Jersey Administrative Code, as it pertains to hepatitis B vaccine and vaccine series. “Adult day health services facilities” are defined in N.J. Admin. Code tit. 8, § 8:43F-1.2 as facility or distinct part of a facility licensed by the NJ Department of Health and Senior Services to provide preventative, diagnostic, therapeutic, and rehabilitative services under medical supervision to meet the needs of functionally impaired adult participants who are not related to the members of the governing authority, in a period of time not exceeding 12 hours. “Pediatric day health services facilities” are defined in N.J. Admin. Code tit. 8, § 8:43F-1.2 as a facility which provides additional services in order to provide for the needs of technologically dependent children or medically unstable children and conforms to specified guidelines. N.J. Admin. Code tit. 8, § 8:43F-7.3(c) requires adult and pediatric day health services facilities to offer yearly influenza immunization to employees. N.J. Admin. Code tit. 8, § 8:43A-14.2, relating to “ambulatory care facilities,” incorporates by reference OSHA Rule 29 CFR § 1910.1030, as it pertains to hepatitis B vaccine and vaccine series. | |
| [165] For New Jersey requirements, see N.J. Admin. Code tit. 8, § 8:43A-28.8, relating to “birth centers.” N.J. Admin. Code tit. 8, § 8:43A-28.8 requires birth centers to offer patients with negative rubella titers the rubella vaccine after delivery and prior to discharge. Requirements governing “birth centers” are located in the chapter of the New Jersey Administrative Code setting forth the standards for the licensing of ambulatory care centers, thus identifying “birth centers” as a type of ambulatory care center under New Jersey’s definition of “ambulatory care center.” N.J. Admin. Code tit. 8, § 8:43A-1.3 defines an “ambulatory center” as a health care facility or distinct part of a health care facility in which preventative, diagnostic, and treatment services are provided to persons who come to the facility to receive services and depart from the facility on the same day. | |
| [166] For New Jersey requirements, see N.J. Admin. Code tit. 8, § 8:43F-7.2(c), N.J. Admin. Code tit. 8, § 8:43F-7.2(e), and N.J. Admin. Code tit. 8, § 8:43F-7.2(d), relating to “adult and pediatric day health services facilities.” N.J. Admin. Code tit. 8, § 8:43F-7.2(c) requires adult and pediatric day health services facilities to document evidence of annual vaccination against influenza for each adult participant in accordance with the recommendations of the Advisory Committee on Immunization Practices of the CDC most recent to the time of vaccination, unless medically contraindicated or the patient refuses the offer of the vaccine in accordance with N.J. Admin. Code tit. 8, § 8:43F-4.4(a)3 (allowing patients to refuse to consent to medical treatment). N.J. Admin. Code tit. 8, § 8:43F-7.2(e) requires that each pediatric day health services facility maintain an up-to-date immunization record or documentation that the child is under a prescribed medical program to obtain immunizations in accordance with the provisions of N.J. Admin. Code tit. 8, § 10:122-7.3(a)2iii and 7.3(a)5 and 6, or documentation that the child is under a prescribed medical program to obtain immunizations in accordance with the provisions of N.J. Admin. Code tit. 8, § 8:57-4. N.J. Admin. Code tit. 8, § 10:122-7.3(a)2 provides that for each child not enrolled in a public or private school, the center shall maintain on file at the center an immunization record in accordance with the provisions of N.J. Admin. Code tit. 8, § 8:57-4.6 and 4.7. N.J. Admin. Code tit. 8, § 8:57-4.6 describes documents accepted as evidence of immunization. N.J. Admin. Code tit. 8, § 8:57-4.7 provides that every school, preschool, or child care center shall maintain an official State of New Jersey School Immunization Record for every pupil. This record shall include the date of each immunization and shall be separated from the child's other medical records for purpose of immunization record audit. N.J. Admin. Code tit. 8, § 10:122-7.3(a)5 provides that if immunizations are contraindicated for medical reasons, the center may choose to admit the child, provided that the parent submits to the center a written statement from a health care provider, as specified in N.J. Admin. Code tit. 8, § 8:57-4.3, attesting to the reason the immunization is medically contraindicated, and the specific time period for which the immunization is medically contraindicated. N.J. Admin. Code tit. 8, § 10:122-7.3(a) 6 provides that a child shall be exempted from a physical examination, immunization or medical treatment if the parent objects thereto in a written statement submitted to the center, signed by the parent, explaining how the examination, immunization or medical treatment conflicts with the child's exercise of bona fide religious tenets or practices. N.J. Admin. Code tit. 8, § 8:57-4.10 through 4.17 provide specific schedule for the following diseases: diphtheria, pertussis, tetanus toxoids, polio virus, measles virus, rubella, mumps, Haemophilus influenzae type b, hepatitis B and varicella. N.J. Admin. Code tit. 8, § 8:43F-7.2(d) requires adult and pediatric day health services facilities to document evidence of annual immunization against pneumococcal in accordance with specified CDC recommendations, unless medically contraindicated or the patient refuses the offer of the vaccine in accordance with N.J. Admin. Code tit. 8, § 8:43F-4.4(a)3 (allowing patients to refuse to consent to medical treatment). This provision also requires that the facility shall provide or arrange for immunization against pneumococcal vaccine, unless the participant refuses. “Pediatric day health services facilities” are defined in N.J. Admin. Code tit. 8, § 8:43F-1.2 as a facility which provides additional services in order to provide for the needs of technologically dependent children or medically unstable children and conforms to specified guidelines. | |
| [169] For New Jersey requirements, see N.J. Admin. Code tit. 10, § 10:48-2.12 and N.J. Admin. Code tit. 10, § 10:48-2.5, relating to “private licensed facilities for persons with developmental disabilities.” N.J. Admin. Code tit. 10, § 10:48-2.12 provides that individuals receiving services in private licensed facilities for the developmentally disabled and developmental centers who are not carriers and who lack natural immunity are offered the hepatitis B vaccine. N.J. Admin. Code tit. 10, § 10:48-2.5 provides that appropriate medical services are required for children receiving services as an admission prerequisite. Note that this is properly characterized as an “offer” requirement based on the language of N.J. Admin. Code tit. 10, § 10:48-2.14, providing that an individual who is competent or the guardian of a minor or incompetent may decline a vaccine offer, after receiving information about the vaccine from the designated staff member. | |
| [170] For New Jersey requirements, see N.J. Admin. Code tit. 10, § 10:47-6.1and N.J. Admin. Code tit. 10, § 10:48-2.14, relating to “private licensed facilities for persons with developmental disabilities.” N.J. Admin. Code tit. 10, § 10:47-6.1 requires private licensed facilities for persons with developmental disabilities to give persons receiving services primary immunizations, as required upon admission, and reimmunizations as recommended on a regular basis for diphtheria, tetanus, pertussis, polio, measles, and other diseases as identified. N.J. Admin. Code tit. 10, § 10:48-2.14 requires that, prior to admission, at least one dose of hepatitis B shall be administered to any individual who has been tested pursuant to the recommendations of the CDC Report Number 50. For emergency admissions where admission occurs before testing and immunization can be initiated, then full hepatitis B vaccination and immunization shall take place as part of the initial admission medical evaluation. Also note N.J. Admin. Code tit. 10, § 10:128-10.16 and N.J. Admin. Code tit. 10, § 10:128-7.2(e), relating to “group homes.” N.J. Admin. Code tit. 10, § 10:128-10.16 requires that the home ensure that all toddlers, infants, and children receive the following childhood immunizations and boosters in accordance with specified recommendations: diphtheria, tetanus, pertussis (DPT) or diphtheria and tetanus toxoids and accellular pertussis (DTaP) vaccine; inactivated poliovirus vaccine (IPV) or all-oral poliovirus vaccine (OPV); measles-mumps-rubella vaccine (MMR); Haemophilus influenzae type b (Hib) vaccine; hepatitis B vaccine; and varicella virus vaccine. N.J. Admin. Code tit. 10, § 10:128-7.2(e) requires that the home ensure all children are appropriately immunized. N.J. Admin. Code tit. 10, § 10:128-1.2 defines “group homes” as any public or private establishment other than foster care that provides board, lodging, care, and treatment services on a 24-hour a day basis to 12 or fewer children in a homelike, community setting. However, the law fails to clarify whether the definition of “group homes” set forth in N.J. Admin. Code tit. 10, § 10:128-1.2 covers residential facilities for the developmentally disabled or mentally retarded. | |
| [173] For New Mexico requirements, see N.M. Admin. Code tit. 7, § 7.8.3.41, relating to “residential shelter care facilities for children,” and N.M. Admin. Code tit. 7, § 7.26.2.86, relating to “intermediate care facilities for the mentally retarded.” N.M. Admin. Code tit.7, § 7.8.3.41 provides that each child in the facility must be immunized according to the immunization schedule of the New Mexico Health Department, Public Health Division. When an immunization record cannot be obtained for the child at the time of admission or within 30 days after admission, the facility shall arrange for immunizations required by the Department of Health. Note that children’s crisis shelters may accept children with no immunization record. N.M. Admin. Code tit. 7, § 7.26.2.86 provides that the facility must have preventative health services for clients that include immunizations, using as a guide the recommendations of the Public Health Service Advisory Committee on Immunization Practices and of the Committee on the Control of Infectious Diseases of the American Academy of Pediatrics. | |
| [180] For New York requirements, see N.Y. Comp. Codes R. & Regs. tit. 10, § 69-3.5 and N.Y. Comp. Codes R. & Regs. tit. 10, § 69-3.6, relating to health care providers, and N.Y. CLS Pub Health § 2500-e(7), relating to practitioners attending newborns. N.Y. Comp. Codes R. & Regs. tit. 10, § 69-3.5 requires health care providers attending newborn children of women with positive HBsAg test results to offer hepatitis B vaccine and hepatitis B immune globulin to such children within 12 hours of birth unless a specified individual determines that the child is not physiologically stable enough to permit immunization. The child must be immunized when they become physiologically stable. Healthcare providers attending newborn children of a woman whose test results are unavailable must offer the hepatitis B vaccine to each such child immediately upon receiving test results showing the mother has tested positive. If a woman’s HBsAg test result is unavailable, and her newborn child is about to be released or 48 hours have elapsed since birth, and if there is a reasonable likelihood that the child is positive for hepatitis B, the attending health care provider must offer or cause to be offered the hepatitis B vaccine to such child. N.Y. Comp. Codes R. & Regs. tit. 10, § 69-3.6 requires that health care providers providing follow-up care for newborns must arrange for follow-up doses of the hepatitis B vaccine to be administered: (1) 1 and 6 months; or (2) 1, 2 and 12 months after the first dose. N.Y. Comp. Codes R. & Regs. tit. 10, § 69-3.1 defines a “health care provider” as a physician or other health care professional licensed to practice in New York State. N.Y. CLS Pub Health § 2500-e(7) provides that if the mother of a newborn infant tests positive for hepatitis B surface antigen, the practitioner attending the infant must offer: (1) the hepatitis B vaccine and hepatitis B immune globulin to the newborn within 12 hours of birth or when the infant is physiologically stable, and (2) immunizing doses of hepatitis B vaccine and follow-up vaccine in accordance with the commissioner’s schedule. If the mother’s test results are unavailable when she is admitted to the hospital for delivery, the practitioner attending the infant must offer the hepatitis B vaccine and hepatitis B immune globulin for the newborn as soon as they receive results showing the mother has tested positive for hepatitis B surface antigen. | |
| [183] For New York requirements, see N.Y. Comp. Codes R. & Regs. tit. 12, § 800.3, which applies the occupational exposure requirements of 29 CFR § 1910.1030 to employers of public employees. 29 CFR § 1910.1030 requires employers to make available the hepatitis B vaccine and vaccination series to all public employees who have occupational exposure. The employer shall ensure that the hepatitis B vaccine and vaccination series and follow-up is made available at no cost to such employees. If the public employee initially declines vaccination but changes their mind while still covered under the standard, the employer shall make available the hepatitis B vaccine. If routine booster dose(s) are recommended by the U.S. Public Health Service, they shall be made available to the employee. | |
| [184] For New York requirements, see N.Y. Comp. Codes R. & Regs. tit. 10, § 751.6(d), relating to “treatment centers” and “diagnostic centers.” N.Y. Comp. Codes R. & Regs. tit. 10, § 751.6(d) requires the operator of a treatment or diagnostic center to ensure that a certificate for immunization against rubella and a certificate for immunization against measles is maintained for all employees born after January 1, 1957. The definition of “health care facility” includes diagnostic and treatment centers as defined in section 751.1. N.Y. Comp. Codes R. & Regs. tit. 10, § 751.1 defines diagnostic center and treatment center as “a medical facility with one or more organized health services not part of an inpatient hospital facility or vocational rehabilitation center primarily engaged in providing services and facilities to out-of-hospital or ambulatory patients by or under the supervision of a physician”. | |
| [186] For New York requirements, see N.Y. CLS Pub Health § 4710-a(1), relating to “shared health facilities,” and N.Y. CLS Pub Health §2805-h, relating to “hospitals (see N.Y. CLS Pub Health § 2801(1))”. N.Y. CLS Pub Health § 4710-a(1) requires the individual responsible for central coordination and management of the activities of a shared health facility to make available immunizations against poliomyelitis, mumps, measles, diphtheria and rubella to each person receiving care who is under the age of eighteen, who has not previously been vaccinated with such vaccines. While the language of the requirement does not make explicit whether this is an “offer” or “ensure” requirement, the presence of exemptions to the administration requirement suggest that vaccination is not voluntary, and thus the regulation is properly characterized as setting forth an “ensure” requirement. N.Y. CLS Pub Health §2805-h requires the person in charge of each hospital to make available immunizations against poliomyelitis, mumps, measles, diphtheria, and rubella to patients under age eighteen who have not previously received them. “Hospitals” are defined in N.Y. CLS Pub Health § 2801(1) as a facility or institution engaged principally in providing services by or under the supervision of a physician or, in the case of a dental clinic or dental dispensary, of a dentist, for the prevention, diagnosis or treatment of human disease, pain, injury, deformity or physical condition, including, but not limited to, a general hospital, public health center, diagnostic center, treatment center, dental clinic, dental dispensary, rehabilitation center other than a facility used solely for vocational rehabilitation, nursing home, tuberculosis hospital, chronic disease hospital, maternity hospital, lying-in-asylum, out-patient department, out-patient lodge, dispensary and a laboratory or central service facility serving one or more such institutions. Thus “hospital,” when referred to in the New York Consolidated Laws, would also include facilities which fall under this chart’s definition of “ambulatory care center.” Note also N.Y. Comp. Codes R. & Regs. tit. 10, § 420.4(d) and 420.3. N.Y. Comp. Codes R. & Regs. tit. 10, § 420.4(d) requires comprehensive ambulatory HIV programs to develop and implement specific policies and procedures for the prevention of disease transmission which require all patients to be immunized against preventable disease. N.Y. Comp. Codes R. & Regs. tit. 10, § 420.3 requires HIV antibody positive infants and children to be provided with immunization. However, the regulatory language fails to specify whether these are “offer” or “ensure” requirements. | |
| [196] For Nevada requirements, see Nev. Admin. Code ch. 441A, § 570, relating to “providers.” Nev. Admin. Code ch. 441A, § 570 requires the health care provider of an infant born to a woman carrying hepatitis B surface antigen to ensure that the infant is given hepatitis B immune globulin and hepatitis B vaccine within 12 hours of birth, with the vaccine series being completed on a schedule established by the division. Nev. Admin. Code ch. 441A, § 110 defines a “provider” as a physician, nurse, physician's assistant, or veterinarian licensed in accordance with state law. | |
| [197] For Nevada requirements, see Nev. Admin. Code ch. 449, § 5315, relating to “facilities for the treatment of irreversible renal disease.” Nev. Admin. Code ch. 449, § 5315 provides that if any member of the staff is susceptible to hepatitis B and has not been vaccinated for that disease, the facility shall offer vaccination for that disease to that member of the staff in accordance with the provisions of 29 CFR § 1910.1030(f)(1) and (2). 29 CFR § 1910.1030(f)(1) and (2) provides that employers must make available the hepatitis B vaccine and vaccine series to all employees who have occupational exposure. The employer shall ensure that the hepatitis B vaccine and vaccination series and follow-up is made available at no cost to the employee. Additional time, place and manner requirements apply to vaccine administration. The employer shall not make participation in a prescreening program a prerequisite for receiving hepatitis B vaccination. If the employee initially declines vaccination but changes their mind while still covered under the standard, the employer shall make the hepatitis B vaccine available. If a routine booster dose(s) is recommended by the U.S. Public Health Service, the dose(s) shall be made available to the employee free of charge. A “facility for the treatment of irreversible renal disease” is defined in Nev. Admin. Code ch. 449, § 0046 as a facility that is not part of a hospital and which provides peritoneal dialysis or hemodialysis or trains a person with a permanent irreversible renal impairment to perform dialysis for himself. Also note Nev. Admin. Code ch. 441A, § 550, relating to “medical facilities.” Nev. Admin. Code ch. 441A, § 550 provides that if a case having a disease caused by invasive Haemophilus influenzae type b is in a medical facility where there is a contact less than 2 years of age, each employee of the medical facility shall complete a course of antimicrobial prophylaxis. If a case having a disease caused by invasive Haemophilus influenzae type b is in a medical facility where there is a contact who is less than 2 years of age, and where 2 persons have been diagnosed as having a disease caused by invasive Haemophilus influenzae type b within 60 days, each member of the staff in the medical facility shall complete a course of antimicrobial prophylaxis, unless medically contraindicated, regardless of whether the staff member has received an immunization against Haemophilus influenzae type b. | |
| [198] For Nevada, no statute or regulation requires any ambulatory care facility to ensure that any patient is vaccinated with any vaccine. Note, however, Nev. Admin. Code ch. 441A, § 550, relating to “medical facilities.” Nev. Admin. Code ch. 441A, § 550 provides that if a case having a disease caused by invasive Haemophilus influenzae type b is in a medical facility where there is a contact who is less than 2 years of age, and where 2 persons have been diagnosed as having a disease caused by invasive Haemophilus influenzae type b within 60 days, each child in the medical facility shall complete a course of antimicrobial prophylaxis, unless medically contraindicated, regardless of whether the child has received an immunization against Haemophilus influenzae type b. | |
| [199] For Nevada requirements, see Nev. Rev. Stat. 432A.230, Nev. Admin. Code ch. 441A, § 675, Nev. Admin. Code ch. 441A, § 610, and Nev. Admin. Code ch. 432A, § 505, relating to “child care facilities.” Nev. Rev. Stat. 432A.230 provides that a child may not be admitted to any child care facility within this state, including a facility licensed by a county or city, unless his parent/guardian submits to the operator of the facility a certificate stating that the child has been immunized and has received proper boosters for that immunization or is complying with the schedules established by regulation pursuant to the Nev. Rev. Stat. 439.550 for the following diseases: diphtheria, tetanus, pertussis if the child is under 6 years of age; poliomyelitis, rubella, rubeola, and such other diseases as the local board of health or the state board of health may determine. The certificate must show that the required vaccines and boosters were given and must bear the signature of a licensed physician or his designee or a registered nurse or his designee attesting that certificate accurately reflects the child’s record of immunization. A child whose parent or guardian has not established a permanent residence in the county in which a child care facility is located and whose history of immunizations cannot be immediately confirmed by a physician in this state or a local health officer, may enter the child care facility conditionally if the parent or guardian: (1) agrees to submit within 15 days a certificate from a physician or local health officer that the child has received or is receiving the required immunizations; and (2) submits proof that he has not established a permanent residence in the county where the facility is located. Nev. Admin. Code ch. 441A, § 675 provides that the same day that a report of a case having rubella or a suspected case considered to have rubella in a school or child care facility is received, the principal, director, or other person in charge of the school or child care facility shall review the immunization records of all enrolled children to identify those who are not adequately immunized against rubella. The person in charge of the child care facility shall notify the parent/legal guardian of children who have not presented proof of immunity to rubella that the child is excluded from attendance at the child care facility, effective the following morning: (1) until proof of immunity to rubella is received by the child care facility; or (2) if the child has not been immunized against rubella because of a medical or religious exemption, until 14 days after the onset of the reported case. Nev. Admin. Code ch. 441A, § 610 provides that on the same day that a report of a case having measles or a suspected case considered to have measles in a school or child care facility is received, the principal, director or other person in charge of the school or child care facility shall review the records of immunization of all enrolled children to identify those who are not adequately immunized against measles. The person in charge of the child care facility shall notify the parent/legal guardian of children who have not presented proof of immunity to measles that the child is excluded from attendance at the child care facility, effective the following morning: (1) until proof of immunity to measles is received by the child care facility; or (2) if the child has not been immunized against measles because of a medical or religious exemption, until 14 days after the onset of the reported case. Nev. Admin. Code ch. 432A, § 505 provides that a child may not be enrolled in a child care facility in this state unless he has been immunized against Haemophilus influenzae type b. A “child care facility” is defined in Nev. Rev. Stat. 432A.024 as: (1) an establishment operated and maintained for the purpose of furnishing care on a temporary or permanent basis, during the day or overnight, to five or more children under 18 years of age, if compensation is received for the care of any of those children; (2) an on-site child care facility; or (3) an outdoor youth program. Because the statutory language is so broad, this chart assumes that the definition of “child care facility” covers residential facilities for the developmentally disabled or mentally retarded. Also note Nev. Admin. Code ch. 441A, § 550, relating to “child care facilities.” Nev. Admin. Code ch. 441A, § 550 provides that if a case having a disease caused by invasive Haemophilus influenzae type b is in a child care facility where there is a contact who is less than 2 years of age, and where 2 persons have been diagnosed as having a disease caused by invasive Haemophilus influenzae type b within 60 days, each child in the child care facility shall complete a course of antimicrobial prophylaxis, unless medically contraindicated, regardless of whether the child has received an immunization against Haemophilus influenzae type b. | |
| [202] For North Carolina requirements, see N.C. Admin. Code tit. 10A, r. 41A.0203 relating to attending physicians. N.C. Admin. Code tit. 10A, r. 41A.0203 provides that infants born to HBsAg-positive mothers shall be given hepatitis B vaccination and hepatitis B immune globulin within 12 hours of birth or as soon as possible after the infant is stabilized. Additional doses of hepatitis B shall be given in accordance with the current published Control of Communicable Diseases Manual (Manual) and Centers for Disease Control and Prevention Guidelines (Guidelines). The infant shall be tested for the presence of HBsAg and anti-HBsAg within 3 to 9 months after the last dose of the regular series of the vaccine; if required because of failure to develop immunity after the regular series, additional doses shall be given in accordance with the Guidelines and the Manual. Infants born to mothers who hepatitis B status is unknown shall be given hepatitis B vaccine within 12 hours of birth, and the mother tested. If the tested mother is found to be HBsAg-positive, the infant shall be given hepatitis B immune globulin as soon as possible and not later than 7 days after birth. When an acutely infected person is the primary caregiver of a susceptible infant less than 12 months of age, the infant shall receive an appropriate dose of hepatitis B immune globulin and hepatitis B vaccinations in accordance with the Manual and the Guidelines. | |
| [203] For North Carolina requirements, see N.C. Gen. Stat. § 130A-152, relating to all agencies having legal custody of any child in North Carolina. N.C. Gen. Stat. § 130A-152 provides that every child shall be immunized against diphtheria, tetanus, whooping cough, poliomyelitis, rubeola, and rubella. In addition, every child shall be immunized against any other disease upon a determination by the Commission that the immunization is in the interest of the public health. Every agency, whether governmental or private, with legal custody of a child is responsible for ensuring that the child has received the required immunizations. If the child has not received the required immunizations at the specified age, the responsible party shall obtain the required immunizations as soon as possible after the lack of immunization is determined. | |
| [206] For North Carolina requirements, see N.C. Admin. Code tit. 10A, r. 27H.0303 and N.C. Admin. Code tit. 10A, r. 27H.0304, relating to “group homes for developmentally disabled persons,” and N.C. Gen. Stat. § 130A-152, relating to all state agencies giving legal custody of children. N.C. Admin. Code tit. 10A, r. 27H.0303 provides that all group home residents shall be screened for hepatitis B virus. If screening indicates any resident or employee is a hepatitis B carrier, the following procedures shall be followed: (1) current residents and direct care employees without antibodies (who are not immune) shall be vaccinated with hepatitis B vaccine as required by 10A NCAC 41A.0203(b)(2); (2) written informed consent or refusal to be vaccinated shall be obtained from the employee and shall be documented in the employee’s personnel record; (3) the hepatitis B vaccination series shall be started within 10 working days following receipt of the screening results for non-immune direct care employees; and (4) during the 3 dose, 6 month immunization process, if a non-immune resident is exposed to the blood or other potentially infectious bodily fluids of a hepatitis B carrier, the procedure as outlined in 10A NCAC 41A.0203 B shall be followed. Note that 10A NCAC 41A.0203(b)(2) requires that, after testing, when a susceptible person has had sexual intercourse exposure to hepatitis B infection, the person shall be given a dose appropriate for their body weight of hepatitis B immune globulin and hepatitis B vaccination as soon as possible; hepatitis B immune globulin shall be given no later than 2 weeks after the last exposure. More generally, Rule .0203 provides for the administration of hepatitis B vaccine and/or hepatitis B globulin to exposed persons. Different procedures apply, depending on the identity of the exposed person and the nature of the contact. N.C. Admin. Code tit. 10A, r. 27H.0304 provides that the group home shall screen prospective residents who have been accepted for admission for hepatitis B infection prior to admission; and screen and offer hepatitis B vaccine to all persons accepted for employment within the first 10 days of employment. If a new resident or a new employee is determined to be a hepatitis B carrier and no hepatitis B carriers have previously been placed in, or are employed by, the group home, the procedure in Rule .0303 of this Section shall be followed. If a current resident or employee is a hepatitis B carrier, new residents and new employees without antibodies (who are not immune) shall begin the hepatitis B vaccine series before entering the home. N.C. Gen. Stat. § 130A-152 provides that every child shall be immunized against diphtheria, tetanus, whooping cough, poliomyelitis, rubeola, and rubella. In addition, every child shall be immunized against any other disease upon a determination by the Commission that the immunization is in the interest of the public health. Every agency, whether governmental or private, with legal custody of a child is responsible for ensuring that the child has received the required immunizations. If the child has not received the required immunizations at the specified age, the responsible party shall obtain the required immunizations as soon as possible after the lack of immunization is determined. | |
| [209] For North Dakota requirements, see N.D. Cent. Code § 23-07-17.1, relating to “child care facilities.” N.D. Cent. Code § 23-07-17.1. provides that a child may not be admitted into any child care facility operating in this state unless the child’s parent or guardian presents to the institution’s authorities a certification from a licensed physician or authorized representative of the state department of health that the child has received immunizations against diphtheria, pertussis, tetanus, measles, rubella, mumps, hepatitis B, Haemophilus influenzae type b, varicella, and poliomyelitis. A child may enter an institution under one of three circumstances: (1) upon submitting written proof from a licensed physician or authorized representative of the state department of health stating that the child has started receiving the required immunization; or (2) has written consent from the child’s parent/legal guardian for a local health service or department to administer the needed immunizations; or (3) has complied with the requirements for a certificate of exemption. This chart assumes that “child care facilities” include “residential child care facilities.” “Residential child care facilities” are defined in N.D. Cent. Code § 50-11-00.1 as a facility other than an occupied private residence providing foster care to more than 8 unrelated children, except as may be otherwise provided by rule or regulation. Based on a plain reading of the definitional language, this chart assumes that the definition of “residential child care facilities” covers residential facilities for the developmentally disabled or mentally retarded. | |
| [213] For Ohio requirements, see Ohio Admin. Code § 4715-20-01, relating to dentists and dental health care workers. Ohio Admin. Code § 4715-20-01 requires all dentists and dental health care workers to show evidence of immunity to or immunization against hepatitis B virus when such immunization does not threaten their health and well-being. Such immunization must begin prior to patient contact. Medical documentation must be maintained in the dental facility for each dentist and dental health care worker providing care in that facility. | |
| [217] For Oklahoma requirements, see Okla. Admin. Code § 310:675-9-31, relating to “nursing and specialized facilities.” Okla. Admin. Code § 310:675-9-31 provides that each facility shall document evidence of the offering of annual vaccination against influenza for each resident and for each employee, in accordance with the recommendations of the Advisory Committee on Immunization Practices (ACIP) for the Centers for Disease Control and Prevention most recent to the time of vaccination. Each facility shall document evidence of the offering of vaccination against pneumococcal disease for each resident, in accordance with the recommendations of the ACIP most recent to the time of vaccination. The immunizations provided for in this section may be waived because of medical contraindication or may be refused. Okla. Admin. Code § 310:675-1-2 defines “specialized facilities” as any facility which offers or provides inpatient long-term care services on a twenty-four hour basis to a limited category of persons requiring such services, including, but not limited to, a facility providing health or habilitation services for developmentally disabled persons, infants and/or children, or Alzheimer's and dementia residents. | |
| [218] For Oklahoma requirements, see Okla. Admin. Code § 130:12-3-4, relating to the J.D. McCarty Center for Children with Developmental Disabilities. Okla. Admin. Code § 130:12-3-4 provides that immunization is required for each inpatient. The person shall provide a current valid immunization record according to the most current Advisory Committee on Immunization Practices (ACIP) recommendations. If immunizations are not current, they shall be brought up to date during the admission with consent of the legal guardian providing no contraindications to immunization exist. | |
| [225] For Oregon requirements, see Or. Admin. R. 437-002-0360, relating to occupational exposure to bloodborne pathogens. Or. Admin. R. 437-002-0360 adopts by reference the requirements of 29 CFR § 1910.1030, requiring employers to make available the hepatitis B vaccine and vaccine series to all employees who have occupational exposure. The employer shall ensure that the hepatitis B vaccine and vaccination series and follow-up is made available at no cost to the employee. Additional time, place and manner requirements apply to vaccine administration. If the employee initially declines vaccination but changes their mind while still covered under the standard, the employer shall make the hepatitis B vaccine available. If a routine booster dose(s) is recommended by the U.S. Public Health Service, the dose(s) shall be made available to the employee free of charge. Also note Or. Rev. Stat. § 433.416, providing that an employer of a health care worker at risk of contracting an infectious disease in the course of employment shall provide to the worker preventative immunization for infectious disease if such preventative immunization is available and medically appropriate. Such preventative immunization shall be provided by the employer at no cost to the employee. A worker shall not be required as a condition of employment to be immunized under this section, unless such immunization is otherwise required under state or federal law, rule or regulation. | |
| [226] For Oregon requirements, see Or. Rev. Stat. § 421.465 and Or. Admin. R. 291-124-0065, relating to inmates. Or. Rev. Stat. § 421.465 requires that, before an inmate is sent to any forest work camp, the superintendent of the institution in which the inmate is confined shall cause the inmate to be given such inoculations as are necessary in the public interest. Or. Admin. R. 291-124-0065 requires that immunizations shall be made available to those inmates whose medical condition would be severely compromised if infected with those communicable diseases for which preventative therapies exist. | |
| [227] For Oregon requirements, see Or. Admin. R. 333-092-0075, relating to “nursing homes for the mentally retarded,” and Or. Rev. Stat. § 433.267, relating to “children’s facilities.” Or. Admin. R. 333-092-0075 provides that all residents shall be immunized and vaccinated for smallpox, diphtheria, tetanus, measles, polio, and pertussis. In addition, when indicated, immunizations against influenza shall be required. Or. Rev. Stat. § 433.267 provides that as a condition of attendance in any children’s facility in this state, every child through grade 12 shall submit a statement of immunizations received, or a statement of exemptions to immunization requirements, or a statement that immunization records will be provided in 30 days (if the child is transferring from another facility), to the facility administrator, unless the facility already has on file a record indicating that the child has received immunizations against the restrictable diseases set forth in Or. Rev. Stat. § 433.273. | |
| [230] For Pennsylvania requirements, see 28 Pa. Code § 27.99(b), relating to physicians attending, treating or examining pregnant women. 28 Pa. Code § 27.99(b) requires that when a mother tests positive for hepatitis B, a physician shall provide the appropriate prophylactic treatment to the newborn within 12 hours of birth. This is properly characterized as an “ensure” requirement because the statutory language also sets forth exemptions to this requirement, indicating that immunization is mandatory. Also note 24 Pa. Cons. Stat. § 14-1413, relating to the duties of school physicians. 24 Pa. Cons. Stat. § 14-1413 provides that the duties of school physicians include the vaccination of children with indigent parents, and official revaccination of children having temporary vaccination certificates. The statutory language does not indicate under what circumstances a physician is required to administer vaccine, only that it is within the purvey of his duties. In addition, note 35 P.S. § 634.3(b), providing that vaccination for the influenza virus and pneumococcal disease shall also be offered to an eligible person at facilities providing ongoing medical care to the extent possible as determined by the facility. 35 P.S. § 634.2 defines an eligible person as a person 65 years of age or older, and a “facility providing ongoing medical care” as including (among other sites) physician’s offices. However, this does not constitute an offer requirement, as the facility may determine that it is not feasible to offer the vaccine to its patients. | |
| [232] For Pennsylvania requirements, see 55 Pa. Code § 3800.143(a) and (e), relating to “child residential treatment facilities.” 55 Pa. Code § 3800.143(a) and (e) require child residential treatment facilities to give each child admitted a health exam within 15 days after admission and annually thereafter, or more frequently under certain circumstances. The health exam shall include immunizations as recommended by the American Academy of Pediatrics’ “Guidelines for Healthy Supervision”. “Child residential treatment facilities” are defined as a premises, or part thereof, operated in a 24-hour living setting in which care is provided for one or more children who are not relatives of the facility operator. The definition of “child” includes an individual who is under 21 years of age and who has committed an act of delinquency before reaching the age of 18 and remains under the jurisdiction of the juvenile court. The definitional language of 55 Pa. Code § 3800.143(a) and (e) thus covers juvenile detention facilities. | |
| [233] For Pennsylvania requirements, see 55 Pa. Code § 6400.141(a) and (c), relating to “community homes for individuals with mental retardation,” and 55 Pa. Code § 3800.143(a) and (e), relating to “child residential treatment facilities.” 55 Pa. Code § 6400.141(a) and (c) require that an individual shall have a physical exam prior to admission and annually thereafter, which shall include (1) immunizations for individuals 18 years of age or younger, as recommended by the U.S. Public Health Service, CDC; and (2) immunizations for individuals 17 years of age or younger, as recommended by the Standards of Child Health Care of the American Academy of Pediatrics. 55 Pa. Code § 3800.143(a) and (e) require that child residential treatment facilities give each child admitted a health exam within 15 days after admission and annually thereafter, or more frequently under certain circumstances. The health exam shall include immunizations as recommended by the American Academy of Pediatrics’ “Guidelines for Healthy Supervision”. “Child residential treatment facilities” are defined as a premises, or part thereof, operated in a 24-hour living setting in which care is provided for one or more children who are not relatives of the facility operator. The definition of “child” includes a child who has mental retardation, with a transfer plan to move to an adult setting by 21 years of age. The definitional language of 55 Pa. Code § 3800.143(a) and (e) thus covers residential facilities for the developmentally disabled or mentally retarded. | |
| [240] For Rhode Island requirements, see R23-17-HCW, “Rules and Regulations Pertaining to Immunization, Testing, and Health Screening for Health Care Workers”, promulgated pursuant to the authority conferred under Chapters 23-17 and 23-17.7.1 of the General Laws of Rhode Island and revised in October 2012. R23-17-HCW § 3.5.6 requires health care facilities to abide by the OSHA Blood Borne Pathogens Standard (29 CFR § 1910.1030), including the offering of hepatitis B vaccination to those health care workers at risk. Also, § 3.5.4 states that annual influenza vaccination is required for all health care workers as defined in R23-17-HCW § 1.6, subject to vaccine supply, and requires each health care facility to develop a specific plan to require annual influenza vaccination of all healthcare workers at no cost to the health care worker. R23-17-HCW § 5.4 further states that any health care worker may refuse the annual seasonal influenza vaccination requirements described in the Regulations provided that he or she provides proper annual written notice of refusal prior to December 15 each year and wears a surgical face mask during each direct patient contact in the performance of his or her duties during any declared period in which influenza is widespread. R23-17-HCW § 1.6 defines “health care worker” as any person who is temporarily or permanently employed by or at, or who serves as a volunteer in, or has an employment contract with, a health care facility as defined in § 2.1 of the Regulations, and has or may have direct contact with a patient in that health care facility. R23-17-HCW § 2.1 defines “health care facilities” as including but not limited to hospitals, nursing facilities, rehabilitation centers, kidney disease treatment centers, freestanding emergency care facilities, facilities providing surgical treatment to patients not requiring hospitalization, physician ambulatory surgery centers and podiatry ambulatory surgery centers, among others. | |
| [241] For Rhode Island requirements, see R23-17-HCW, “Rules and Regulations Pertaining to Immunization, Testing, and Health Screening for Health Care Workers”, promulgated pursuant to the authority conferred under Chapters 23-17 and 23-17.7.1 of the General Laws of Rhode Island and revised in October 2012. R23-17-HCW § 3.5.1 states that prior to employment, all health care workers (with the exception of health care workers who receive a medical exemption) must provide evidence of immunity to measles, mumps, and rubella via either two doses of MMR vaccine or two doses of live measles-containing vaccine, two doses of live mumps-containing vaccine, and one dose of rubella vaccine, or laboratory evidence of immunity or laboratory confirmation of disease. For current health care workers, unvaccinated health care workers born before 1957 who lack laboratory evidence of measles immunity or laboratory confirmation of disease, two doses of MMR vaccine are recommended. (During an outbreak of measles, two doses of MMR vaccine are required for unvaccinated health care workers born before 1957 who lack laboratory evidence of measles immunity or laboratory confirmation of disease.) Also, § 3.5.2 states that all health care workers (with the exception of health care workers who receive a medical exemption) must provide evidence of immunity to varicella via (a) two doses of varicella vaccine, with the second dose administered at least four weeks after the first dose, (b) laboratory evidence of immunity or laboratory confirmation of disease, (c) a healthcare provider diagnosis of varicella or healthcare provider verification of history of varicella disease, or (d) history of herpes zoster based on healthcare provider diagnosis. Finally, § 3.5.3 states that prior to employment, a single dose of Tdap (tetanus-diphtheria-pertussis) vaccine is required for all health care workers who have not previously received a dose of Tdap vaccine. Effective January 1, 2014, the requirement also applies to current employees as well as new employees. R23-17-HCW § 1.6 defines “health care worker” as any person who is temporarily or permanently employed by or at, or who serves as a volunteer in, or has an employment contract with, a health care facility as defined in § 2.1 of the Regulations, and has or may have direct contact with a patient in that health care facility. R23-17-HCW § 2.1 defines “health care facilities” as including but not limited to hospitals, nursing facilities, rehabilitation centers, kidney disease treatment centers, freestanding emergency care facilities, facilities providing surgical treatment to patients not requiring hospitalization, physician ambulatory surgery centers and podiatry ambulatory surgery centers, among others. | |
| [243] For South Carolina requirements, see S.C. Code Regs. 61-108, relating to “freestanding or mobile technology,” and S.C. Code Regs. 61-91, relating to “ambulatory surgical facilities.” S.C. Code Regs. 61-108 and S.C. Code Regs. 61-91 provide that all direct care staff who perform tasks involving contact with blood, blood-contaminated body fluids, other body fluids, or sharps shall have the hepatitis B vaccination series unless the vaccine is contraindicated or an individual is offered the series and declines. Also, all direct care staff shall have an annual influenza vaccination unless contraindicated or offered and declined, and all direct care staff shall have been vaccinated or have evidence of immunity for measles, rubella, and varicella prior to patient contact unless contraindicated or offered and declined. This chart interprets S.C. Code Regs. 61-108 and S.C. Code Regs. 61-91 as “ensure” requirements because exemptions to administration requirements are provided for, indicating that immunization is mandatory except under specified circumstances. | |
| [245] For South Carolina requirements, see S.C. Code Regs. 114-590, relating to “residential group care facilities for children.” S.C. Code Regs. 114-590 provides that each child shall be provided with appropriate inoculations. S.C. Code Regs. 114-590 defines “residential group care facilities for children” as including those organizations which provide temporary or long-term, full time residential care for children on a year-round basis such as child caring institutions, emergency shelters, group homes and organizations with supervised individual living facilities. Child caring institutions and group homes may also be further categorized as low management facilities, moderate management facilities, and high management facilities. Boarding schools that do not operate year-round or do not offer services beyond those associated with school programming are not encompassed within these regulations. “Group home” means any facility that provides residential care and maintenance to fewer than 10 children. “Child caring institution” means any facility that provides residential care and maintenance to 10 or more children. Based on a plain reading of the definitions of “residential group care facilities for children,” “group homes,” and “child caring institutions,” this chart assumes that the definition of “residential group care facilities for children” covers residential facilities for the developmentally disabled or mentally retarded. | |
| [247] For South Dakota requirements, see S.D. Admin. R. 44:04:02:09, relating to “medical facilities.” S.D. Admin. R. 44:04:02:09 provides that pathogen control must include a written exposure control plan, approved by the facility’s medical director or physician responsible for infection control, that addresses the requirements contained in 29 CFR § 1910.1030. 29 CFR § 1910.1030 requires employers to make available the hepatitis B vaccine and vaccine series to all employees who have occupational exposure. The employer shall not make participation in a prescreening program a prerequisite for receiving hepatitis B vaccination. If the employee initially declines vaccination but changes their mind while still covered under the standard, the employer shall make the hepatitis B vaccine available. If a routine booster dose(s) is recommended by the U.S. Public Health Service, the dose(s) shall be made available to the employee free of charge. See also South Dakota Executive Order 2014-11, which requires all state-employed personnel providing direct health care services in a clinic, office, home, or other setting, or any state-employed personnel whose routine work duties brings them into direct contact with a client or patient in a patient or client care area, and all state-employed personnel entering a licensed healthcare facility on a routine basis as part of their job responsibilities to be vaccinated against influenza by December 1 of each year. Exceptions to the requirement are provided to any person who has a documented medical contraindication to the influenza vaccination or who is adherent to a religious doctrine whose teachings are opposed to immunizations. South Dakota Executive Order 2014-11 applies to state employees working in healthcare facilities rather than all ambulatory care facility employees and therefore does not constitute a requirement for purposes of this database. | |
| [248] For South Dakota requirements, see S.D. Codified Laws § 13-28-7.1, requiring any pupil entering school or an early childhood program to present to the appropriate school authorities certification from a licensed physician that the child has received or is in the process of receiving adequate immunization against poliomyelitis, diphtheria, pertussis, rubeola, rubella, mumps, tetanus, and varicella, according to recommendations provided by the Department of Health. The Department of Health may modify or delete any of the required immunizations. As an alternative to the requirement for a physician's certification, the pupil may present: (1) Certification from a licensed physician stating the physical condition of the child would be such that immunization would endanger the child's life or health; or (2) A written statement signed by one parent or guardian that the child is an adherent to a religious doctrine whose teachings are opposed to such immunization. In South Dakota, the Department of Health’s Program Administrator for Correctional Health Services considers that juvenile detention facilities are certified schools, and immunizations are provided in such facilities pursuant to statutory requirements for schools. Communication from Joan Schueller, November 9, 2005. | |
| [251] For South Dakota requirements, see S.D. Admin. R. 67:42:09:19, relating to “child placement agencies,” and S.D. Codified Laws § 27B-3-17 and § 27B-3-18, relating to “state institutions for persons with developmental disabilities.” S.D. Admin. R. 67:42:09:19 requires the agency to obtain current immunizations and vaccinations in accordance with S.D. Codified Laws § 13-28-7.1 for each child in its care. S.D. Codified Laws § 13-28-7.1 provides that each pupil entering school or an early childhood program in this state shall, prior to admission, be required to present to the appropriate school authorities certification from a licensed physician that the child has received a test for tuberculosis and is free from a contagious form of tuberculosis and the child has received or is in the process of receiving adequate immunization against poliomyelitis, diphtheria, pertussis, rubeola, rubella, mumps, tetanus, and varicella, according to recommendations provided by the Department of Health. “Child placement agencies” are defined in S.D. Admin. R. 67:42:09:01 to include “group homes.” “Group homes” are further defined in S.D. Admin. R. 46:11:01:01 as a congregate residential facility, other than a supervised apartment, for individuals with developmental disabilities, which is certified by the department according to chapter 46:11:02 to provide residential services, training in skills needed for independent living, recreational activities, and basic supervision for individuals with developmental disabilities. S.D. Codified Laws § 27B-3-17 provides that any person with a developmental disability voluntarily or involuntarily admitted to the facility shall be tested for communicable diseases as deemed necessary by a licensed physician in charge of tests and immunizations at the facility, by such means of tests and immunizations as are approved by the Department of Health. S.D. Codified Laws § 27B-3-18 provides that the facility shall provide to persons with developmental disabilities the required tests and the immunizations that are not provided by a parent or guardian, and have not been exempted pursuant to § 27B-3-17. This chart assumes that S.D. Codified Laws § 27B-3-17 and § 27B-3-18 set forth “ensure” requirements because exemptions to the administration requirement are provided, indicating that the immunization requirements are mandatory. Also note S.D. Admin. R. 46:17:05:02, requiring the South Dakota Development Center to provide or obtain preventative or general medical care as well as annual physical examinations of each individual that include immunizations. However, the language is too vague to conclusively determine whether this is an “offer” or “ensure” requirement. | |
| [254] For Tennessee requirements, see Tenn. Comp. R. & Regs. 0250-4-2-.07, relating to “group care homes,” Tenn. Comp. R. & Regs. 0250-4-5-.07, relating to “residential child caring agencies,” Tenn. Comp. R. & Regs. 0940-5-1-.05, relating to “mental retardation institutional habilitation facilities,” and Tenn. Comp. R. & Regs. 0940-5-24-.01, relating to “mental retardation residential habilitation facilities.” Tenn. Comp. R. & Regs. 0250-4-2-.07 and Tenn. Comp. R. & Regs. 0250-4-5-.07 provide that the following immunizations shall be begun before admission and must be completed within 6 months: diphtheria, whooping cough (for children under 7 years of age), tetanus, polio, measles, rubella, mumps and others recommended by the physician. Tenn. Comp. R. & Regs. 0940-5-1-.05 requires the facility to ensure that each client is provided with immunizations as required by the Department of Health and Environment unless contraindicated by a physician’s order. Tenn. Comp. R. & Regs. 0940-5-24-.01 requires the facility to require that a service recipient receive immunizations as required by the Department of Health unless contraindicated by a doctor’s written orders. Tenn. Code Ann. § 39-17-1603 defines “group care homes” as a home operated by any person, society, agency, corporation, or institution, or any group which receives 7 or more children for full-time care outside their own homes in facilities owned or rented and operated by the organization. A plain reading of the broad language used to describe “group care homes” suggests that the statutory definition would cover residential facilities for the developmentally disabled or mentally retarded. Tenn. Comp. R. & Regs. 0250-4-5-.01 defines “residential child caring agencies” as any institution, society, agency, or facility, whether incorporated or not, which either primarily or incidentally provides full time care for 13 or more children under 17 years of age outside their own homes in facilities owned or rented and operated by the organization. For licensing purposes this definition is further expanded to mean the full-time care of 13 or more children in one or more buildings on contiguous property with one administrator. A plain reading of the broad language used to describe “residential child caring agencies” suggests that the statutory definition would cover residential facilities for the developmentally disabled or mentally retarded. | |
| [259] For Texas requirements, see Tex. Health & Safety Code § 161.004(c) and 25 Tex. Admin. Code § 97.101(d). Tex. Health & Safety Code § 161.004(c) provides that physicians must administer any needed immunizations or refer for immunization children admitted to a hospital ER or outpatient clinic. 25 Tex. Admin. Code § 97.101(d) requires all physicians and other health care providers who provide health care to children to administer needed vaccines or refer every child needing immunization to another provider. Note also that Tex. Health & Safety Code § 161.0052(d) provides that the Texas State Board of Medical Examiners by rule shall require a physician responsible for the management of a physician's office that provides ongoing medical care to elderly persons to offer, to the extent possible as determined by the physician, the opportunity to receive the pneumococcal and influenza vaccines to each elderly person who receives ongoing care at the office. However, this does not constitute an offer requirement as the physician may determine that it is not feasible to offer the vaccine to his/her patients. | |
| [263] For Texas requirements, see 25 Tex. Admin. Code § 96.202, relating to all publicly owned or financed institutions, and 25 Tex. Admin. Code § 117.34(a)(1), relating to “end stage renal disease facilities.” 25 Tex. Admin. Code § 96.202 provides that all publicly owned or financed institutions that provide health services, even if health services are not their primary purpose, shall comply with state and federal laws regarding bloodborne pathogen exposure. The federal OSHA requirement, 29 CFR § 1910.1030, requires that employers make available the hepatitis B vaccine series to all employees who have occupational exposure. If the employee initially declines the vaccine but changes their mind while still covered under the standard, the employer shall make hepatitis B vaccine available. If a routine booster dose(s) is recommended by the U.S. Public Health Service, the dose(s) shall be made available to the employee free of charge. 25 Tex. Admin. Code § 117.34(a)(1) incorporates by reference 29 CFR § 1910.1030. Note also 25 Tex. Admin. Code §1.702, which requires each health care facility to develop, implement, and enforce a policy and procedures to protect its patients from vaccine preventable diseases. The policy must, among other things, require covered individuals to receive vaccines for the vaccine preventable disease specified by the facility based on the level of risk the individual presents to patients by the individuals routine and direct exposure to patients, specify the vaccines a covered individual is required to receive based on the level of risk the individual presents to patients by the individuals routine and direct exposure to patients, and include procedures for verifying whether a covered individual has complied with the policy. The policy must include procedures for covered individuals to be exempt from the required vaccines for medical conditions identified as contraindications or precautions by the federal Centers for Disease Control and Prevention, and may include procedures for exemptions based on reasons of conscience, including a religious belief. 25 Tex. Admin. Code §1.701 defines “health care facility” to include ambulatory surgical centers, birthing centers, abortion facilities, end stage renal disease facilities, and freestanding emergency medical care facilities, among others, licensed under the Texas Health and Safety Code. | |
| [264] For Texas requirements, see 25 Tex. Admin. Code § 117.34, relating to “end stage renal disease facilities”. 25 Tex. Admin. Code § 117.34 requires facility staff to make available hepatitis B vaccine to all patients who are susceptible, provided that they are willing to pay for the vaccine. Note also that Tex. Health & Safety Code § 161.0052(c) provides that the executive commissioner of the Health and Human Services Commission by rule shall require an end stage renal disease facility to offer, to the extent possible as determined by the facility, the opportunity to receive the pneumococcal and influenza vaccines to each elderly person who receives ongoing care at the facility if a physician, or an advanced nurse practitioner or physician assistant on behalf of a physician, determines that the vaccine is in the person's best interest. However, this does not constitute an offer requirement as the facility may determine that it is not feasible to offer the vaccine to its patients. | |
| [265] For Texas requirements, see 25 Tex. Admin. Code § 97.101(d), relating to all healthcare providers providing health care to children in Texas. 25 Tex. Admin. Code § 97.101(d) requires all healthcare providers providing health care to children in Texas to administer needed vaccines or refer for immunization each child examined. | |
| [268] For Texas requirements, see Tex. Health & Safety Code § 161.005, 25 Tex. Admin. Code § 97.102, and 25 Tex. Admin. Code § 97.61, relating to facilities of the Texas Department of Criminal Justice and the Texas Youth Commission. Tex. Health & Safety Code § 161.005 requires that on admission to a facility of the Texas Youth Commission or the Texas Department of Criminal Justice, the facility physician shall administer needed vaccinations to the child or refer the child for vaccinations. 25 Tex. Admin. Code § 97.102 requires that the facility physician administer needed immunizations or refer the child for immunization, where needed immunizations are diphtheria, tetanus, poliomyelitis, pertussis, Haemophilus influenzae type b, measles, mumps, rubella, hepatitis B and varicella. 25 Tex. Admin. Code § 97.61 provides that the vaccines required by 25 Tex. Admin. Code § 97.63 are also required for all children in the State of Texas, including children admitted, detained, or committed in Texas Department of Criminal Justice, Texas Mental Health and Mental Retardation, and Texas Youth Commission facilities. 25 Tex. Admin. Code § 97.63 requires a child or student to show acceptable evidence of vaccination prior to entry, attendance, or transfer to a child-care facility or public or private elementary or secondary school, or institution of higher education. Children enrolled in child-care facilities, pre-kindergarten, or early childhood programs shall have the following: (1) age-appropriate vaccination against diphtheria, pertussis, tetanus, poliomyelitis, Haemophilus influenzae type b, measles, mumps, rubella, hepatitis B, and varicella in accordance with the Texas Department of Health Immunization Schedule as informed by the Advisory Committee on Immunization Practices’ (ACIP) recommendations and adopted by the Texas Board of Health and published in the Texas Register annually; and (2) age-appropriate vaccination against hepatitis A for children attending a child-care facility, pre-kindergarten or early childhood programs located in a high incidence geographic area as designated by the department. § 97.63 also provides further information about schedules and dosages. | |
| [272] For Texas requirements, see Tex. Health & Safety Code § 161.005, 25 Tex. Admin. Code § 97.102, and 25 Tex. Admin. Code § 97.61, relating to facilities of the Texas Department of Mental Health and Retardation. Tex. Health & Safety Code § 161.005 requires that on admission to a facility of the Texas Department of Mental Health and Retardation, the facility physician shall administer needed vaccinations to the child or refer the child for vaccinations. 25 Tex. Admin. Code § 97.102 requires that the facility physician administer needed immunizations or refer the child for immunization, where needed immunizations are diphtheria, tetanus, poliomyelitis, pertussis, Haemophilus influenzae type b, measles, mumps, rubella, hepatitis B and varicella. 25 Tex. Admin. Code § 97.61 provides that the vaccines required by 25 Tex. Admin. Code § 97.63 are also required for all children in the State of Texas, including children admitted, detained, or committed in Texas Department of Criminal Justice, Texas Mental Health and Mental Retardation, and Texas Youth Commission facilities. 25 Tex. Admin. Code § 97.63 requires a child or student to show acceptable evidence of vaccination prior to entry, attendance, or transfer to a child-care facility or public or private elementary or secondary school, or institution of higher education. Children enrolled in child-care facilities, pre-kindergarten, or early childhood programs shall have the following: (1) age-appropriate vaccination against diphtheria, pertussis, tetanus, poliomyelitis, Haemophilus influenzae type b, measles, mumps, rubella, hepatitis B, and varicella in accordance with the Texas Department of Health Immunization Schedule as informed by the Advisory Committee on Immunization Practices’ (ACIP) recommendations and adopted by the Texas Board of Health and published in the Texas Register annually; and (2) age-appropriate vaccination against hepatitis A for children attending a child-care facility, pre-kindergarten or early childhood programs located in a high incidence geographic area as designated by the department. § 97.63 also provides further information about schedules and dosages. | |
| [276] For Utah requirements, see Utah Admin. Code R386-702-9, subsections 5-7, which provide that every hospital and birthing facility shall develop a policy to assure that infants born to HBsAg positive mothers receive hepatitis B immune globulin (HBIG) and hepatitis B vaccine, administered at separate injection sites, within 12 hours of birth, and that infants born to mothers whose HBsAg status is unknown receive hepatitis B vaccine within 12 hours of birth, and if the infant is born preterm with birth weight less than 2,000 grams, that infant also receives HBIG within 12 hours. Local health departments shall perform the following activities or assure that they are performed: Infants born to HBsAg positive mothers complete the hepatitis B vaccine series as specified in Table 3.18, page 328 and Table 3.21, page 333 of the reference listed in [(8)]subsection (9), children born to HBsAg positive mothers are tested for HBsAg and antibody against hepatitis B surface antigen (anti-HBs) at 9 to 15 months of age (3-9 months after the third dose of hepatitis B vaccine) to monitor the success of therapy and identify cases of perinatal hepatitis B infection, and children who test negative for HBsAg and do not demonstrate serological evidence of immunity against hepatitis B when tested as described in (b) receive additional vaccine doses and are retested as specified on page 332 of the reference listed in [(8)]subsection (9). The provisions of subsections (5) and (6) do not apply if the pregnant woman or the child's guardian, after being informed of the possible consequences, objects to any of the required procedures on the basis of religious or moral beliefs. The hospital or birthing facility shall document the basis of the objection. | |
| [279] For Utah requirements, see Utah Admin. Code R432-500-11, relating to “freestanding ambulatory surgical centers.” Utah Admin. Code R432-500-11 provides that facilities shall be in compliance with the Occupational Safety and Health Administration’s (OSHA) Bloodborne Pathogens Standard. The OSHA Bloodborne Pathogens standard, set forth in 29 CFR § 1910.1030, requires employers to make available the hepatitis B vaccine and vaccine series to all employees who have occupational exposure. If the employee initially declines vaccination but changes their mind while still covered under the standard, the employer shall make the hepatitis B vaccine available. If a routine booster dose(s) is recommended by the U.S. Public Health Service, the dose(s) shall be made available to the employee free of charge. | |
| [280] For Utah requirements, see Utah Admin. Code R547-1-16, relating to “residential nonsecure community programs,” and Utah Admin. Code R547-3-3, relating to “juvenile jail facilities certified beyond a 6 hour hold.” Utah Admin. Code R547-1-16 provides that a residential program shall ensure that the youth has received all immunizations and booster shots which are required by the Department of Health within 30 days of his/her admission. A residential program shall also establish an ongoing immunization program. Utah Admin. Code R547-3-3 provides that, for juveniles detained in jail beyond six hours, a history of the juvenile's immunizations will be obtained within 30 days of admission and at the time the health appraisal data are collected. Immunizations are to be updated, as required, within legal constraints. | |
| [281] For Utah requirements, see Utah Admin. Code R432-152-16, relating to “mental retardation facilities.” Utah Admin. Code R432-152-16 requires the facility to provide immunizations, using as a guide the current recommendations of the Public Health Service Advisory Committee on Immunization Practices or of the Committee on the Control of Infectious Diseases of the American Academy of Pediatrics. | |
| [283] For Vermont requirements, see VT. Code R. 13-140-042, relating to occupational exposure. VT. Code R. 13-140-042 incorporates 29 CFR § 1910.1030, providing that employers must make available the hepatitis B vaccine and vaccine series to all employees who have occupational exposure. The employer shall ensure that the hepatitis B vaccine and vaccination series and follow-up is made available at no cost to the employee. If the employee initially declines vaccination but changes their mind while still covered under the standard, the employer shall make the hepatitis B vaccine available. If a routine booster dose(s) is recommended by the U.S. Public Health Service, the dose(s) shall be made available to the employee free of charge. | |
| [284] For Vermont requirements, see VT. Code R. 13-150-007, relating to “intermediate care facilities for the mentally retarded.” VT. Code R. 13-150-007 requires the facility to have preventive health services for residents that include immunizations, using as a guide the recommendations of the Public Health Service Advisory Committee on Immunization Practices and of the Committee on the Control of Infectious Diseases of the American Academy of Pediatrics. | |
| [291] For Washington requirements, see Wash. Admin. Code § 246-329-110 (2007), relating to childbirth centers. Wash. Admin. Code § 246-329-110(1)(f)(ii) provides that birth centers must provide or offer to employees Hepatitis B vaccination according to Wash. Admin. Code § 296-62-08001. See also Wash. Admin. Code § 296-823-13005 relating to occupational exposure. Wash. Admin. Code § 296-823-13005 provides that employers must ensure that the hepatitis B vaccine series is available to all employees who have occupational exposure and that it is made available at no cost to the employee, the vaccine series is provided in accordance with the recommendations of the United States Public Health Service that are current at the time these evaluations and procedures take place, and the vaccine series is made available to any employee who initially declines the vaccination but later decides to accept while still covered under this chapter. | |
| [292] For Washington requirements, see Wash. Admin. Code § 137-91-080, relating to “adult correctional institutions.” Wash. Admin. Code § 137-91-080 requires the health care program operated by the department of corrections to include immunizations, as indicated. | |
| [293] For Washington requirements, see Wash. Admin. Code § 388-148-0340, relating to “group care facilities” and “staffed residential homes.” Wash. Admin. Code § 388-148-0340 provides that children must have proof of current immunizations. Facilities may accept a child who has not received all immunizations on a conditional basis if immunizations are started as soon as medically possible. Wash. Admin. Code § 388-148-0010 defines a “group care facility” as a location maintained and operated for a group of children on a twenty-four-hour basis. Wash. Admin. Code § 388-148-0010 defines a “staffed residential home” as a licensed home providing twenty-four-hour care for six or fewer children or expectant mothers. The home may employ staff to care for children or expectant mothers. It may or may not be a family residence. Based on a plain reading of the definitional language, this chart assumes that the definition of “group care facilities” and “staffed residential homes” covers residential facilities for the developmentally disabled and mentally retarded. | |
| [294] For West Virginia requirements, see Department of Human Services, Minimum Licensing Requirements for Group Residential Facilities in West Virginia, 78CSR3, section 76 and section 78, relating to “group residential facilities.” West Virginia, 78CSR3, section 76 requires residential facilities, after attempting to determine a child's immunization history, to ensure that the child has received all immunizations and booster shots which are required by the Department of Health. This process shall be initiated within 30 days of his/her admission. Section 78 provides that a residential facility shall make every effort to compile a complete past medical history on every child. W. Va. Code § 27-17-1 defines a “group residential facility” as a facility which is owned or leased by a behavioral health service provider and which: (1) provides residential services and supervision for individuals who are developmentally disabled or behaviorally disabled; (2) is occupied as a residence by not more than eight individuals who are developmentally disabled and not more than three supervisors, or is occupied as a residence by not more than twelve individuals who are behaviorally disabled and not more than three supervisors; (3) is licensed by the department of health or the division of human services; and (4) complies with the state fire commission for residential facilities. | |
| [296] For Wisconsin requirements, see Wis. Adm. Code § 124.07, relating to “hospitals.” Wis. Adm. Code § 124.07 provides that the hospital's employee health program shall include vaccination or confirmed immunity against rubella for everyone who has direct contact with rubella patients, pediatric patients or female patients of childbearing age. No individual without documented vaccination against or immunity to rubella may be placed in a position in which he or she has direct contact with rubella patients, pediatric patients or female patients of childbearing age, except that individuals placed in these positions before February 1, 1988 shall have one year after February 1, 1988 to comply with this requirement, and that individuals newly placed in these positions on or after February 1, 1988 shall have 30 days after they begin working in these positions to comply with this requirement. Wis. Stat. § 50.33 defines a “hospital” as any building, structure, institution or place devoted primarily to the maintenance and operation of facilities for the diagnosis, treatment of, and medical or surgical care for 3 or more non-related individuals hereinafter designated patients, suffering from illness, disease, injury, or disability, whether physical or mental, and including pregnancy, and regularly making available at least clinical laboratory services, and diagnostic X-ray services and treatment facilities for surgery, or obstetrical care, or other definitive medical treatment. “Hospital” may include, but not in limitation thereof by enumeration, related facilities such as outpatient facilities, nurses’, interns’, and resident’s quarters, training facilities and central service facilities operated in connection with hospitals. “Hospital” includes “special hospitals” or those hospital facilities that provide a limited type of medical or surgical care, including orthopedic hospitals, children’s hospitals, critical access hospitals, mental hospitals, psychiatric hospitals or maternity hospitals. Because the definition of “hospital” does not restrict covered facilities to those providing 24-hour care, this chart assumes that the definition of “hospital” includes facilities that would be designated “ambulatory care facilities” under the definition provided by this chart. | |
| [297] For Wisconsin requirements, see Wis. Adm. Code § 52.63 and Wis. Admin. Code § 52.41, relating to “residential care centers for children and youth,” and Wis. Adm. Code § 52.05, relating to “child care institutions.” Wis. Adm. Code § 52.63 provides that any child who has not received primary immunization prior to admission against poliomyelitis, diphtheria, tetanus, whooping cough (to age 6), mumps, rubella, or rubeola shall be so immunized within 30 days after admission. Necessary booster shots shall be administered to children on admission and while in care at time intervals recommended by the American Academy of Pediatrics or the Division of Public Health. Wis. Admin. Code § 52.41 provides that each center shall have a written operating plan, describing available treatments. Available treatments shall include health care services to residents, including immunization of residents. Wis. Adm. Code § 52.03 defines a “residential care center for children and youth” as a residential facility required to be licensed as a child care agency under Wis. Stat. § 48.60, which provides treatment and custodial services for children, youth and young adults ages 18, 19, and 20. Note that “residential care centers for children and youth” were formerly called child care institutions, and in Wis. Stat. § 48 are referred to as child welfare agencies. Wis. Adm. Code § 52.05 provides that any child who has not received primary immunization prior to admission against poliomyelitis, diphtheria, tetanus, whooping cough (to age 6), mumps, rubella, or rubeola shall be so immunized within 30 days after admission. Necessary booster shots shall be administered to children on admission and while in care at time intervals recommended by the American Academy of Pediatrics or the Division of Health. Wis. Adm. Code § 52.63 defines “child care institution” as a child welfare agency which regularly provides care and maintenance for children within the confines of its building. Wis. Adm. Code § 52.63 defines a “child welfare agency” as any person required to be licensed under Wis. Stat. § 48.60. Wis. Stat. § 48.60 provides that no person may receive children, with or without transfer of legal custody, to provide care and maintenance for 75 days in any consecutive 12-month period for 4 or more such children at any one time unless that person obtains a license to operate a child welfare agency from the department. Based on a plain reading of the definitional language, this chart assumes that “residential care centers for youth and children” and “child care institutions” include juvenile detention centers. | |
| [299] For Wisconsin requirements, see Wis. Adm. Code § 52.63 and Wis. Admin. Code § 52.41, relating to “residential care centers for children and youth,” Wis. Adm. Code § 52.05, relating to “child care institutions,” and Wis. Adm. Code § 134.66, relating to “facilities serving people with developmental disabilities.” Wis. Adm. Code § 52.63 provides that any child who has not received primary immunization prior to admission against poliomyelitis, diphtheria, tetanus, whooping cough (to age 6), mumps, rubella, or rubeola shall be so immunized within 30 days after admission. Necessary booster shots shall be administered to children on admission and while in care at time intervals recommended by the American Academy of Pediatrics or the Division of Public Health. Wis. Admin. Code §52.41 provides that each center shall have a written operating plan, describing available treatments. Available treatments shall include health care services to residents, including immunization of residents. Wis. Adm. Code § 52.03 defines a “residential care center for children and youth” as a residential facility required to be licensed as a child care agency under Wis. Stat. § 48.60, which provides treatment and custodial services for children, youth and young adults ages 18, 19, and 20. Note that “residential care centers for children and youth” were formerly called child care institutions, and in Wis. Stat. § 48 are referred to as child welfare agencies. Wis. Adm. Code § 52.05 provides that any child who has not received primary immunization prior to admission against poliomyelitis, diphtheria, tetanus, whooping cough (to age 6), mumps, rubella, or rubeola shall be so immunized within 30 days after admission. Necessary booster shots shall be administered to children on admission and while in care at time intervals recommended by the American Academy of Pediatrics or the Division of Health. Wis. Adm. Code § 52.63 defines “child care institution” as a child welfare agency which regularly provides care and maintenance for children within the confines of its building. Wis. Adm. Code § 52.63 defines a “child welfare agency” as any person required to be licensed under Wis. Stat. § 48.60. Wis. Stat. § 48.60 provides that no person may receive children, with or without transfer of legal custody, to provide care and maintenance for 75 days in any consecutive 12 months period for 4 or more such children at any one time unless that person obtains a license to operate a child welfare agency from the department. Wis. Adm. Code § 134.66 provides that the facility shall promptly detect resident health problems by means of adequate medical surveillance and regular medical examinations, including annual examinations of vision and hearing, routine immunizations and tuberculosis control measures, and shall refer residents for treatment of these problems. | |
| [513] For Tennessee requirements, see Tenn. Comp. R. and Regs. 1200-8-10-.04 (2007), relating to standards for ambulatory surgical treatment centers. Tenn. Comp. R. and Regs. 1200-8-10-.04(20)(f) provides that the facility shall have an annual influenza vaccination program which shall include at least the offer of influenza vaccination to all staff and independent practitioners or accept documented evidence of vaccination from another vaccine source or facility.The program shall also include a signed declination statement on record from all who refuse vaccination for other than medical contraindications, education of direct care personnel about influenza transmission and control, and an annual evaluation of the program including reasons for non-participation. | |
| [518] For D.C. requirements, see 22 DCMR § 2615.6 and .9, relating to “maternity centers”. 22 DCMR § 2615.6 states that all personnel must have a pre-employment physical examination, including tuberculin testing, and demonstrate evidence of immunity to rubella or a rubella vaccination prior to employment. 22 DCMR § 2615.9 states that all maternity center personnel who are exposed to blood shall demonstrate evidence of full immunization against hepatitis B or documentation of refusal. | |
| [521] For Pennsylvania, no regulation or statute specifically requires ambulatory care facilities to offer any immunization to their patients. Note, however, 35 P.S. § 634.3(b), providing that vaccination for the influenza virus and pneumococcal disease shall also be offered to an eligible person at facilities providing ongoing medical care to the extent possible as determined by the facility. 35 P.S. § 634.2 defines an eligible person as a person 65 years of age or older, and a “facility providing ongoing medical care” as including (among other sites) hemodialysis centers. However, this does not constitute an offer requirement, as the facility may determine that it is not feasible to offer the vaccine to its patients. | |
| [522] For Rhode Island requirements, see R.I. Code R. 03-012-001 relating to training schools and detention centers under the Division of Juvenile Correctional Services. R.I. Code R. 03-012-001, Policy 1200.1101 states that all residents excluding overnight and weekend holds will receive a comprehensive physical examination during the intake process. The procedure from Policy 1200.1101 for the intake physical examination further states that each resident admitted on weekdays shall be given a comprehensive physical examination by a qualified physician forty-eight (48) hours following admission, and residents admitted on weekends shall be examined within seventy-two hours (72) hours following admission. The comprehensive medical examination shall include required immunizations and a blood profile to include VDRL and rubella titre, sickle cell, and HBsAg, among others. | |
| [535] For Minnesota requirements, see Minn. R. 5205.0010 (2004), which states that the Minnesota Department of Labor and Industry Occupational Safety and Health Codes and rules are amended by incorporating and adopting by reference, and thereby making a part thereof , Title 29 of the Code of Federal Regulations, “Occupational Exposure to Bloodborne Pathogens; Final Rules.” 29 CFR § 1910.1030 provides that employers must make available the hepatitis B vaccine and vaccine series to all employees who have occupational exposure. The employer shall ensure that the hepatitis B vaccine and vaccination series and follow-up is made available at no cost to the employee. Additional time, place and manner requirements apply to vaccine administration. | |
| [549] For California requirements, see Cal. Code Regs. tit. 8, § 5193, relating to all occupational exposures. Cal. Code Regs. tit. 8, § 5193 requires that for all employees with occupational exposure, hepatitis B vaccination shall be made available after the employee has received the training required in subsection (g)(2)(G)9. and within 10 working days of initial assignment to all employees who have occupational exposure unless the employee has previously received the complete hepatitis B vaccination series, antibody testing has revealed that the employee is immune, or the vaccine is contraindicated for medical reasons. If the employee initially declines vaccine but at a later date while still covered under the standard changes their mind, the employer shall make the hepatitis B vaccine available at that time. If a routine booster dose(s) of hepatitis B vaccine is recommended by the U.S. Public Health Service at a future date, such booster dose(s) shall be made available. See also Cal. Code Regs. tit. 8, § 5199, relating to “aerosol transmissible diseases”. Cal. Code Regs. tit. 8, § 5199(h)(5) requires employers to make available to all susceptible healthcare workers with occupational exposure all vaccine doses listed in Appendix E. Doses listed in Appendix E include seasonal influenza vaccine, measles, mumps, and rubella vaccine, varicella vaccine, and tetanus-diphtheria-acellular pertussis (Tdap) vaccine. Employers are required to ensure that employees who decline to accept a recommended and offered vaccination sign the declination statement in Appendix C1 for each declined vaccine. Cal. Code Regs. tit. 8, § 5199 applies to hospitals, skilled nursing facilities, clinics, medical offices and other outpatient medical facilities, among others. Outpatient medical facilities whose policy is not to diagnose or treat aerosol transmissible diseases are not required to comply with this standard if they meet certain other conditions. The requirements in subsection (h)(5) will become effective on September 1, 2010. | |
| [556] For Massachusetts requirements, see Mass. Regs. Code tit. 105, § 140.150, relating to requirements that personnel be vaccinated against influenza virus.Mass. Regs. Code tit. 105, § 140.150(B) provides that each clinic shall ensure that all personnel are vaccinated with seasonal influenza vaccine unless an individual declines vaccination in accordance with Mass. Regs. Code tit. 105, § 140.150(F). Mass. Regs. Code tit. 105, § 140.150(A) defines personnel as individuals employed by or affiliated with the hospital, whether directly, by contract with another entity, or as an independent contractor, paid or unpaid, including but not limited to employees, members of the medical staff, contract employees or staff, students, and volunteers who either work at or come to the licensed hospital site, whether or not such individual(s) provide direct patient care. Mass. Regs. Code tit. 105, § 140.020 defines clinic as “any entity, however organized, whether conducted for profit or not for profit, which is advertised, announced, established or maintained for the purpose of providing ambulatory medical, surgical, dental, physical rehabilitation, or mental health services. | |
| [566] For Colorado requirements, see 6 CCR 1011-1, Chapter 2, Part 10, pertaining to influenza immunization of healthcare workers. 6 CCR 1011-1 Chapter 2, §10.8 provides that each licensed hospital, hospital unit, ambulatory surgical center and long-term care facility shall have a written policy regarding the annual influenza immunization of its healthcare workers that, at a minimum, ensures that each of its healthcare workers has either proof of immunization or a medical exemption signed by a physician, physician’s assistant, advanced practice nurse or nurse midwife licensed in the State of Colorado stating that influenza vaccination for that individual is medically contraindicated as described in the product labeling approved by the United States Food and Drug Administration. 6 CCR 1011-1 Chapter 2, §10.8 additionally provides that such written policy must ensure that each healthcare worker who does not have proof of immunization wears a surgical or procedure mask during influenza season when in direct contact with patients and in common areas as specified by the licensee’s policy. 6 CCR 1011-1 Chapter 2, §10.6 provides for exemptions to the requirements of Sections 10.7 through 10.12 if a licensed healthcare entity demonstrates that it has vaccinated a targeted percentage of its employees in a given year, using its own methodology, and continues to use the same or more stringent methodology. The minimum targets required for the exemption are 60 percent of employees vaccinated by December 31, 2012; 75 percent of employees vaccinated by December 31, 2013, and 90 percent of employees vaccinated by December 31, 2014 and December 31 of each year thereafter. 6 CCR 1011-1 Chapter 2, §10.5 defines an ambulatory surgical center as a facility that is licensed and regulated pursuant to 6 CCR 1011-1, Chapter XX, Ambulatory Surgical Center and defines a healthcare worker as any person working in a healthcare entity who has the potential for exposure to patients, residents, or consumers of the healthcare entity and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air. The definition of healthcare worker does not include volunteers. | |
Disclaimer: The purpose of this database is to provide researchers, policymakers, and state and local public health practitioners with descriptive information concerning state immunization-related law. No part of this legal analysis involves providing legal advice or answering specific questions of law on behalf of any person or organization.
Page last reviewed: November 19, 2014
Content source: National Center for Immunization and Respiratory Diseases