House Bill 25-1027 Preamended

A Bill for an Act

• Page 1, Line 101Concerning modifications to statutes governing disease

• Page 1, Line 102control.

Bill Summary

(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)

The bill amends various statutes governing the operations of the department of public health and environment (department) regarding disease control. Specifically, sections 1 through 9 of the bill:

• Repeal the governor's expert emergency epidemic response committee (GEEERC);
• Direct the state board of health to review and approve the department's emergency response and recovery plan every 3 years; and
• Require the executive director of the department or, if the executive director is not the chief medical officer, the chief medical officer to convene a group of subject matter experts to develop crisis standards of care to be used in responding to a public health emergency.
• Allow the records of a physician assistant to be used to create a certificate of immunization for a student;
• Eliminate a provision regarding a plan for complying with immunization requirements since it is not one of the ways for complying with school immunization requirements;
• Repeal the 14-day period within which a student whose certificate of immunization is not up to date to comply with immunization requirements to attend school and instead direct the state board of health to establish a timeline for compliance that is no shorter than 14 days after notice of noncompliance is received;
• Extend from February 15 to April 15 the deadline for a school to distribute the annual letter to parents specifying the school's aggregate immunization rates and the immunization requirements applicable for the next school year;
• Remove gendered pronouns and replace them with gender-neutral language; and
• Repeal the requirement for schools to notify the department and the local public health agency when a student is suspended or expelled from school for noncompliance with immunization requirements.

Sections 10 through 15 modify school immunization provisions as follows to:

Section 16 extends from July 15 to September 15 the date by which the department is required to submit to the general assembly an annual report summarizing health-care-associated infections data received from health facilities in the state.

Section 17 repeals the requirement for certain health-care providers to offer a hepatitis C screening test to individuals born between 1945 and 1965 and instead directs the state board of health to adopt standards, consistent with recommendations from the federal centers for disease control and prevention, for hepatitis C screening tests.

• This Unofficial Version Includes Committee

• Amendments Not Yet Adopted on Second Reading

• Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:

• Page 2, Line 2SECTION 1.  In Colorado Revised Statutes, 25-1-105, add (4) as

• Page 3, Line 1follows:

• Page 3, Line 225-1-105.  Executive director - chief medical officer -

• Page 3, Line 3qualifications - salary - office - duties - crisis standards of care.

• Page 3, Line 4(4) (a)  In the event of a public health emergency, if the governor

• Page 3, Line 5and the executive director and, if the executive director is not

• Page 3, Line 6the chief medical officer, the chief medical officer agree that

• Page 3, Line 7crisis standards of care are needed to respond to the public

• Page 3, Line 8health emergency, the executive director or, if the executive

• Page 3, Line 9director is not the chief medical officer, the chief medical

• Page 3, Line 10officer shall:

• Page 3, Line 11(I)  Assemble a group of subject matter experts to develop

• Page 3, Line 12crisis standards of care for use by health-care providers and

• Page 3, Line 13health-care facilities in responding to the public health

• Page 3, Line 14emergency; and

• Page 3, Line 15(II)  Activate all or portions of the crisis standards of

• Page 3, Line 16care as needed during the public health emergency.

• Page 3, Line 17(b)  Upon agreement of the governor and the executive

• Page 3, Line 18director and, if the executive director is not the chief medical

• Page 3, Line 19officer, the chief medical officer that the crisis standards of

• Page 3, Line 20care are no longer needed to respond to the public health

• Page 3, Line 21emergency, the executive director or, if the executive director

• Page 3, Line 22is not the chief medical officer, the chief medical officer shall

• Page 3, Line 23vacate the crisis standards of care.

• Page 3, Line 24SECTION 2.  In Colorado Revised Statutes, 25-1-108, add (1)(i)

• Page 3, Line 25as follows:

• Page 3, Line 2625-1-108.  Powers and duties of state board of health - rules -

• Page 3, Line 27definitions. (1)  In addition to all other powers and duties conferred and

• Page 4, Line 1imposed upon the state board of health by this part 1, the board has the

• Page 4, Line 2following specific powers and duties:

• Page 4, Line 3(i) (I)  Every three years, to review and amend, as

• Page 4, Line 4necessary, the department's internal emergency response and

• Page 4, Line 5recovery plan that addresses the public health response to acts

• Page 4, Line 6of bioterrorism, pandemic influenza, and epidemics caused by

• Page 4, Line 7novel and highly fatal infectious agents.

• Page 4, Line 8(II)  As used in this subsection (1)(i):

• Page 4, Line 9(A)  "Internal emergency response and recovery plan"

• Page 4, Line 10means the portion of the state emergency operations plan

• Page 4, Line 11prepared and updated by the department that specifies

• Page 4, Line 12operations that will be implemented if there is an occurrence or

• Page 4, Line 13imminent threat of an emergency epidemic.

• Page 4, Line 14(B)  "State emergency operations plan" means the plan

• Page 4, Line 15developed in accordance with section 24-33.5-705 (2) by the office

• Page 4, Line 16of emergency management in the division of homeland security

• Page 4, Line 17and emergency management in the department of public safety

• Page 4, Line 18to address the preparation, prevention, mitigation, response, and

• Page 4, Line 19recovery from emergencies and disasters.

• Page 4, Line 20SECTION 3.  In Colorado Revised Statutes, repeal 24-33.5-704.5

• Page 4, Line 21(1).

• Page 4, Line 22SECTION 4.  In Colorado Revised Statutes, 24-33.5-704.5,

• Page 4, Line 23amend (2) as follows:

• Page 4, Line 2424-33.5-704.5.  Continuity of operations plans - reports to

• Page 4, Line 25general assembly. (2)  Each department that administers a publicly

• Page 4, Line 26funded safety net program shall develop a continuity of operations plan

• Page 4, Line 27The plan shall establish that establishes procedures for the response

• Page 5, Line 1by, and continuation of operations of, the department and the safety net

• Page 5, Line 2program in the event of an emergency epidemic. Each department shall

• Page 5, Line 3file its plan with the executive director of the department of public health

• Page 5, Line 4and environment and shall update the plan at least annually. In addition,

• Page 5, Line 5notwithstanding section 24-1-136 (11), each department shall submit a

• Page 5, Line 6report by March 1 of each year to the health and human services

• Page 5, Line 7committee committees of the senate and the public health care and

• Page 5, Line 8human services committee of the house of representatives, or any

• Page 5, Line 9successor committees, regarding the status of the department's plan, as

• Page 5, Line 10well as the status of any other plans or procedures of the department

• Page 5, Line 11regarding emergency and disaster preparedness.

• Page 5, Line 12SECTION 5.  In Colorado Revised Statutes, 2-3-1502, repeal (6)

• Page 5, Line 13as follows:

• Page 5, Line 142-3-1502.  Definitions. As used in this part 15, unless the context

• Page 5, Line 15otherwise requires:

• Page 5, Line 16(6)  "GEEERC" means the governor's expert emergency epidemic

• Page 5, Line 17response committee created in section 24-33.5-704.5.

• Page 5, Line 18SECTION 6.  In Colorado Revised Statutes, 2-3-1503, amend

• Page 5, Line 19(1)(a) and (2) as follows:

• Page 5, Line 202-3-1503.  Legislative emergency preparedness, response, and

• Page 5, Line 21recovery committee - creation - membership - duties. (1) (a)  There is

• Page 5, Line 22hereby created a legislative emergency preparedness, response, and

• Page 5, Line 23recovery committee. The legislative committee shall develop a plan for

• Page 5, Line 24the response by, and continuation of operations of, the general assembly

• Page 5, Line 25and the legislative service agencies in the event of an emergency

• Page 5, Line 26epidemic or disaster. The legislative committee shall cooperate and

• Page 5, Line 27coordinate with the division and the department and the GEEERC in

• Page 6, Line 1developing the plan The legislative committee shall develop and shall

• Page 6, Line 2submit the plan to the speaker of the house of representatives, the

• Page 6, Line 3president of the senate, the governor, the executive director of the

• Page 6, Line 4department, and the director of the division. and the GEEERC no later

• Page 6, Line 5than July 1, 2011. The legislative committee shall meet at least annually

• Page 6, Line 6to review and amend the plan as necessary and shall provide any updated

• Page 6, Line 7plan to the persons individuals or entities specified in this paragraph (a)

• Page 6, Line 8subsection (1)(a). The legislative committee may recommend legislation

• Page 6, Line 9pertaining to the preparedness, response, and recovery by, and

• Page 6, Line 10continuation of operations of, the general assembly and the legislative

• Page 6, Line 11service agencies in the event of an emergency epidemic or disaster. The

• Page 6, Line 12legislative committee shall provide information to and fully cooperate

• Page 6, Line 13with the division and the department and the GEEERC in fulfilling its

• Page 6, Line 14duties under this section.

• Page 6, Line 15(2)  In the event of an emergency epidemic or disaster that the

• Page 6, Line 16governor declares to be a disaster emergency pursuant to section

• Page 6, Line 1724-33.5-704, C.R.S., the legislative committee shall convene as rapidly

• Page 6, Line 18and as often as necessary to advise the speaker of the house of

• Page 6, Line 19representatives, the president of the senate, and the legislative service

• Page 6, Line 20agencies regarding reasonable and appropriate measures to be taken by

• Page 6, Line 21the general assembly and the legislative service agencies to respond to the

• Page 6, Line 22emergency epidemic or disaster and protect the public health, safety, and

• Page 6, Line 23welfare. The legislative committee shall communicate, cooperate, and

• Page 6, Line 24seek advice and assistance from the division and the department and the

• Page 6, Line 25GEEERC in responding to the emergency epidemic or disaster.

• Page 6, Line 26SECTION 7.  In Colorado Revised Statutes, 24-33.5-703, repeal

• Page 6, Line 27(2) as follows:

• Page 7, Line 124-33.5-703.  Definitions. As used in this part 7, unless the

• Page 7, Line 2context otherwise requires:

• Page 7, Line 3(2)  "Committee" means the governor's expert emergency epidemic

• Page 7, Line 4response committee created in section 24-33.5-704.5.

• Page 7, Line 5SECTION 8.  In Colorado Revised Statutes, 24-33.5-711.5,

• Page 7, Line 6amend (1) as follows:

• Page 7, Line 724-33.5-711.5.  Liability - limits on damages and compensation

• Page 7, Line 8- immunity for good faith compliance with rules and orders.

• Page 7, Line 9(1)  Neither The state nor the members of the expert emergency epidemic

• Page 7, Line 10response committee designated or appointed pursuant to section

• Page 7, Line 1124-33.5-704.5 are is not liable for any a claim based upon the

• Page 7, Line 12committee's advice provided by an officer or employee of a state

• Page 7, Line 13department to the governor or the alleged negligent exercise or

• Page 7, Line 14performance of, or failure to exercise or perform, an act relating to an

• Page 7, Line 15emergency epidemic. Liability against a member of the committee an

• Page 7, Line 16officer or employee of a state department may be found only for

• Page 7, Line 17wanton or willful misconduct or willful disregard of the best interests of

• Page 7, Line 18protecting and maintaining the public health. Damages awarded on the

• Page 7, Line 19basis of such liability shall not exceed one hundred thousand dollars for

• Page 7, Line 20any injury to or damage suffered by one person or three hundred thousand

• Page 7, Line 21dollars for an injury to or damage suffered by three or more persons in the

• Page 7, Line 22course of an emergency epidemic.

• Page 7, Line 23SECTION 9.  In Colorado Revised Statutes, 25-1.5-102, amend

• Page 7, Line 24(1)(b)(I) as follows:

• Page 7, Line 2525-1.5-102.  Epidemic and communicable diseases - powers and

• Page 7, Line 26duties of department - rules - definitions. (1)  The department has, in

• Page 7, Line 27addition to all other powers and duties imposed upon it by law, the

• Page 8, Line 1powers and duties provided in this section as follows:

• Page 8, Line 2(b) (I)  To investigate and monitor the spread of disease that is

• Page 8, Line 3considered part of an emergency epidemic, as defined in section

• Page 8, Line 424-33.5-703 (4), to determine the extent of environmental contamination

• Page 8, Line 5resulting from the emergency epidemic, and to rapidly provide

• Page 8, Line 6epidemiological and environmental information to the governor's expert

• Page 8, Line 7emergency epidemic response committee, created in section

• Page 8, Line 824-33.5-704.5 state board of health.

• Page 8, Line 9SECTION 10.  In Colorado Revised Statutes, 25-4-901, repeal

• Page 8, Line 10(1); and add (1.6) and (1.8) as follows:

• Page 8, Line 1125-4-901.  Definitions. As used in this part 9, unless the context

• Page 8, Line 12otherwise requires:

• Page 8, Line 13(1)  "Certificate of immunization" means one of the following

• Page 8, Line 14forms of documentation that include the dates and types of immunizations

• Page 8, Line 15administered to a student:

• Page 8, Line 16(a)  A paper document that includes information transferred from

• Page 8, Line 17the records of a licensed physician, registered nurse, or public health

• Page 8, Line 18official; or

• Page 8, Line 19(b)  An electronic file or a hard copy of an electronic file provided

• Page 8, Line 20to the school directly from the immunization tracking system, established

• Page 8, Line 21pursuant to section 25-4-2403.

• Page 8, Line 22(1.6)  "Immunization record" means a paper or electronic

• Page 8, Line 23document from the records of a licensed physician, a physician

• Page 8, Line 24assistant authorized pursuant to section 12-240-107 (6), an

• Page 8, Line 25advanced practice registered nurse, or a public health official

• Page 8, Line 26that includes the dates and types of immunizations administered

• Page 8, Line 27to a student.

• Page 9, Line 1(1.8)  "Official certificate of immunization" means one of

• Page 9, Line 2the following forms of documentation that includes the dates

• Page 9, Line 3and types of immunizations administered to a student:

• Page 9, Line 4(a)  Information from an immunization record transferred

• Page 9, Line 5by a licensed physician, a physician assistant authorized

• Page 9, Line 6pursuant to section 12-240-107 (6), an advanced practice

• Page 9, Line 7registered nurse, a public health official, or a school official

• Page 9, Line 8onto a paper or electronic version of the official certificate of

• Page 9, Line 9immunization form created and maintained by the department of

• Page 9, Line 10public health and environment; or

• Page 9, Line 11(b)  An electronic file or a hard copy of an electronic file

• Page 9, Line 12provided to the school directly from the immunization tracking

• Page 9, Line 13system, established pursuant to section 25-4-2403.

• Page 9, Line 14SECTION 11.  In Colorado Revised Statutes, 25-4-902, amend

• Page 9, Line 15(1) introductory portion, (1)(a), (2), (3), (4)(a)(II), and (4)(b); and repeal

• Page 9, Line 16(1)(b) as follows:

• Page 9, Line 1725-4-902.  Immunization prior to attending school -

• Page 9, Line 18standardized immunization information. (1)  A student shall not attend

• Page 9, Line 19any school in the state of Colorado on or after the dates specified in

• Page 9, Line 20section 25-4-906 (4) unless he or she the student or the student's

• Page 9, Line 21parent or legal guardian has presented one of the following to the

• Page 9, Line 22appropriate school official:

• Page 9, Line 23(a)  An up-to-date official certificate of immunization from a

• Page 9, Line 24licensed physician, physician assistant authorized pursuant to section

• Page 9, Line 2512-240-107 (6), advanced practice registered nurse, or authorized

• Page 9, Line 26representative of the department of public health and environment or a

• Page 9, Line 27local public health agency stating that the student has received

• Page 10, Line 1immunization against communicable diseases as specified by the state

• Page 10, Line 2board of health, based on recommendations of the advisory committee on

• Page 10, Line 3immunization practices of the centers for disease control and prevention

• Page 10, Line 4in the federal department of health and human services American

• Page 10, Line 5Academy of Pediatrics or its successor organization; or

• Page 10, Line 6(b)  A written authorization signed by one parent or legal guardian,

• Page 10, Line 7an emancipated student, or a student eighteen years of age or older

• Page 10, Line 8requesting that local public health officials administer the immunizations;

• Page 10, Line 9or

• Page 10, Line 11(2)  If the student's official certificate of immunization is not up

• Page 10, Line 12to date according to the requirements of the state board of health, the

• Page 10, Line 13parent or guardian of the student or, if the student is emancipated

• Page 10, Line 14or eighteen years of age or older, the emancipated student or the

• Page 10, Line 15student eighteen years of age or older shall submit to the school, within

• Page 10, Line 16fourteen thirty days after receiving direct personal notification that the

• Page 10, Line 17official certificate of immunization is not up to date, documentation

• Page 10, Line 18indicating that the next required immunization has been given and that

• Page 10, Line 19includes a written plan for completion of all required immunizations.

• Page 10, Line 20The scheduling of immunizations in the written plan shall follow

• Page 10, Line 21medically recommended minimum intervals approved by the state board

• Page 10, Line 22of health. If the student begins but does not continue or complete the

• Page 10, Line 23written plan, he or she the school shall be suspended or expelled

• Page 10, Line 24suspend or expel the student pursuant to this part 9.

• Page 10, Line 25(3)  Notwithstanding the provisions of subsection (1) of this

• Page 10, Line 26section, a school shall enroll a student who is in out-of-home placement

• Page 10, Line 27within five school days after receiving the student's education information

• Page 11, Line 1and records as required in section 22-32-138, C.R.S., regardless of

• Page 11, Line 2whether the school has received the items specified in subsection (1) of

• Page 11, Line 3this section. Upon enrolling the student, the requirements of

• Page 11, Line 4subsections (1) and (2) of this section apply, and the school shall

• Page 11, Line 5notify the student's legal guardian that, unless the school receives the

• Page 11, Line 6student's official certificate of immunization or a written authorization

• Page 11, Line 7for administration of immunizations certificate of exemption within

• Page 11, Line 8fourteen days after the student enrolls, the school shall will suspend the

• Page 11, Line 9student until such time as the school receives the official certificate of

• Page 11, Line 10immunization or the authorization certificate of exemption.

• Page 11, Line 11(4) (a)  On or before January 15, 2021, the department of public

• Page 11, Line 12health and environment shall develop and provide to the department of

• Page 11, Line 13education and the department of human services a standardized document

• Page 11, Line 14regarding childhood immunizations. The department of education and the

• Page 11, Line 15department of human services shall post the standardized immunization

• Page 11, Line 16document on their websites on or before January 31, 2021, and on or

• Page 11, Line 17before January 31 each year thereafter. The standardized document must

• Page 11, Line 18be updated annually and must include, but need not be limited to:

• Page 11, Line 19(II)  A list of immunizations currently recommended for children

• Page 11, Line 20by the advisory committee on immunization practices of the centers for

• Page 11, Line 21disease control and prevention in the federal department of health and

• Page 11, Line 22human services and the recommended age at which each immunization

• Page 11, Line 23should be given, as specified by the state board of health in

• Page 11, Line 24accordance with subsection (1)(a) of this section;

• Page 11, Line 25(4) (b)  On or before February 15, 2021 April 15, 2026, and on or

• Page 11, Line 26before February 15 April 15 each year thereafter, a school shall include

• Page 11, Line 27on the document described in subsection (4)(a) of this section the

• Page 12, Line 1school's specific immunization and exemption rates for the measles,

• Page 12, Line 2mumps, and rubella vaccine for the school's enrolled student population

• Page 12, Line 3for the prior school year compared to the vaccinated children standard

• Page 12, Line 4described in section 25-4-911. The school may include on the document

• Page 12, Line 5the school's specific immunization and exemption rates for any other

• Page 12, Line 6vaccine for the school's enrolled student population for the prior school

• Page 12, Line 7year. The school shall directly distribute the document to the parent or

• Page 12, Line 8legal guardian of each student enrolled in its school, emancipated

• Page 12, Line 9students, or students eighteen years of age or older, consistent with

• Page 12, Line 10section 25-4-903 (5).

• Page 12, Line 11SECTION 12.  In Colorado Revised Statutes, 25-4-902.5, amend

• Page 12, Line 12(1) as follows:

• Page 12, Line 1325-4-902.5.  Immunization prior to attending a college or

• Page 12, Line 14university - tuberculosis screening process development. (1)  Except

• Page 12, Line 15as provided in section 25-4-903, no a student shall not attend any college

• Page 12, Line 16or university in the state of Colorado on or after the dates specified in

• Page 12, Line 17section 25-4-906 (4) unless the student can present to the appropriate

• Page 12, Line 18official of the school a an official certificate of immunization from a

• Page 12, Line 19licensed physician, licensed physician assistant authorized under section

• Page 12, Line 2012-240-107 (6), licensed advanced practice registered nurse, or authorized

• Page 12, Line 21representative of the department of public health and environment or

• Page 12, Line 22county, district, or municipal public health agency stating that the student

• Page 12, Line 23has received immunization against communicable diseases as specified

• Page 12, Line 24by the state board of health. or a written authorization signed by one

• Page 12, Line 25parent or guardian or the emancipated student or the student eighteen

• Page 12, Line 26years of age or older requesting that local health officials administer the

• Page 12, Line 27immunizations or a plan signed by one parent or guardian or the

• Page 13, Line 1emancipated student or the student eighteen years of age or older for

• Page 13, Line 2receipt by the student of the required inoculation or the first or the next

• Page 13, Line 3required of a series of inoculations within thirty days.

• Page 13, Line 4SECTION 13.  In Colorado Revised Statutes, 25-4-903, amend

• Page 13, Line 5(2) introductory portion, (2)(a), (2)(b)(II)(B), (2.2)(a)(III), (2.2)(b)(II),

• Page 13, Line 6and (2.2)(b)(III) as follows:

• Page 13, Line 725-4-903.  Exemptions from immunization - rules. (2)  A

• Page 13, Line 8Unless a student is exempted pursuant to this section, the parent

• Page 13, Line 9or legal guardian of a student shall have his or her the student

• Page 13, Line 10immunized, unless the student is exempted pursuant to this section, or an

• Page 13, Line 11emancipated student or a student eighteen years of age or older or, if a

• Page 13, Line 12student is emancipated or eighteen years of age or older, the

• Page 13, Line 13student shall have himself or herself themself immunized. unless the

• Page 13, Line 14student is exempted pursuant to this section. A student is exempted from

• Page 13, Line 15receiving the required immunizations in the following manner:

• Page 13, Line 16(a)  By submitting to the student's school a completed certificate

• Page 13, Line 17of medical exemption from a licensed physician, physician assistant

• Page 13, Line 18authorized pursuant to section 12-240-107 (6), or advanced practice

• Page 13, Line 19registered nurse that the physical condition of the student is such that one

• Page 13, Line 20or more specified immunizations would endanger his or her the

• Page 13, Line 21student's life or health or are medically contraindicated due to other

• Page 13, Line 22medical conditions; or

• Page 13, Line 23(b) (II) (B)  A complete certificate of nonmedical exemption must

• Page 13, Line 24include the signature of a person who is authorized pursuant to title 12 to

• Page 13, Line 25administer immunizations within his or her the person's scope of

• Page 13, Line 26practice to the student for whom the certificate of nonmedical exemption

• Page 13, Line 27is sought. Nothing in this subsection (2)(b)(II)(B) requires a person

• Page 14, Line 1authorized pursuant to title 12 to administer immunizations within his or

• Page 14, Line 2her the person's scope of practice to sign a certificate of nonmedical

• Page 14, Line 3exemption. Notwithstanding any law or rule to the contrary, a body that

• Page 14, Line 4regulates the professional conduct of a person who is authorized pursuant

• Page 14, Line 5to title 12 to administer immunizations within his or her the person's

• Page 14, Line 6scope of practice to the student for whom the certificate is sought shall

• Page 14, Line 7not order a disciplinary action against the person because the person

• Page 14, Line 8authorized to sign the certificate signed such certificate pursuant to this

• Page 14, Line 9subsection (2)(b)(II)(B). It is unlawful for the employer or any a

• Page 14, Line 10professional organization to retaliate against a person because the person

• Page 14, Line 11authorized to sign a certificate signed such certificate pursuant to this

• Page 14, Line 12subsection (2)(b)(II)(B).

• Page 14, Line 13(2.2) (a) (III)  A person authorized pursuant to title 12 to

• Page 14, Line 14administer immunizations within his or her the person's scope of

• Page 14, Line 15practice to the student for whom the certificate of nonmedical exemption

• Page 14, Line 16is sought and who signs the certificate of nonmedical exemption form

• Page 14, Line 17shall provide a copy of a completed certificate of nonmedical exemption

• Page 14, Line 18to the student's parent or legal guardian, the emancipated student, or the

• Page 14, Line 19student eighteen years of age or older.

• Page 14, Line 20(b) (II)  A person authorized pursuant to title 12 to administer

• Page 14, Line 21immunizations within his or her the person's scope of practice to the

• Page 14, Line 22student for whom the certificate of nonmedical exemption is sought and

• Page 14, Line 23who signs the certificate of nonmedical exemption shall submit the

• Page 14, Line 24nonmedical exemption data to the immunization tracking system created

• Page 14, Line 25in section 25-4-2403.

• Page 14, Line 26(III)  Notwithstanding subsections (2.2)(b)(I) and (2.2)(b)(II) of

• Page 14, Line 27this section, a licensed physician, a physician assistant authorized

• Page 15, Line 1pursuant to section 12-240-107 (6), an advanced practice registered nurse,

• Page 15, Line 2or a person authorized pursuant to title 12 to administer immunizations

• Page 15, Line 3within his or her the person's scope of practice is not subject to a

• Page 15, Line 4regulatory sanction for failing to submit medical exemption or

• Page 15, Line 5nonmedical exemption data to the immunization tracking system.

• Page 15, Line 6SECTION 14.  In Colorado Revised Statutes, amend 25-4-904.5

• Page 15, Line 7as follows:

• Page 15, Line 825-4-904.5.  Annual alignment evaluation. The department of

• Page 15, Line 9public health and environment shall annually evaluate the state's

• Page 15, Line 10immunization practices, including an examination of updated best

• Page 15, Line 11practices and guidelines recommended by the advisory committee on

• Page 15, Line 12immunization practices of the centers for disease control and prevention

• Page 15, Line 13in the federal department of health and human services American

• Page 15, Line 14Academy of Pediatrics or its successor organization. The state

• Page 15, Line 15board of health shall review the department of public health and

• Page 15, Line 16environment's annual evaluation and may update the state's immunization

• Page 15, Line 17practices pursuant to the department of public health and environment's

• Page 15, Line 18annual evaluation.

• Page 15, Line 19SECTION 15.  In Colorado Revised Statutes, amend 25-4-905 as

• Page 15, Line 20follows:

• Page 15, Line 2125-4-905.  Immunization of indigent children. (1)  The county,

• Page 15, Line 22district, or municipal public health agency; a public health or school nurse

• Page 15, Line 23under the supervision of a licensed physician or physician assistant

• Page 15, Line 24authorized under section 12-240-107 (6); or the department of public

• Page 15, Line 25health and environment, in the absence of a county, district, or municipal

• Page 15, Line 26public health agency or public health nurse, shall provide, at public

• Page 15, Line 27expense to the extent that funds are funding is available, immunizations

• Page 16, Line 1required by this part 9 to each child whose parents or guardians cannot

• Page 16, Line 2afford to have the child immunized or, if emancipated, who cannot

• Page 16, Line 3himself or herself themself afford immunization and who has not been

• Page 16, Line 4exempted. The department of public health and environment shall provide

• Page 16, Line 5all vaccines necessary to comply with this section as far as funds funding

• Page 16, Line 6will permit. Nothing in this section precludes the department of public

• Page 16, Line 7health and environment from distributing vaccines to physicians,

• Page 16, Line 8physician assistants authorized under section 12-240-107 (6),

• Page 16, Line 9advanced practice registered nurses, or others as required by law or the

• Page 16, Line 10rules of the department. No An indigent child shall not be excluded,

• Page 16, Line 11suspended, or expelled from school unless the immunizations have been

• Page 16, Line 12available and readily accessible to the child at public expense.

• Page 16, Line 13(2)  Notwithstanding any other provision of this part 9 to the

• Page 16, Line 14contrary, programs and services that provide immunizations to children

• Page 16, Line 15for communicable diseases shall be made available to a child regardless

• Page 16, Line 16of his or her the child's race, religion, gender, ethnicity, national origin,

• Page 16, Line 17or immigration status.

• Page 16, Line 18SECTION 16.  In Colorado Revised Statutes, 25-4-906, amend

• Page 16, Line 19(1), (2), and (4) as follows:

• Page 16, Line 2025-4-906.  Certificate of immunization - forms. (1)  The

• Page 16, Line 21department of public health and environment shall provide official

• Page 16, Line 22certificates of immunization to the schools, private physicians, and

• Page 16, Line 23county, district, and municipal public health agencies. Upon the

• Page 16, Line 24commencement of the gathering of epidemiological information pursuant

• Page 16, Line 25to section 25-4-2403 to implement the immunization tracking system,

• Page 16, Line 26such form shall include a notice that informs a parent or legal guardian

• Page 16, Line 27that he or she the parent or legal guardian has the option to exclude

• Page 17, Line 1his or her their infant's, child's, or student's immunization information

• Page 17, Line 2from the immunization tracking system created in section 25-4-2403.

• Page 17, Line 3A school official may accept any immunization record provided by

• Page 17, Line 4a licensed physician, registered nurse, or public health official may be

• Page 17, Line 5accepted by the school official as certification as proof ofimmunization

• Page 17, Line 6if the information is transferred to the official certification of

• Page 17, Line 7immunization. and verified by the school official.

• Page 17, Line 8(2) (a) (I)  Except as provided in subsection (2)(a)(II) of this

• Page 17, Line 9section, each school shall maintain on file an official certificate of

• Page 17, Line 10immunization for every student enrolled in the school.

• Page 17, Line 11(II)  In lieu of an official certificate of immunization, a

• Page 17, Line 12licensed children's residential camp may maintain on file an

• Page 17, Line 13out-of-state immunization record for an out-of-state camper

• Page 17, Line 14attending the residential camp.

• Page 17, Line 15(b) (I)  When a student withdraws, transfers, is promoted,

• Page 17, Line 16or otherwise leaves a school, the school shall:

• Page 17, Line 17(A)  Upon request, returnthe official certificate shall be

• Page 17, Line 18returned of immunization to the parent or guardian of a student or, if

• Page 17, Line 19a student is emancipated or eighteen years of age or older, to the

• Page 17, Line 20emancipated student; or student eighteen years of age or older when a

• Page 17, Line 21student withdraws, transfers, is promoted, or otherwise leaves the school,

• Page 17, Line 22or the school shall

• Page 17, Line 23(B)  Transfer the official certificate of immunization with the

• Page 17, Line 24student's school record to the new school.

• Page 17, Line 25(II)  Upon a college or university student's request, the college or

• Page 17, Line 26university shall forward the official certificate of immunization

• Page 17, Line 27shall be forwarded as specified by the student.

• Page 18, Line 1(4)  All students enrolled in any school in Colorado on and after

• Page 18, Line 2August 15, 1979, shall furnish the required official certificate of

• Page 18, Line 3immunization or shall be suspended or expelled from school. Students

• Page 18, Line 4enrolling in school in Colorado for the first time on and after July 1, 1978,

• Page 18, Line 5shall provide a an official certificate of immunization or shall be

• Page 18, Line 6excluded from school except as provided in section 25-4-903.

• Page 18, Line 7SECTION 17.  In Colorado Revised Statutes, 25-4-907, repeal (2)

• Page 18, Line 8as follows:

• Page 18, Line 925-4-907.  Noncompliance. (2)  In the event of suspension or

• Page 18, Line 10expulsion of a student, school officials shall notify the state department

• Page 18, Line 11of public health and environment or the county, district, and municipal

• Page 18, Line 12public health agency. An agent of said department shall then contact the

• Page 18, Line 13parent or guardian or the emancipated student or student eighteen years

• Page 18, Line 14of age or older in an effort to secure compliance with this part 9 in order

• Page 18, Line 15that the student may be reenrolled in school.

• Page 18, Line 16SECTION 18.  In Colorado Revised Statutes, 25-3-603, amend

• Page 18, Line 17(1) as follows:

• Page 18, Line 1825-3-603.  Department reports. (1)  Notwithstanding section

• Page 18, Line 1924-1-136 (11)(a)(I), on or before July 15, 2017 September 15, 2025, and

• Page 18, Line 20each July 15 September 15 thereafter, the department shall submit to the

• Page 18, Line 21health and human services committees of the house of representatives and

• Page 18, Line 22of the senate, or their successor committees, a report summarizing

• Page 18, Line 23the risk-adjusted health-facility data. The department shall post the report

• Page 18, Line 24on its website.

• Page 18, Line 25SECTION 19.  In Colorado Revised Statutes, 25-4-2005, amend

• Page 18, Line 26(1) as follows:

• Page 18, Line 2725-4-2005.  Hepatitis C testing - recommendations - definitions

• Page 19, Line 1- rules - repeal. (1) (a) (I)  The department recommends that each

• Page 19, Line 2primary health-care provider or physician, physician assistant, or nurse

• Page 19, Line 3practitioner who treats a patient in an inpatient or outpatient setting offer

• Page 19, Line 4a person born between the years of 1945 and 1965 a hepatitis C screening

• Page 19, Line 5test or hepatitis C diagnostic test unless the health-care provider providing

• Page 19, Line 6such services reasonably believes that:

• Page 19, Line 7(a)  (A)  The patient is being treated for a life-threatening

• Page 19, Line 8emergency;

• Page 19, Line 9(b)  (B)  The patient has previously been offered or has been the

• Page 19, Line 10subject of a hepatitis C screening; or

• Page 19, Line 11(c)  (C)  The patient lacks capacity to consent to a hepatitis C

• Page 19, Line 12screening test.

• Page 19, Line 13(II)  This subsection (1)(a) is repealed, effective July 1, 2026.

• Page 19, Line 14(b) (I)  The state board of health created in section

• Page 19, Line 1525-1-103 shall adopt rules establishing standards for hepatitis

• Page 19, Line 16C screening and diagnostic tests for use by primary health-care

• Page 19, Line 17providers, physicians, physician assistants, or nurse

• Page 19, Line 18practitioners who treat patients in an inpatient or outpatient

• Page 19, Line 19setting. The board shall ensure that the screening and

• Page 19, Line 20diagnostic test standards align with recommendations of the

• Page 19, Line 21federal centers for disease control and prevention for hepatitis

• Page 19, Line 22C screening and diagnostic testing.

• Page 19, Line 23(II)  The rules adopted by the board pursuant to this

• Page 19, Line 24subsection (1)(b) shall take effect on July 1, 2026.

• Page 19, Line 25SECTION 20.  Safety clause. The general assembly finds,

• Page 19, Line 26determines, and declares that this act is necessary for the immediate

• Page 19, Line 27preservation of the public peace, health, or safety or for appropriations for

• Page 20, Line 1the support and maintenance of the departments of the state and state

• Page 20, Line 2institutions.