School Entry Immunization Frequently Asked Questions

This FAQ is intended to provide an overview of SB20-163 (eff. 6/26/20) and the resulting changes to school entry immunization requirements. This FAQ is for informational purposes only and does not constitute legal advice. Specific questions should be referred to the school district’s legal counsel.

Background

In recent years, concerns have grown as the number of cases of vaccine-preventable diseases—and the costs associated with treating such cases—has increased.[1] For the 2018-2019 school year, Colorado ranked last among the states for reported kindergarten measles, mumps, and rubella (MMR) vaccination rates at 87.4%[2], below the 95% level that is needed to protect against outbreaks of measles.[3]

During the 2019 legislative session, a bill was proposed, HB19-1312, to eliminate non-medical exemptions and require parents to submit a form in-person to the state or local health department the first time they seek a non-medical exemption, instead of submitting the forms directly to a school; the bill failed.

In fall 2019, some Colorado schools began fully enforcing state law requiring immunization documentation—either immunization records or exemption forms—and denying admission to those without appropriate documents.[4]

In December 2019, three children were diagnosed with measles at Children’s Hospital. It took an estimated 3,600 hours of staff time and cost approximately $300,000 to perform contact tracing of the 258 other patients who may have been exposed.[5] It was against this backdrop that SB20-163 was introduced in February 2020.

Q: Does SB20-163 remove exemptions for parents who don't want to vaccinate their child in order to attend school?

A. No, the bill did not remove any exemptions. The bill combines exemptions based upon a religious belief or personal belief into one new category, nonmedical exemptions[6]; there is no change to obtaining a medical exemption and parents are still able to obtain medical or nonmedical exemptions for their child.[7]

Q: Does SB20-163 require students to receive vaccinations for the flu, HPV, or COVID-19?

A. No, neither this bill nor any other state law requires students receive vaccinations for the flu, HPV, or COVID-19. SB20-163 did not change or add to the vaccines already required for students attending Colorado schools.

Q: Which vaccines are required to enter school?

A. Per the Colorado Board of Health, based on recommendations of the advisory committee on immunization practices of the CDC in the U.S. Department of Health and Human Services, the following vaccines against communicable diseases are required for entry to any K-12 school in Colorado[8]:

 
* Students 4 through 6 years of age are required to have their final doses of DTaP, IPV, MMR, and Varicella prior to kindergarten entry.
** Students are required to have Tdap prior to entry into 6th grade. One dose of Tdap is required for 6th through 12th grades.

Q: What changes were made to school entry immunization requirements?

A. As discussed above, the bill combines exemptions based on a religious or personal belief into one new category, nonmedical exemptions. Further changes include:

• Allowing a qualified licensed physician assistant to issue an up-to-date certificate of immunization[9];

• Requiring the filing of a certificate of medical exemption, certificate of completion of the online education module, or a certificate of nonmedical exemption (if an up-to-date certificate of immunization or written authorization requesting that local public health officials administer immunizations is not submitted)[10];

• Exempting homeschooled students from the school entry immunization requirements[11];

• Allowing a school district, charter school, or private school to require compliance with the school entry immunization requirements for homeschooled students who attend school for part of the day[12].

Q: What other changes does SB20-163 make?

A. Standardized documentation. The bill also requires the Colorado Department of Public Health and Environment (CDPHE), by January 15, 2021, to develop and provide CDE and the Colorado Department of Human Services a standardized document regarding childhood immunizations that both departments must post on their websites on or before January 31, 2021, and each year thereafter.[13] The standardized document must now include:

• updated references to the immunization practices of the CDC[14];

• a place on the document where a school can include the school’s specific immunization and exemption rates for the MMR vaccine and every other vaccine for the school’s enrolled student population for the previous school year compared to the vaccinated children standard[15]; and

• a statement that the school is required to collect and report the school’s specific immunization and exemption rates as compared to the vaccinated children standard, and that the school does not control these rates or establish the vaccinated children standard.[16]

CDPHE must also develop and publish standardized certificates of medical and nonmedical exemption forms and make both forms available on its website.[17] These forms will be limited to requests for information related to collecting data pertaining to a medical or nonmedical exemption and will not require the student’s parent/legal guardian to provide any demographic data beyond the student’s name, date of birth, sex, school’s name and location, and the parent’s/legal guardian’s name or any information that would identify a religious belief or reasons for a personal belief.[18] Parents/legal guardians will have the option to exclude their student’s medical or nonmedical exemption information from the immunization tracking system.[19]

School distribution of document. The bill requires schools, on or before February 15, 2021, and every year thereafter, to include on the document the school’s specific immunization and exemption rates for the MMR vaccine for the school’s enrolled student population for the previous school year compared to the vaccinated children standard.[20] Schools are authorized, but not required, to include the immunization and exemption rates for other vaccines on the document. Schools must directly distribute the document to the parent/legal guardian of each enrolled student, emancipated students, or students who are 18 or older.[21]

Exemption process. Previously, parents/legal guardians were able to exempt their student by submitting, to the student’s school, either certification of medical exemption from a licensed physician, licensed and qualified physician assistant, or advanced practice nurse or submitting a statement of exemption, signed by the parent/legal guardian, on the basis of a religious or personal belief.

While the process for obtaining a medical exemption remains the same, the bill now requires parents/legal guardians to obtain a nonmedical exemption for their student by submitting either a completed certificate of completion of the online education module or completed and signed certificate of nonmedical exemption.[22]

Immunization tracking system. The bill requires CDPHE to maintain an immunization tracking system to enable the gathering of epidemiological information and investigation of communicable diseases (establishing the tracking system was previously optional).[23] All immunization and exemption data that is submitted is subject to confidentiality requirements.[24]

Vaccinated children standard. The bill also establishes a vaccinated children standard, whereby the immunization rate goal for every school is 95% of the student population to be vaccinated according to the school immunization schedule established by CDPHE.[25] In order to achieve this immunization goal, CDPHE will work with local public health agencies and schools to provide information and technical assistance regarding best practices to educate and engage with students and families about vaccines, the risks of vaccine-preventable diseases, and where vaccines are administered.[26]

Q: What did not change in the school entry immunization requirements?

A. As discussed above, parents/legal guardians are still able to obtain medical or nonmedical exemptions for their student. There has been no change to either the list of required vaccines or the vaccination schedule. Additionally, the application of school entry immunization requirements to all schools in Colorado, including public, private, or parochial schools, has not changed.

Q: Does SB20-163 apply to private or charter schools? What about online schools or programs?

A. Yes, the bill applies to all schools in Colorado, including public, private, parochial, and charter schools.[27] Neither the bill nor any other state law exempts students enrolled or participating in online schools or programs; if the online school or program is offered by a public, private, or parochial school, the school entry immunization requirements apply.

Q: Does SB20-163 apply to homeschooled students?

A. No, the bill exempts students who are participating in nonpublic home-based educational programs.[28] However, a school district, charter school, or private school may require a homeschooled student who attends school for part of the day (or who participates in a “shared school” program) to comply with the school entry immunization requirements.[29]

Additionally, parents or legal guardians of students who are enrolled in, but do not attend, an independent or parochial school that provides a basic academic education, or who participate in a nonpublic home-based educational program must still provide the student’s immunization records or a statement signed by the parent or legal guardian that the student is exempt from immunization.[30]

Q: Are there any changes to CASB sample school board policies as a result of SB20-163?

Updated: June 2021