AN ACT Relating to immunizations for infectious diseases; adding new sections to chapter 43.20 RCW; adding a new section to chapter 43.20A RCW; adding a new section to chapter 43.70 RCW; adding a new section to chapter 70.47 RCW; adding a new section to chapter 41.05 RCW; adding a new section to chapter 18.130 RCW; adding a new section to chapter 70.41 RCW; adding a new section to chapter 70.175 RCW; adding a new section to chapter 18.51 RCW; adding a new section to chapter 18.46 RCW; adding new sections to chapter 70.01 RCW; creating new sections; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. A new section is added to chapter 43.20 RCW to read as follows:

LEGISLATIVE INTENT. The legislature finds that there has been an increase in the number of children and adults contracting infectious diseases. The legislature further finds that this trend has occurred despite the availability of safe and effective immunizations that can prevent these life-threatening diseases. The legislature further finds that parents and guardians of children as well as at risk adults are often unaware of the need for immunizations, the appropriate age to receive such immunizations, and the public health risks of the failure to be properly immunized.

The legislature declares that it is in the public health interest of the people of the state of Washington that all children should be appropriately immunized. It further declares that at-risk adults including those adults who work in health and long-term care settings should also be appropriately immunized to stop the spread of infectious disease in these settings.

NEW SECTION. Sec. 2. A new section is added to chapter 43.20 RCW to read as follows:

IMMUNIZATION REQUIREMENT. Effective January 1, 1992, it shall be the responsibility of the parent or legal guardian of every child in the state to ensure that their child complies with the immunization schedules developed by the state board under section 3 of this act, provided that nothing in this chapter shall require immunization of a child where:

(1) A physician licensed under chapter 18.71 or 18.57 RCW has determined that a particular vaccine is not medically advisable for the child, provided that where it is determined by the physician that a particular vaccine is not contraindicated, the child will be required to receive the immunization; or

(2) The parent or legal guardian of the child has objections to the required immunizations based upon religious beliefs.

NEW SECTION. Sec. 3. A new section is added to chapter 43.20 RCW to read as follows:

STATE BOARD OF HEALTH ACTIVITIES. (1) The state board shall adopt a rule by October 1, 1991, that establishes a schedule of appropriate immunizations against infectious diseases for children, at-risk adults, health care professionals, and other adults working in health and long-term care settings. The schedule shall include the type of immunization recommended and the appropriate age for receiving vaccines. The state board may modify by rule the recommended immunization schedule from time to time. When implementing this section the state board shall consider recommended immunization schedules developed by such bodies as the federal center for disease control. The state board shall exempt from the immunization requirements in sections 9 through 13 of this act those personnel employed by health care professionals who have no patient contact.

(2) The state board shall make immunization schedules required by this section available to the secretary of health, the secretary of social and health services, the administrator of the basic health plan, the administrator of the state health care authority, and the general public no later than November 1, 1991.

NEW SECTION. Sec. 4. A new section is added to chapter 43.20A RCW to read as follows:

STATE SERVICE RECIPIENTS--DEPARTMENT OF SOCIAL AND HEALTH SERVICES. (1) Effective January 1, 1992, the parent or legal guardian of a child who is eligible to receive services from, through, or purchased by the department shall be responsible for providing to the department within ninety days of receiving such services:

(a) A certificate showing that the child has completed the state board of health recommended infectious disease immunization schedule or is making satisfactory progress in complying with the schedule;

(b) A waiver signed by a physician licensed under chapter 18.71 or 18.57 RCW stating that a particular vaccine is not medically advisable for the child. When it is determined by the physician that a particular vaccine is not contraindicated, the child will be required to receive the immunization; or

(c) A written certification signed by a parent or legal guardian of the child stating that the signer has objections to the required immunizations based upon religious beliefs: PROVIDED, That no person may be denied benefits under this chapter for failure to provide the certificate or waiver set forth herein.

(2) The secretary shall grant to parents or guardians of children who are receiving department services on or before January 1, 1992, ninety days to comply with the requirements of this section.

(3) The secretary shall decide the manner in which certificates and waivers required by this section shall be prepared and made available.

(4) The secretary may establish by rule a procedure to periodically check whether children are making satisfactory progress in complying with the appropriate immunization schedules. Such monitoring shall, to the extent possible, be conducted during the course of routine contact with the parent or guardian of the child.

(5) The secretary shall coordinate with the secretary of health, the administrator of the basic health plan, and the administrator of the state health care authority in the preparation of certificates and waivers required for the administration of this section to assure minimum paperwork and prevent duplicative compliance requirements for children receiving state services or benefits from more than one state agency.

(6) The secretary shall seek whatever federal waivers are necessary to implement the provisions of this section.

NEW SECTION. Sec. 5. A new section is added to chapter 43.70 RCW to read as follows:

STATE SERVICE RECIPIENTS--DEPARTMENT OF HEALTH. (1) Effective January 1, 1992, the parent or guardian of a child who is eligible to receive services from, through, or purchased by the department shall be responsible for providing to the department within ninety days of receiving such services:

(2) The secretary shall grant to parents or guardians of children who are receiving department services on or before January 1, 1992, ninety days to comply with the requirements of this section.

(3) The secretary shall decide the manner in which certificates and waivers required by this section may be prepared and made available.

(5) The secretary shall coordinate with the secretary of social and health services, the administrator of the basic health plan, and the administrator of the state health care authority in the preparation of certificates and waivers and required for the administration of this section to assure minimum paperwork and duplicative compliance requirements for children receiving state services or benefits from more than one state agency.

(6) The secretary shall seek whatever federal waivers are necessary to implement the provisions this section.

NEW SECTION. Sec. 6. A new section is added to chapter 70.47 RCW to read as follows:

STATE SUBSIDIZED HEALTH CARE INSURANCE RECIPIENTS--BASIC HEALTH PLAN. (1) Effective January 1, 1992, the parent or guardian of a child who is enrolled in the plan shall be responsible for providing to the plan administrator within ninety days of enrollment:

(2) The administrator shall grant to parents and guardians of children enrolled in the plan on or before January 1, 1992, ninety days to comply with the requirements of this section.

(3) The administrator shall decide the manner in which certificates and waivers required by this section shall be prepared and made available.

(4) The administrator may establish by rule a procedure to periodically check whether children are making satisfactory progress in complying with the appropriate immunization schedules. Such monitoring shall, to the extent possible, be conducted when the parent or guardian of the child has routine contact with the plan or health care contractors authorized to provide services under the plan.

(5) The administrator shall coordinate with the administrator of the state health care authority, and the secretaries of health and social and health services to assure minimum paperwork and duplicative compliance requirements for children receiving state services or benefits from more than one state agency.

NEW SECTION. Sec. 7. A new section is added to chapter 41.05 RCW to read as follows:

STATE EMPLOYEE BENEFIT RECIPIENTS--STATE HEALTH CARE AUTHORITY. (1) Effective January 1, 1992, the parent or guardian of a child who is enrolled as a dependent in the plan shall be responsible for providing to the administrator within ninety days of enrollment:

(2) The administrator shall grant to parents and guardians of children enrolled in the plan on or before January 1, 1992, ninety days to comply with the requirements of this section.

(3) The administrator shall decide the manner in which certificates and waivers required by this section shall be prepared and made available.

(4) The administrator may establish by rule a procedure to periodically check whether children are making satisfactory progress in complying with the appropriate immunization schedules. Such monitoring shall, to the extent possible, be conducted when the parent or guardian of the child has any routine contact with the plan or health care contractors authorized to provide services under the plan.

(5) The administrator shall coordinate with the administrator of the basic health plan, and the secretaries of health and social and health services to assure minimum paperwork and duplicative compliance requirements for children receiving state services or benefits from more than one state agency.

NEW SECTION. Sec. 8. A new section is added to chapter 18.130 RCW to read as follows:

IMMUNIZATION REQUIRED FOR REGULATED HEALTH CARE PROFESSIONALS. (1) Effective January 1, 1992, health care professionals regulated under one of the disciplining authorities cited in RCW 18.130.040, who are determined by the state board of health to present a risk of contracting and spreading preventable infectious diseases covered by the board's immunization schedules, shall present evidence of appropriate immunization to the department upon the renewal of their license, and for those applicants for licensure, prior to the issuance of a license.

(2) The department shall accept in lieu of evidence of immunization:

(a) A waiver signed by a physician licensed under chapter 18.71 or 18.57 RCW stating that a particular vaccine is not medically advisable for the health care professional. When it is determined by the physician that a particular vaccine is not contraindicated, the health care professional will be required to receive the immunization; or

(b) A written certification signed by the health care professional stating his or her objections to the required immunizations based upon religious beliefs.

(3) The department shall prescribe forms necessary to meet the requirements of this section.

NEW SECTION. Sec. 9. A new section is added to chapter 70.41 RCW to read as follows:

IMMUNIZATION REQUIRED FOR PERSONS WORKING IN STATE REGULATED HEALTH CARE FACILITIES--HOSPITALS. (1) Effective January 1, 1992, a hospital shall require as a condition of employment or continued employment that all applicants and hospital personnel provide evidence of meeting the immunization requirements as defined by the state board of health under section 3 of this act.

(2) A hospital shall not require employees to provide evidence of immunizations if the employees are regulated under one of the disciplining authorities cited in RCW 18.130.040 or if the employees have no patient contact and are exempt from immunization requirements by the state board of health.

(3) The hospital shall accept in lieu of evidence of immunization:

(a) A waiver signed by a physician licensed under chapter 18.71 or 18.57 RCW stating that a particular vaccine is not medically advisable for the employee. When it is determined by the physician that a particular vaccine is not contraindicated, the employee will be required to receive the immunization; or

(b) A written certification signed by the employee stating his or her objections to the required immunizations based upon religious beliefs;

(4) The department shall prescribe forms necessary to meet the requirements of this section.

(5) The hospital shall maintain proof of immunizations, waivers, and certificates for current employees covered by this section.

NEW SECTION. Sec. 10. A new section is added to chapter 70.175 RCW to read as follows:

IMMUNIZATION REQUIRED FOR PERSONS WORKING IN STATE REGULATED HEALTH CARE FACILITIES--RURAL HEALTH CARE FACILITY. (1) Effective January 1, 1992, a rural health care facility shall require as a condition of employment or continued employment that all personnel employed by the facility provide evidence of meeting applicable immunization requirements as defined by the state board of health under section 3 of this act.

(2) The rural health care facility shall not require employees to provide evidence of immunizations if the employees are regulated under one of the disciplining authorities cited in RCW 18.130.040 or if the employees have no patient contact and are exempt from immunization requirements by the state board of health.

(3) The rural health care facility shall accept in lieu of evidence of immunization:

(b) A written certification signed by the employee stating his or her objections to the required immunizations based upon religious beliefs.

(4) The department shall prescribe forms necessary to meet the requirements of this section.

(5) The rural health care facility shall maintain proof of immunizations, waivers, and certificates for current employees covered by this section.

NEW SECTION. Sec. 11. A new section is added to chapter 18.51 RCW to read as follows:

IMMUNIZATION REQUIRED FOR PERSONS WORKING IN STATE REGULATED HEALTH CARE FACILITIES--NURSING HOMES. (1) Effective January 1, 1992, a nursing home shall require as a condition of employment or continued employment that all personnel employed by the nursing home provide evidence of meeting applicable immunization requirements as defined by the state board of health under section 3 of this act.

(2) The nursing home shall not require employees to provide evidence of immunizations if such employees are regulated under one of the disciplining authorities cited in RCW 18.130.040 or if such employees have no patient contact and are exempt from immunization requirements by the state board of health.

(3) The nursing home shall accept in lieu of evidence of immunization:

(b) A written certification signed by the employee stating his or her objections to the required immunizations based upon religious beliefs.

(4) The department shall prescribe forms necessary to meet the requirements of this section.

(5) The nursing home facility shall maintain proof of immunizations, waivers, and certificates for current employees covered by this section.

NEW SECTION. Sec. 12. A new section is added to chapter 18.46 RCW to read as follows:

IMMUNIZATION REQUIRED FOR PERSONS WORKING IN STATE REGULATED HEALTH CARE FACILITIES--MATERNITY HOMES. (1) Effective January 1, 1992, a maternity home shall require as a condition of employment or continued employment that all personnel employed by the maternity home provide evidence of meeting applicable immunization requirements as defined by the state board of health under section 3 of this act.

(2) The maternity home shall not require employees to provide evidence of immunizations if such employees are regulated under one of the disciplining authorities cited in RCW 18.130.040 or if such employees have no patient contact and are exempt from immunization requirements by the state board of health.

(3) The maternity home shall accept in lieu of evidence of immunization:

(b) A written certification signed by the employee stating his or her objections to the required immunizations based upon religious beliefs.

(4) The department shall prescribe forms necessary to meet the requirements of this section.

(5) The maternity home shall maintain proof of immunizations, waivers, and certificates for current employees covered by this section.

NEW SECTION. Sec. 13. A new section is added to chapter 70.01 RCW to read as follows:

IMMUNIZATIONS REQUIRED FOR UNREGULATED PERSONNEL WORKING IN UNREGULATED HEALTH CARE SETTINGS. (1) Effective January 1, 1992, a health care professional regulated under one of the disciplining authorities cited in RCW 18.130.020 shall require of his or her employees that as a condition of employment or continued employment they provide evidence of meeting applicable immunization requirements as defined by the state board of health in section 3 of this act. The health care professional shall not require immunization compliance of his or her employees who are currently regulated under one of the disciplining authorities cited in RCW 18.130.040 or who are employees who have no patient contact and are exempt from immunization requirements by the state board of health.

(2) The employing health care professional shall accept in lieu of evidence of immunization:

(b) A written certification signed by the employee stating his or her objections to the required immunizations based upon religious beliefs.

(3) The department shall prescribe forms necessary to meet the requirements of this section.

(4) The employing health care professional shall maintain proof of immunizations, waivers, and certificates required by this section.

NEW SECTION. Sec. 14. A new section is added to chapter 70.01 RCW to read as follows:

VOUCHER DEMONSTRATION PROJECT. (1) The secretary of social and health services shall establish a voucher demonstration project to reimburse eligible health care providers who administer to children under the age of eighteen appropriate immunizations for infectious diseases identified by the state board of health. The amount of the voucher shall be established by the secretary of social and health services.

(a) An eligible health care provider means a health care practitioner licensed in the state of Washington who is authorized by their license to administer immunizations.

(b) Any child under the age of eighteen who resides in the project site location is eligible for a voucher.

(2) The secretary of social and health services, in consultation with the secretary of health:

(a) Shall select up to two project sites where immunization rates are below the state-wide average and where financial barriers appear to be a major cause of the lower than average rates.

(b) Should establish the geographic boundaries of the project sites in a manner that represents logical health care catchment areas.

(3) The secretary of social and health services shall:

(a) Coordinate with the secretary of health and the administrators of the basic health plan and the state health care authority to assure that no duplication of payment to providers for immunization administration occurs across state-funded programs.

(b) Coordinate with the secretary of health in the development of coupon voucher booklets that shall include at least the following: (i) The reimbursement vouchers required by this section; (ii) general educational information about infectious diseases; and (iii) the appropriate immunization schedules developed by the state board of health.

(c) Coordinate with the secretary of health to develop and implement a system of distributing voucher coupon booklets and a cost-efficient system to track compliance among children with the state board of health recommended immunizations.

(d) Coordinate with the secretary of health to develop strategies to encourage parents to have their children immunized according to state board of health recommendations.

(e) Coordinate the implementation of this section with other existing state and local infectious disease immunization efforts.

NEW SECTION. Sec. 15. A new section is added to chapter 70.01 RCW to read as follows:

IMMUNIZATION DEMONSTRATION PROJECTS. (1) Effective January 1, 1992, the secretary of health may establish up to four immunization demonstration projects in four communities in the state with the purpose of identifying innovative ways to increase infectious disease immunizations among children and other at-risk populations.

(a) The projects shall be located in one urban and one rural community east of the Cascade mountains and one urban and one rural community west of the Cascade mountains.

(b) In selecting project sites the secretary shall give priority to communities where immunization rates are below the state average and where there are access barriers to immunization services.

(2) To the extent possible, funding for projects must be used to enhance existing immunization efforts in the community or, when necessary, to plan for and implement new immunization efforts where none exist. Projects shall identify the populations at greatest risk in the community and concentrate efforts on these populations. Project funding shall not be used to purchase vaccine or to pay for, or subsidize, provider administrative fees.

(3) The secretary shall use appropriate immunization schedules developed by the state board of health when implementing the provisions of this section.

(4) The secretary shall coordinate the demonstration projects with other state and local infectious disease immunization efforts.

(5) The secretary shall report to the health care committees of the legislature by December 1, 1993, on the effectiveness of the projects and shall make recommendations as to whether they should be continued or expanded.

(6) This section shall expire on June 30, 1994.

NEW SECTION. Sec. 16. If specific funding for the purposes of sections 14 and 15 of this act, referencing this act by bill number, is not provided by June 30, 1991, in the omnibus appropriations act, sections 14 and 15 of this act, shall be null and void.

NEW SECTION. Sec. 17. Section headings as used in this act do not constitute any part of the law.

NEW SECTION. Sec. 18. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect immediately.