State Immunization Laws for Healthcare
Workers and Patients

Immunization Administration Requirements For
MMR

** Click on each result to read the abridged text of the state immunization law.

States	Hospital Employees
AL	No[22]
AK	Ensure[26]
AZ	No
AR	No
CA	Offer[553]
CO	No
CT	No
DC	No[64]
DE	No
FL	No
GA	No
HI	No
ID	No
IL	Ensure[86]
IN	No
IA	No
KS	No
KY	No
LA	No
ME	Ensure[117]
MD	Ensure[123]
MA	Ensure[130]
MI	No
MN	No
MS	No
MO	No
MT	No
NE	No
NH	No[147]
NJ	Offer[160]
NM	Ensure[172]
NY	Ensure[176]
NV	No[191]
NC	No
ND	No
OH	No
OK	Ensure[215]
OR	No[222]
PA	No
RI	Ensure[236]
SC	No
SD	No
TN	No
TX	No[575]
UT	No
VT	No
VA	No[287]
WA	No
WV	No
WI	Ensure[295]
WY	No

[22] For Alabama, no regulation or statute specifically refers to vaccination against measles, mumps, or rubella for hospital employees. However, note Ala. Admin. Code r. 420-5-7-.04, requiring each hospital to establish vaccination requirements for employees that are consistent with current recommendations from the Federal Centers for Disease Control and Prevention and the Federal Occupational Safety and Health Administration. These requirements apply only to those facilities covered by Alabama’s definition of a hospital, defined in Ala. Admin. Code r. 420-5-7-.04 as a health institution planned, organized, and maintained for offering to the public generally facilities and beds for use in the diagnosis and/or treatment of illness, disease, injury, deformity, abnormality or pregnancy, when the institution offers such care or service for not less than 24 consecutive hours in any week to 2 or more individuals not related by blood or marriage to the owner and/or chief executive officer/administrator.
[26] For Alaska requirements, see Alaska Admin. Code tit. 7 § 12.650, relating to “facilities and local units of health and social services.” Alaska Admin. Code tit. 7 § 12.650 requires each facility to have an employee health program that requires evidence of immunization against rubella. Note that these requirements apply only to those facilities identified in the regulation, and not all settings covered by the chart’s definition of hospital. “Facilities and local units” are defined in Alaska Admin. Code tit. 7 § 12.990 as including (among others) the following facilities: general acute care and rural primary care hospitals, critical access hospitals, and specialized hospitals.
[64] For D.C., no regulation or statute specifically refers to vaccination against measles, mumps, or rubella for hospital employees. However, note 22 DCMR § B2017.10, requiring that immunization against communicable disease shall be required of all employees and all other persons who routinely come into contact with patients or patient areas. This regulation only applies to those institutions meeting the definition of “hospital” set forth in 22 DCMR § 2099.
[86] For Illinois requirements, see Ill. Admin. Code tit. 77, § 250.1820, relating to nursery personnel. Ill. Admin. Code tit. 77, § 250.1820 provides that evidence of prior rubella infection or rubella vaccination shall be required of nursery personnel. This regulation only applies to those institutions covered by the Illinois definition of hospital set forth in 210 Ill. Comp. Stat. Ann. § 85/3. 210 Ill. Comp. Stat. Ann. § 85/3 defines hospitals as any institution, place, building, or agency, public or private, whether organized for profit or not, devoted primarily to the maintenance and operation of facilities for the diagnosis and treatment or care of 2 or more unrelated persons admitted for overnight stay or longer in order to obtain medical, including obstetric, psychiatric, and nursing, care of illness, disease, injury, infirmity, or deformity. Also note Ill. Admin. Code tit. 77, § 250.450. While this regulation does not specifically relate to MMR vaccine, it does require more broadly each hospital to establish an employee health program that includes required immunizations. This regulation only applies to those institutions covered by the Illinois definition of hospital set forth in 210 Ill. Comp. Stat. Ann. § 85/3.
[117] For Maine requirements, see Code Me. R. § 10-144-264(2), relating to “Designated Healthcare Facilities.” Code Me. R. § 10-144-264(2) provides that Designated Healthcare Facilities shall require of all employees proof of immunization or documented immunity against rubeola, mumps, rubella, varicella, and hepatitis B. Employees shall present the Designated Healthcare Facility with a Certificate of Immunization from a specified healthcare provider, and which contains certain specified information. No chief administrative officer may permit any employee to be in attendance at work without a certificate of immunization for each disease or other acceptable evidence of immunity to each disease, or documentation of exemption or declination. “Designated Healthcare Facilities” are defined in Code Me. R. § 10-144-264(1) as a licensed nursing facility, residential care facility, intermediate care facility for the mentally retarded, multi-level health care facility, hospital, or home health agency.	Top of Page
[123] For Maryland requirements, see MD. Regs. Code tit. 10, § 06.01.12 and MD. Regs. Code tit. 10, § 06.01.15, relating to “hospitals.” MD. Regs. Code tit. 10, § 06.01.12 provides that a worker born after 1956 working at least 20 hours each week who is newly retained as medical staff, a direct or contractual employee, or a volunteer of a hospital classified as a “general hospital” under Health-General Article, § 19-307, Annotated Code of Maryland, shall have documentation of receipt of one dose of live measles virus vaccine after becoming 1 year old or proof of immunity by blood test for antibody to rubeola. MD. Regs. Code tit. 10, § 06.01.15 provides that a worker born after 1956 working at least 20 hours each week who is newly retained as medical staff, a direct or contractual employee, or a volunteer of a hospital classified as a “general hospital” under Health-General Article, § 19-307, Annotated Code of Maryland, shall have documentation of receipt of one dose of live rubella virus vaccination on or after becoming 1 year old or proof of immunity by blood test for antibody to rubella. Md. Health-General Code Ann. § 19-301 defines a hospital as an institution that: (1) has a group of at least 5 physicians who are organized as a medical staff for the institution; (2) maintains facilities to provide, under the supervision of the medical staff, diagnostic and treatment services for 2 or more unrelated individuals; and (3) admits or retains the individuals for overnight care. Md. Health-General Code Ann. § 19-307 provides that a hospital shall be classified as a general hospital if the hospital at least has the facilities and provides the services that are necessary for the general medical and surgical care of patients. Note that this requirement only applies to those facilities falling within Maryland’s definition of “hospital.”
[130] 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. This requirement only applies to those institutions covered by the Massachusetts definition of “hospital.” “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.
[147] For New Hampshire, no statute or regulation requires any hospital to ensure that any employees are vaccinated with MMR 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.
[160] For New Jersey requirements, see N.J. Admin. Code tit. 8, § 8:43G-20.2(g), relating to “hospitals.” N.J. Admin. Code tit. 8, § 8:43G-20.2(g) provides that hospitals must offer rubella and rubeola vaccine to all employees. Note this regulation only applies to those facilities covered by the New Jersey definition of hospital. N.J. Admin. Code tit. 8, § 8.43G defines a hospital as an institution which maintains facilities for the diagnosis, treatment and care of 2 or more unrelated individuals suffering from illness, injury or deformity and where emergency, out-patient, surgical, obstetrical, convalescent or other medical and nursing care is rendered for periods exceeding 24 hours.	Top of Page
[172] For New Mexico requirements, see N.M. Admin. Code tit. 7, § 7.7.2.21, relating to “acute care, limited services, and special hospitals.” N.M. Admin. Code tit.7, § 7.7.2.21 provides that vaccination or confirmed immunity against rubella shall be required for everyone having direct contact with rubella patients, pediatric patients, or female patients of childbearing age. No individual without documented vaccination against rubella or immunity to rubella may be placed in a position where he/she has direct contact with rubella patients, pediatric patients or female patients of childbearing age. N.M. Admin. Code tit. 7, § 7.7.2.7 defines “acute care hospitals” as a hospital providing emergency services, in-patient medical and nursing care for acute illness, injury, surgery or obstetrics; ancillary services such as pharmacy, clinical laboratory, radiology, and dietary are required for acute-care hospitals. N.M. Admin. Code tit. 7, § 7.7.2.7 defines “limited services hospitals” as a hospital that limits admissions according to medical or surgical specialty, type of disease or medical condition, or a hospital that limits its inpatient hospital services to surgical services or invasive diagnostic treatment procedures; a limited services hospital must have emergency services, inpatient medical and nursing care for acute illness, injury, and surgery, and must offer ancillary services including pharmacy, clinical laboratory, radiology, and dietary. N.M. Admin. Code tit. 7, § 7.7.2.7 defines “special hospitals” as a hospital that treats patients that have diagnosis-related group classifications for two-thirds of all its patients that fall into no more than two major diagnosis categories, or if at least two-thirds of its patients are classified in a specific diagnosis category; an example of a special hospital is a psychiatric or rehabilitation hospital.
[176] For New York requirements, see N.Y. Comp. Codes R. & Regs. tit. 10, § 405.3, relating to “hospitals.” N.Y. Comp. Codes R. & Regs. tit. 10, § 405.3 requires the hospital to require of all personnel, as a condition of employment, a certificate of immunization against rubella, and a certificate of immunization against measles. This requirement is implemented through personnel policies and practices which the chief executive officer of the hospital shall develop and implement. If one of the practitioners designated at 405.3(10)(iii) certifies that the vaccine is contraindicated, the immunization requirements will be inapplicable until they are no longer found to be detrimental to the employee’s health. This requirement only applies to those facilities falling under New York’s regulatory definition of “hospital,” and not all those facilities identified as a hospital by the chart’s definition. N.Y. Comp. Codes R. & Regs. tit. 10, § 700.2 defines a “hospital” as an institution with beds for one or more inpatients not related to the operator which is primarily engaged in providing services and facilities to inpatients by or under the supervision of a physician, and which meets the following requirements: (1) provides diagnostic and therapeutic services for medical diagnosis, treatment and care of injured and sick persons and has, as a minimum, laboratory and radiology services and organized departments of medicine and surgery; (2) has an organized medical staff which may include, in addition to doctors of medicine, doctors of osteopathy and dentistry; (3) has bylaws, rules and regulations pertaining to standards of medical care and service rendered by its medical staff; (4) maintains medical records for all patients; (5) has a requirement that every patient be under the care of a member of the medical staff; (6) provides 24-hour patient services; and (7) has a written utilization review plan acceptable to the NYSDOH; and (8) has agreements with a home care agency.
[191] For Nevada, no statute or regulation requires any hospital to ensure that any employees are vaccinated with MMR vaccine. However, 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.
[215] For Oklahoma requirements, see Okla. Admin. Code § 310:667-5-4, relating to “hospitals.” Okla. Admin. Code § 310:667-5-4 provides that an immunization history shall be part of each pre-employment examination. The immunization history shall include documentation of immunity to measles, mumps, rubella, and varicella. Birth before 1957 is considered acceptable evidence of immunity to measles, mumps, and rubella, with the exception that birth before 1957 is not acceptable evidence of immunity to rubella for female employees born before 1957 who can become pregnant. Persons born in 1957 or later can be considered immune to measles, mumps, or rubella only if they have documentation of one of the following: (1) measles or mumps disease diagnosed by a physician or licensed independent practitioner; (2) laboratory evidence of measles, mumps, or rubella immunity; or (3) vaccination on or after the first birthday with 2 doses of live measles vaccine, and at least one dose of live rubella vaccine. Okla. Stat. tit. 63, § 1-701 defines a “hospital” as any institution, place, building or agency, public or private, whether organized for profit or not, devoted primarily to the maintenance and operation of facilities for the diagnosis, treatment, or care of patients admitted for overnight stay or longer in order to obtain medical care, surgical care, obstetrical care, or nursing care for illness, disease, injury, infirmity, or deformity. Subject to certain exceptions, places where pregnant females are admitted and receive care incident to pregnancy, abortion, or delivery shall be considered to be a “hospital” within the meaning of this article, regardless of the number of patients received or the duration of their stay. The term “hospital” includes general medical surgical hospitals, specialized hospitals, critical access and emergency hospitals, and birthing centers.	Top of Page
[222] For Oregon, while no statute or regulation requires any hospital to ensure that any employee is vaccinated with MMR vaccine, 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.
[236] 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.) 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.
[287] For Virginia, no statute or regulation requires any hospital to ensure that any employees are vaccinated with MMR vaccine. Note, however, 12 Va. Admin. Code § 5-410-490, providing that hospitals shall have an infection control committee to periodically evaluate, and revise as needed, infection control policies, procedures, and techniques for all appropriate phases of hospital operation and service in order to protect patients, employees, and visitors. These policies shall include, but are not limited to, appropriate employee health screening and immunization, among other things.
[295] 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.	Top of Page
[553] For California requirements, see 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.
[575] For Texas, no regulation or statute specifically refers to vaccination against measles, mumps, or rubella for hospital employees. However, note 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 hospitals licensed under Chapter 241 of the Texas Health and Safety Code and hospitals maintained or operated by the state.

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