SB 1377: Immunizations: medical exemptions.

(1)Existing law prohibits the governing authority of a school or other institution from unconditionally admitting any person as a pupil unless, before the persons admission to that institution, the person has been fully immunized against various diseases, including any disease deemed appropriate by the State Department of Public Health. Existing law provides for medical exemptions from immunization requirements.

Existing law requires the department to develop and make available for use by licensed physicians and surgeons an electronic, standardized, statewide medical exemption certification form to be transmitted directly to the departments California Immunization Registry (CAIR) and submitted directly to the school or institution at which the child will attend, submitted directly to the governing authority of the school or institution, or submitted to that governing authority through the CAIR where applicable. Existing law requires the form to be the only documentation of a medical exemption that the governing authority may accept. Existing law requires the department to identify medical exemption forms that do not meet specified criteria for appropriate medical exemptions. Existing law requires inappropriate or otherwise invalid exemptions to be reviewed by the State Public Health Officer or a physician and surgeon, and authorizes the revocation of the medical exemption. Existing law requires the department to notify the Medical Board of California or the Osteopathic Medical Board of California, as appropriate, of any physician and surgeon who has 5 or more medical exemption forms in a calendar year that are revoked. Existing law authorizes the appeal of a revoked medical exemption by a parent or guardian, as specified.

This bill would repeal these provisions.

Existing law, prior to January 1, 2021, exempts a child from immunization requirements 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 for which the physician and surgeon does not recommend immunization.

This bill would exempt a child from immunization requirements if the parent or guardian files with the governing authority a written statement, as described above. The bill would prohibit the department, a local health department, or a third-party review panel from revoking, invalidating, or conditioning a medical exemption duly issued by a licensed physician and surgeon, except by final order of a court upon clear and convincing evidence of fraud. The bill would prohibit the department and local health departments from auditing, disciplining, or referring a physician and surgeon to the Medical Board of California or Osteopathic Medical Board of California based solely on the number of medical exemptions issued.

(2)Existing law establishes the Medical Board of California and the Osteopathic Medical Board of California for the licensure and regulation of physicians and surgeons and osteopathic physicians and surgeons. Existing law authorizes the boards to, among other things, investigate and discipline licensees for misconduct.

This bill would prohibit a physician and surgeon from being investigated, disciplined, or otherwise acted against by any state department or board based on their issuance of medical exemptions unless the medical exemption is found to be fraudulent or otherwise invalid. The bill would prohibit a medical exemption from being considered in any investigation or action against a physician and surgeon that is otherwise unrelated to medical exemptions.

(3)Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care, and makes a willful violation of the act a crime. Existing law provides for the regulation of health insurers by the Department of Insurance.

This bill would prohibit a health care service plan or health insurer from denying coverage, imposing higher premiums, canceling a policy, or otherwise penalizing an enrollee or insured because a covered minor holds a medical exemption. Because a violation of this requirement by a health care service plan would be a crime, this bill would impose a state-mandated local program.

(4)Existing law provides for the licensure and regulation of health facilities, as defined, by the State Department of Public Health. Existing law makes a violation of those provisions a misdemeanor.

This bill would prohibit a health facility from denying medically necessary care on the basis of a medical exemption. Because a violation of this provision would be a crime, this bill would impose a state-mandated local program.

(5)The bill would require the State Department of Public Health to repeal or amend any regulation inconsistent with this bill on or before July 1, 2027.

(6)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.