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HOUSE DOCKET, NO. 2749 FILED ON: 1/19/2023
HOUSE . . . . . . . . . . . . . . . No. 2151
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Paul J. Donato
_________________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act promoting community immunity.
_______________
PETITION OF:
NAME:DISTRICT/ADDRESS :DATE ADDED:Paul J. Donato35th Middlesex1/19/2023Rebecca L. RauschNorfolk, Worcester and Middlesex1/20/2023Jack Patrick Lewis7th Middlesex1/25/2023David Henry Argosky LeBoeuf17th Worcester1/31/2023Carmine Lawrence Gentile13th Middlesex2/7/2023James B. EldridgeMiddlesex and Worcester2/14/2023Vanna Howard17th Middlesex2/14/2023Samantha Montaño15th Suffolk2/14/2023Erika Uyterhoeven27th Middlesex2/22/2023 1 of 9
HOUSE DOCKET, NO. 2749 FILED ON: 1/19/2023
HOUSE . . . . . . . . . . . . . . . No. 2151
By Representative Donato of Medford, a petition (accompanied by bill, House, No. 2151) of
Paul J. Donato and others relative to immunizations against infectious disease which give rise to
a declared public health state of emergency. Public Health.
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Third General Court
(2023-2024)
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An Act promoting community immunity.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Chapter 76 of the General Laws is hereby amended by striking out section
215, as appearing in the 2020 Official Edition, and inserting in place thereof the following
3section:-
4 Section 15. All schools shall comply with the requirements established in chapter 111P.
5 SECTION 2. Said chapter 76, as so appearing, is hereby further amended by striking out
6section 15C and inserting in place thereof the following section:-
7 Section 15C. All institutions of higher learning shall comply with the requirements
8established in chapter 111P.
9 SECTION 3. Section 15D of said chapter 76, as so appearing, is hereby repealed. 2 of 9
10 SECTION 4. Section 24N of chapter 111 of the General Laws, as appearing in the 2020
11Official Edition, is hereby amended, in line 32, by inserting after the word “24M” the following
12words:- , and to administer chapter 111P.
13 SECTION 5. The General Laws are hereby amended by inserting after chapter 111O the
14following chapter:-
15 CHAPTER 111P.
16 COMMUNITY IMMUNITY.
17 Section 1. This chapter shall be known and may be cited as the Community Immunity
18Act.
19 Section 2. As used in this chapter, the following words shall have the following meanings
20unless the context clearly requires otherwise:-
21 “Covered program”, (a) a child care center, an early education and care program, a family
22child care home, a large family child care home, a public preschool program, or a school-aged
23child care program, as defined in section 1A of chapter 15D; (b) a school, whether public, private
24or charter, that provides education to students in any combination of grade levels from
25kindergarten to grade 12, inclusive, and including, but not limited to, any school activity open to
26children who are otherwise instructed in accordance with section 1 of chapter 76; (c) a
27recreational camp; or (d) an institution of higher education, whether public or private.
28 “Department”, the department of public health.
29 “Exemption”, written acknowledgement from the department that a participant is excused
30from the schedule. 3 of 9
31 “Herd immunity”, population-wide resistance to the spread of an infectious disease
32within that population, resulting from a sufficient percentage of people receiving one or more
33immunizations against the disease.
34 “Immunization”, an inoculation administered for the purpose of making a person resistant
35to an infectious disease.
36 “Participant”, a person who engages in 1 or more activities of a covered program through
37enrollment or other registration process.
38 “Provider”, a health care provider licensed by an agency, board or division of the
39commonwealth who, acting within their scope of practice, may lawfully administer an
40immunization.
41 “Responsible adult”, a parent or legal guardian of a participant, a participant who is an
42emancipated minor, or a participant who has achieved the age of majority.
43 “Schedule”, the immunization administration schedule established by the department and
44consistent with generally accepted medical practice.
45 Section 3. To enroll in a covered program, a participant’s records shall include: (a)
46documentation of immunizations in accordance with the schedule; (b) an exemption
47acknowledgement letter issued by the department, consistent with this chapter; (c) evidence that
48the participant is in the process of obtaining immunizations with the objective of compliance
49with the schedule; (d) for public schools only, evidence that the participant moved into the
50commonwealth not more than 90 days before the date of enrollment and the responsible adult is
51making a good faith effort to obtain the necessary immunization documentation or exemption 4 of 9
52acknowledgement; or (e) evidence that more than 30 days have elapsed since a declaration of
53exemption form was submitted to the department. A private covered program may implement
54immunization requirements more stringent than those set forth in this chapter; provided, that the
55program creates and maintains a written immunization policy, which shall be made available to
56all responsible adults; and provided further, that no private covered program shall refuse to
57accept medical exemptions.
58 Section 4. There shall be two types of immunization exemptions: (a) medical, for a
59participant whose medical conditions or circumstances preclude the administration of an
60immunization, as determined in the best medical judgment of a provider; and (b) religious, for a
61participant who holds, or whose family holds, sincere religious beliefs conflicting with
62immunizations.
63 Section 5. The department shall prepare and maintain separate standardized declaration of
64exemption forms for medical and religious exemptions to required vaccinations. The department
65shall make the forms available to covered programs and the public online and, as necessary, in
66 hard copy. Covered programs shall provide a declaration of exemption form to a
67responsible adult or a participant only upon request.
68 Section 6. The declaration of medical exemption form shall include, without limitation:
69(i) a checklist of generally accepted contraindications to immunizations that shall be completed
70by a provider; (ii) a statement that the provider has an established provider-patient relationship
71with the participant; (iii) a request for the signature of the provider; (iv) a request for a unique
72government-issued professional identification number assigned to the provider; (v) a request for
73the signature of the responsible adult; and (vi) requests for dates for all signatures. 5 of 9
74 Section 7. The declaration of religious exemption form shall include, without limitation:
75(i) a statement that the participant or responsible adult has a sincere religious belief conflicting
76with immunizations; (ii) a certification that the responsible adult has provided a complete and
77accurate copy of the religious exemption declaration to the participant’s primary health care
78provider, including the provider’s name and contact information; (iii) an acknowledgement of
79receipt from a provider on the participant’s primary health care team; and (iv) a request for the
80dated signature of the responsible adult. The form shall include a statement from the department
81that refusing to immunize is against public health policy and may result in serious illness or
82death of the participant or others. The department may provide alternative requirements to
83clauses (ii) and (iii) of this section if a participant does not have a primary health care provider.
84The form shall not require disclosure of a participant’s particular religious beliefs.
85 Section 8. A responsible adult shall submit a completed declaration of exemption form to
86the department for review. The department shall determine the method of submission, whether
87electronic, hard copy, or both.
88 Section 9. The department shall review each declaration of exemption form submitted in
89accordance with this chapter. The department shall acknowledge each validly executed and
90accurately completed form with a letter indicating that the participant is exempt from required
91vaccinations and including the expiration date of the exemption. If the declaration of exemption
92form is improperly completed, the department shall advise the responsible adult of the remedial
93action necessary for resubmission.
94 Section 10. Whenever practicable, the department shall review and issue a response in
95accordance with section 9 of this chapter not more than 30 days after receipt of the declaration of 6 of 9
96exemption form. An exemption acknowledged by the department shall be valid for a period of
97not more than 1 year from the final signature date on the declaration. The department may, in its
98sole discretion, require covered programs to exclude exempted participants during a public
99health emergency.
100 Section 11. All covered programs shall annually report total numbers of participants who
101have been immunized and participants who are exempt from immunization requirements,
102delineated
103 by exemption type, as applicable, to the department, in a method determined by the
104department, and shall distribute the data from the report to all responsible adults electronically or
105in hard copy. Distribution shall not be required if it would result in disclosure of personal
106information as defined in section 1 of chapter 93H or otherwise violate applicable privacy laws.
107 Section 12. The department shall annually publish immunizations and exemptions data,
108delineated by exemption type, as applicable, for each covered program and school district on its
109website and may publish such data in hard copy. The department may also publish data by
110municipality, county, or other geographic designation, or by other criteria in its discretion.
111Publication shall not be required whenever doing so would result in disclosure of personal
112information as defined in section 1 of chapter 93H or otherwise violate applicable privacy laws.
113The department shall directly disseminate electronic copies of any published data to the school
114physician or nurse assigned to any public covered program pursuant to section 53 of chapter 71.
115 Section 13. Any covered program that has not achieved herd immunity shall be
116designated as an elevated risk program. Any covered program that fails to report immunization
117and exemption rates consistent with this chapter shall be designated an elevated risk program. 7 of 9
118Elevated risk program designations shall remain in place until the department, in its sole
119discretion, determines that the covered program has sufficiently improved immunity rates in the
120covered program population. The department shall maintain a public, online list of elevated risk
121programs.
122 Section 14. The department shall create a notice to responsible adults about an elevated
123risk designation. An elevated risk program shall issue the notice to all responsible adults for
124participants or those seeking enrollment in the program during the period in which the
125designation is in place not more than 10 days after receiving an elevated risk program
126designation. The department may require elevated risk programs to organize and invite all
127responsible adults to a presentation by the department about immunization safety, immunization
128efficacy and herd immunity. Whenever practicable, the presentation shall be conducted within 45
129days after the designation is received.
130 Section 15. The department shall develop and make available online an informational
131pamphlet about immunization safety and immunization efficacy. The department shall distribute
132the informational pamphlet, either electronically or in hard copy, to every responsible adult who
133submits a declaration of exemption form pursuant to this chapter. All elevated risk programs
134shall distribute the informational pamphlet, either electronically or in hard copy, to all
135responsible adults for participants or those seeking enrollment in the program during the period
136in which the designation is in place.
137 Section 16. The department shall promulgate regulations to implement this chapter,
138except that the department of early education and care, department of elementary and secondary
139education, 8 of 9
140 and department of higher education shall promulgate regulations to implement
141application of this chapter to covered programs falling within each department’s jurisdiction.
142 Section 17. In conjunction with and as facilitated by the departments listed in section 16
143of this chapter, as well as partnerships with trusted community-based organizations and local
144public health departments, health care providers, or clergy, the department shall conduct
145outreach to support the delivery of medically accurate information about immunizations,
146including but not limited to the availability of programs funded through the Vaccine Purchase
147Trust Fund established in section 24N of chapter 111. Such outreach shall focus on, but not be
148limited to, immunization gap populations in under-vaccinated communities.
149 Section 18. The department shall collect and report data on immunizations against any
150infectious disease which has given rise to a declared public health state of emergency in the
151commonwealth. Daily immunization data reports, which the department shall publish on its
152website, shall include the number of individuals receiving the immunization, delineated by age
153and geographic location, including municipal, county, and statewide counts. The department
154shall collect infectious disease immunization data by key socioeconomic and demographic
155indicators, including race, gender, ethnicity, disability, sexual orientation and gender identity,
156primary language, occupation, household income, residence in elder care facilities and other
157congregate care settings, and housing status, and report such data on its website not less than
158weekly, except where publication would result in disclosure of personal information as defined
159in section 1 of chapter 93H or would otherwise violate applicable privacy laws. 9 of 9
160 SECTION 6. Section 12F of chapter 112 of the General Laws, as appearing in the 2020
161Official Edition, is hereby amended by striking out, in lines 14 and 15, the words “have come in
162contact with” and inserting in place thereof the following words:- be at risk of contracting.
163 SECTION 7. Said section 12F of said chapter 112, as so appearing, is hereby further
164amended by inserting after the word “diagnosis”, in line 18, the following word:- , prevention.
165 SECTION 8. Chapter 5 of the Acts of 1995 is hereby amended by striking out section
166122.
167 SECTION 9. Sections 1 through 5, inclusive, of this act shall take effect on July 1, 2025.
168Remaining sections of this act shall take effect upon its passage.