The Governor Signs Two Bills Which Will Change the Medical Exemption Requirements for School Vaccinations

Category: Special Bulletins
Date: Sep 11, 2019 07:23 PM

Governor Gavin Newsom signed two vaccination bills earlier this week, SB 276 and SB 714, which will materially change the medical exemption process for student vaccinations.  SB 276 was drafted as the initial bill, and SB 714 is a clean-up bill, which contains revisions to SB 276. 

Under existing law, all private schools must require documentary proof of each entrant’s immunization status, and may not admit for attendance any student unless he or she has received the required immunizations prescribed by the State Department of Public Health.  However, existing law also provides a medical exemption for students from these immunization requirements.  Under this medical exemption, a written statement by a licensed physician must be submitted to the school that provides information that the student has a physical condition or medical circumstances that make immunizations unsafe for the student, indicating the specific nature and probable duration of their medical condition or circumstances, including, but not limited to, family medical history.  (Health and Safety Code, § 120370, subd. (b)).   

SB 276 and SB 714 change the requirements for this medical exemption and impose the following requirements for physicians, parents, schools, and the State, as set forth below:

1.      Use of Standardized Medical Exemption Form

Under SB 276, the State Department of Public Health, by January 1, 2021, is required to develop and make available for use by licensed physicians and surgeons an electronic, standardized, statewide medical exemption request form that would be transmitted using the California Immunization Registry (CAIR) and which, commencing January 1, 2021, would be the only documentation of a medical exemption that a school may accept.

At a minimum, the medical exemption form must require all of the following:

  • The name, California medical license number, business address, and telephone number of the physician and surgeon who issued the medical exemption, and of the primary care physician of the child, if different from the physician who issued the medical exemption.
  • The name of the child for whom the exemption is sought, the name and address of the child’s parent or guardian, and the name and address of the child’s school or other institution.
  • A statement certifying that the physician has conducted a physical examination and evaluation of the child consistent with the relevant standard of care and complied with all applicable requirements of this law.
  • Whether the physician who issued the medical exemption is the child’s primary care physician.  If the issuing physician is not the child’s primary care physician, the issuing physician shall also provide an explanation as to why the issuing physician and not the primary care physician is filling out the medical exemption form.
  • How long the physician has been treating the child.
  • A description of the medical basis for which the exemption for each individual immunization is sought.  Each specific immunization shall be listed separately and space on the form shall be provided to allow for the inclusion of descriptive information for each immunization for which the exemption is sought.
  • Whether the medical exemption is permanent or temporary, including the date upon which a temporary medical exemption will expire.  A temporary exemption shall not exceed one year.  All medical exemptions shall not extend beyond the grade span, as defined by this law.
  • An authorization for the department to contact the issuing physician for purposes of this law and for the release of records related to the medical exemption to the department, the Medical Board of California, and the Osteopathic Medical Board of California.
  • A certification by the issuing physician that the statements and information contained in the form are true, accurate, and complete.

 2.      Obligations of Physicians and Surgeons to Provide Notice of Requirements to Parents

Commencing January 1, 2021, if a parent or guardian requests a licensed physician and surgeon to submit a medical exemption for the parent’s or guardian’s child, the physician and surgeon shall inform the parent or guardian of the requirements set forth in SB 276.  If the parent or guardian consents, the physician and surgeon shall examine the child and submit a completed medical exemption certification form to the State Department of Public Health.

3.      Requirements by Schools to Submit Annual Reports on Immunization Status to the State

Existing law requires the governing authority of a school to file a written report on the immunization status of new students to the school with the State Department of Public Health and the local health department at times and on forms prescribed by the State Department of Public Health.  SB 276 requires these reports to be filed on at least an annual basis.

4.      State’s Review of Medical Exemptions

SB 276 requires the State Department of Public Health to annually review immunization reports from schools and institutions to identify schools with an overall immunization rate of less than 95%, physicians and surgeons who submitted 5 or more medical exemption forms in a calendar year, and schools and institutions that do not report immunization rates to the department.  SB 276 requires a clinically trained department staff member who is a physician and surgeon or a registered nurse to review all medical exemption forms submitted meeting those conditions.  SB 276 authorizes the medical exemptions determined by that staff member to be inappropriate or otherwise invalid to be reviewed by the State Public Health Officer or a physician and surgeon designated by the State Public Health Officer, and revoked by the State Public Health Officer or physician and surgeon designee, under prescribed circumstances.  SB 714 provides that medical exemptions issued prior to January 1, 2020, will not be revoked unless the exemption was issued by a physician or surgeon that has been subject to disciplinary action by the Medical Board of California or the Osteopathic Medical Board of California.

5.      Appeal Process

SB 276 authorizes a parent or guardian to appeal a medical exemption denial or revocation to the Secretary of California Health and Human Services.  The appeal would be conducted by an independent expert review panel of licensed physicians and surgeons established by the secretary.  SB 276 requires the independent expert review panel to evaluate appeals consistent with specified guidelines and to submit its decision to the secretary.  SB 276 requires the secretary to adopt the determination of the independent expert review panel and promptly issue a written decision to the child’s parent or guardian.  The final decision of the secretary would not be subject to further administrative review.

SB 276 allows a child whose medical exemption revocation is appealed to continue in attendance at the school without being required to commence the immunization schedule required for conditional admittance, provided that the appeal is filed within 30 calendar days of revocation of the medical exemption.

SB 276 requires the Department of Public Health and the independent expert review panel to comply with all applicable state and federal privacy and confidentiality laws and would authorize disclosure of information submitted in the medical exemption form in accordance with requirements set forth in the law.  

6.      Medical Exemptions obtained Prior to January 1, 2021

Prior to January 1, 2021, if the parent or guardian files with the governing authority a written statement by a licensed physician and surgeon to the effect that the physical condition of the child is such, or medical circumstances relating to the child are such, that immunization is not considered safe, indicating the specific nature and probable duration of the medical condition or circumstances, including, but not limited to, family medical history, for which the physician and surgeon does not recommend immunization, that child shall be exempt from vaccination requirements. 

A child who has a medical exemption issued before January 1, 2020, is allowed to continue enrollment at the School until the child enrolls in the next grade span, which is each of the following: (A) Birth to preschool, inclusive; (B) Kindergarten and grades 1 to 6, inclusive, including transitional kindergarten; and (C) Grades 7 to 12, inclusive.

On and after July 1, 2021, a school may not unconditionally admit or readmit or advance any student to 7th-grade level, unless the student has been immunized or has a medical exemption through a procedure that includes the completion of a compliant statewide form.

The new legislation will not go into effect until January 1, 2020, and many of the requirements set forth above will not go into effect until January 1, 2021.  The State Department of Public Health has until January 1, 2021 to develop and make available for use the electronic, standardized, statewide medical exemption form.  We will update you when this form and other guidance from the Department becomes available.

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