An Act To Provide Autonomy for Health Care Providers To Practice Patient-centered Care by Amending the Laws Governing Medical Exemptions to Immunization Requirements
Maine Legislature, Session 129, LD 0987
Committee: Education and Cultural Affairs
Sponsors: BLACK, SAMPSON, DAVIS, FOLEY, GUERIN, KEIM, MIRAMANT, KESCHL, O'CONNOR, WARREN
Amends: 20-A MRSA §6353, 20-A MRSA §6355, 20-A MRSA §6358, 20-A MRSA §6359, 22 MRSA §802, 22 MRSA §8302-A

Legislative Document
No. 987
S.P. 277
In Senate, February 26, 2019
An Act To Provide Autonomy for Health Care Providers To 
Practice Patient-centered Care by Amending the Laws Governing 
Medical Exemptions to Immunization Requirements
Reference to the Committee on Education and Cultural Affairs suggested and ordered 
printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator BLACK of Franklin.
Cosponsored by Representative SAMPSON of Alfred and
Senators: DAVIS of Piscataquis, FOLEY of York, GUERIN of Penobscot, KEIM of Oxford, 
MIRAMANT of Knox, Representatives: KESCHL of Belgrade, O'CONNOR of Berwick, 
WARREN of Hallowell.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  20-A MRSA §6353, sub-§1, as enacted by PL 1983, c. 661, §8, is 
amended to read:
1.  Certificate of immunization.  "Certificate of immunization" means a written 
statement from a physician, nurse health care provider or public health official who has 
administered an immunizing agent to a child, specifying the dosage administered and the 
date it was administered.
Sec. 2.  20-A MRSA §6353, sub-§3-A is enacted to read:
3-A.  Health care provider.  "Health care provider" means a physician, nurse or 
person that is licensed or otherwise authorized in this State to prescribe an immunizing 
agent.
Sec. 3.  20-A MRSA §6355, sub-§1, as enacted by PL 1983, c. 661, §8, is 
amended to read:
1.  Written assurance. The parent provides a written assurance the child will be 
immunized within 90 days by private effort or provides, where applicable, a written 
consent to the child's immunization by a public health officer, physician, nurse or other 
authorized person or a health care provider in public or private employ.
Sec. 4.  20-A MRSA §6355, sub-§2, as amended by PL 2001, c. 326, §2, is 
further amended to read:
2.  Medical exemption.  The parent or the child provides a physician's health care 
provider's written statement that immunization against one or more of the diseases may 
be medically inadvisable as determined by the health care provider.  An exemption under 
this subsection is at the sole discretion of the health care provider providing the written 
statement.  The Commissioner of Education and the Department of Health and Human 
Services may not adopt rules limiting the application of this subsection, including, but not 
limited to, rules establishing requirements for medical exemptions and rules requiring 
review, acceptance or rejection of medical exemptions by the Commissioner of Education 
or the Department of Health and Human Services.
Sec. 5.  20-A MRSA §6358, sub-§2, as enacted by PL 1983, c. 661, §8, is 
repealed.
Sec. 6.  20-A MRSA §6359, sub-§1, ¶A, as amended by PL 1991, c. 146, §1, is 
further amended to read:
A.    "Certificate of immunization" means a written statement from a physician, nurse 
health care provider or public health official who has administered an immunizing 
agent to a student, specifying the dosage administered and the date it was 
administered.
Sec. 7.  20-A MRSA §6359, sub-§1, ¶G-1, as enacted by PL 1991, c. 146, §2, is 
repealed.
Sec. 8.  20-A MRSA §6359, sub-§3, ¶A, as amended by PL 1991, c. 146, §3, is 
further amended to read:
A.    The parent or the student provides a physician's health care provider's written 
statement or a written statement from a school health provider that immunization 
against one or more of the diseases may be medically inadvisable as determined by 
the health care provider.  An exemption under this paragraph is at the sole discretion 
of the health care provider providing the written statement.  The school may not 
adopt policies limiting the application of this paragraph, including, but not limited to, 
policies establishing requirements for medical exemptions and policies requiring the 
school's review, acceptance or rejection of medical exemptions.
Sec. 9.  20-A MRSA §6359, sub-§6, as amended by PL 1991, c. 146, §4, is 
further amended to read:
6.  Rules; requirements; reports.  The Director of the Bureau of Health shall adopt 
rules necessary for the effective implementation of this subchapter, including, but not 
limited to, rules establishing immunization requirements and medical exceptions to 
receiving vaccines or toxoids for each disease, school record keeping and reporting 
requirements or guidelines and procedures for the exclusion of nonimmunized students 
from school.
Immunization requirements more stringent than the provisions of this subchapter may be 
adopted by a school board or by policy of a private school's governing board.
Sec. 10.  22 MRSA §802, sub-§4-B, ¶A, as enacted by PL 2001, c. 185, §2, is 
amended to read:
A.    A medical exemption is available to an employee who provides a physician's 
health care provider's written statement that immunization against one or more 
diseases may be medically inadvisable as determined by the health care provider.  An 
exemption under this paragraph is at the sole discretion of the health care provider 
providing the written statement.  The department may not adopt rules limiting the 
application of this paragraph, including, but not limited to, rules establishing 
requirements for medical exemptions and rules requiring review, acceptance or 
rejection of medical exemptions by the department.  For the purposes of this 
paragraph, "health care provider" has the same meaning as in Title 20-A, section 
6353, subsection 3-A.
Sec. 11.  22 MRSA §8302-A, sub-§1, ¶B, as enacted by PL 1997, c. 494, §10 
and affected by §15, is amended to read:
B.  The health and safety of the children and staff, including training on 
communicable diseases.  Rules adopted by the department that require a child 
attending a child care facility to be immunized must provide that a medical 
exemption is available if the child's parent or legal guardian provides a health care 
provider's written statement that immunization against one or more diseases may be 
medically inadvisable as determined by the health care provider.  An exemption is at 
the sole discretion of the health care provider providing the written statement.  The 
department may not adopt rules limiting the application of this paragraph, including, 
but not limited to, rules establishing requirements for medical exemptions and rules 
requiring review, acceptance or rejection of medical exemptions by the department.  
For the purposes of this paragraph, "health care provider" has the same meaning as in 
Title 20-A, section 6353, subsection 3-A;
Sec. 12.  22 MRSA §8302-A, sub-§2, ¶H, as enacted by PL 1997, c. 494, §10 
and affected by §15, is amended to read:
H.  Health and safety of the children and staff.  Rules adopted by the department that 
require a child attending day care in the home of a family child care provider to be 
immunized must provide that a medical exemption is available if the child's parent or 
legal guardian provides a health care provider's written statement that immunization 
against one or more diseases may be medically inadvisable as determined by the 
health care provider.  An exemption is at the sole discretion of the health care 
provider providing the written statement.  The department may not adopt rules 
limiting the application of this paragraph, including, but not limited to, rules 
establishing requirements for medical exemptions and rules requiring review, 
acceptance or rejection of medical exemptions by the department.  For the purposes 
of this paragraph, "health care provider" has the same meaning as in Title 20-A, 
section 6353, subsection 3-A;
SUMMARY
This bill provides that a medical exemption from immunization for the purposes of 
attendance at a nursery school, a child care facility, a family child care provider or an 
elementary, secondary or postsecondary school, or for employees at certain health care 
facilities, is at the sole discretion of the student's or employee's health care provider.  It 
prohibits the adoption of rules or policies related to medical exemptions, including, but 
not limited to, rules or policies that establish requirements for medical exemptions and 
rules or policies requiring the review, acceptance or rejection of medical exemptions.  
The bill also removes the authority of school boards, the governing boards of private 
schools and municipalities to have more stringent immunization requirements than state 
law.