STATE OF MAINE
IMMUNIZATION REQUIREMENTS FOR HEALTHCARE WORKERS
10-144 CODE OF MAINE RULES
CHAPTER 264
Maine Department of Health and Human Services
Maine Center for Disease Control and Prevention
11 State House Station
Augusta, Maine 04333-0011
Date Amended: November 10, 2021
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10-144 DEPARTMENT OF HEALTH AND HUMAN SERVICES
MAINE CENTER FOR DISEASE CONTROL AND PREVENTION
Chapter 264: IMMUNIZATION REQUIREMENTS FOR HEALTHCARE WORKERS
Purpose: This rule is issued pursuant to the statutory authority of the Department of Health and Human
Services to establish procedures for the control and prevention of communicable diseases and to require
immunization of the employees of Designated Healthcare Facilities as set forth in 22 MRS §802. The
purpose of the immunization requirements set forth in this rule is to reduce the risk of exposure to and
transmission of vaccine-preventable diseases among healthcare workers, patients, and other members of
the public in Designated Healthcare Facilities. Limiting transmission of vaccine-preventable diseases in
Designated Healthcare Facilities also serves to reduce the risk of these diseases spreading throughout the
general population. This rule prescribes the dosage for required immunizations; specifies the employees
and certain contractors Designated Healthcare Facilities must exclude if the specified immunization
requirements are not met; describes conditions under which unimmunized employees and certain
contractors may be excluded by order of a Public Health Official, and defines recordkeeping
responsibilities and reporting requirements for Designated Healthcare Facilities and their Chief
Administrative Officers.
SECTION 1. DEFINTIONS
A. Certificate of Immunization means a written statement from a physician, nurse,
physician assistant or health official who has administered an immunization to an
employee, specifying the vaccine administered and the date it was administered.
Secondary school or collegiate health records, having been compiled and maintained as
an official document based on certificates of immunization, which provide at a minimum
the month and year that the immunization was administered and/or which contain copies
of laboratory evidence of immunity, may also be accepted as proof of immunization.
B. Chief Administrative Officer means the person designated as the president, chief
executive officer, administrator, director or otherwise the senior official of a Designated
Healthcare Facility.
C. Declination means a formal process where an individual makes an informed choice
declining Hepatitis B vaccination, following standards and procedures established by the
federal Occupational Safety and Health Administration (OSHA) regulations (29 CFR
§1910.1030(f)(2)(iv) (effective July 6, 1992).
D. Department means the Department of Health and Human Services.
E. Designated Healthcare Facility means a licensed nursing facility, residential care
facility, Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID),
multi-level healthcare facility, hospital, or home health agency subject to licensure by the
State of Maine, Department of Health and Human Services Division of Licensing and
Certification.
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F. Disease means the following conditions which may be preventable by immunization:
1. Rubeola (measles);
2. Mumps;
3. Rubella (German measles);
4. Varicella (chicken pox);
5. Hepatitis B.;
6. Influenza; and
7. COVID-19.
G. Employee means, for purposes of this rule, any person who performs any service for
wages or other remuneration for a Designated Healthcare Facility, including independent
contractors. Persons who provide ad hoc, non-health care services for a Designated
Healthcare Facility and have no potential for direct contact (clinical, hands-on, or face-to-
face interaction) with staff, patients, or visitors of a Designated Healthcare Facility are
not included in this definition of employee. For illustrative purposes only, these may
include, but are not limited to, landscapers, snow plow operators, and delivery persons.
H. Exclusively work remotely means to provide services while outside the physical
premises of a Designated Healthcare Facility and have no direct contact (clinical, hands-
on, or face-to-face interaction) with patients, visitors, and other employees.
I. Exemption means a formal procedure to procure discharge from requirement to vaccinate.
J. Health Official means, for the purposes of this rule, any person who is authorized to
administer immunizations.
K. Immunization means a vaccine, antitoxin, or other substance used to increase an
individual's immunity to disease.
L. Public Health Official means a local health officer, the Director of the Maine Center for
Disease Control and Prevention (Maine CDC), or a designated employee or agent of the
Maine Department of Health and Human Services (Department).
M. Public Health Threat means a condition or behavior that can reasonably be expected to
place others at significant risk of exposure to a toxic agent or environmental hazard or
infection with a notifiable disease or condition, as defined in 22 MRS §801.
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SECTION 2. IMMUNIZATIONS REQUIRED
A. Except as otherwise provided by law, each Designated Healthcare Facility in the State of
Maine must require for all employees who do not exclusively work remotely a Certificate
of Immunization, or Proof of Immunity, subject to Section 4(B) of this rule, against:
1. Rubeola (measles);
2. Mumps;
3. Rubella (German measles);
4. Varicella (chicken pox);
5. Hepatitis B;
6. Influenza;
7. COVID-19.
B. In accordance with 29 CFR §1910.1030(f)(1)(i) (effective July 6, 1992) of the
Occupational Safety and Health Administration (OSHA) regulations, Designated
Healthcare Facilities must make available the Hepatitis B vaccine to all healthcare
workers with a risk of occupational exposure, provided at no cost to the employee and at
a reasonable time and place.
C. No Chief Administrative Officer may permit any employee who does not exclusively
work remotely to be in attendance at work without a Certificate of Immunization for each
disease Proof of Immunity as described in Section 4(B) of this rule, or documentation of
an authorized exemption or declination in accordance with 22 MRS § 802(4-B).
SECTION 3. EXEMPTIONS
An employee who does not provide a Certificate of Immunization or Proof of Immunity, as
described in Section 4(B) for a vaccine required under this rule may be permitted to attend work
if that employee is exempt in accordance with 22 MRS § 802 (4-B), unless otherwise provided by
law. Documentation for an employee’s immunization exemption must be maintained in the
permanent health record for that employee for a minimum of six years after termination.
SECTION 4. CERTIFICATE of IMMUNIZATION and PROOF OF IMMUNITY
A. Certificate of Immunization
To demonstrate proper immunization against each disease, an employee must present the
Designated Healthcare Facility with a Certificate of Immunization from a physician,
nurse or health official who has administered the immunization(s) to the employee.
Physicians within their own practice may authorize their own employees to issue a
certificate of immunization on behalf of the physician. The certificate must specify the
immunization(s), and the date(s), including month and year, on which it was
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administered. Physicians, having reviewed official patient records created by another
practitioner which indicate that a particular patient has received an immunization on a
specified date, demonstrating at a minimum the month and year the immunization was
given, may certify that the immunization was given. Adequately prepared secondary
and/or collegiate school health records will also be considered acceptable for the purpose
of meeting this requirement.
B. Proof of Immunity
To demonstrate that an employee is immune to any of the diseases listed in Section
5(A)(1)-(5), the employee may present the hospital/facility Designated Healthcare
Facility with laboratory evidence demonstrating immunity, or other acceptable evidence
of immunity. (See Section 7(-B) Individual Health Records.) No Proof of Immunity is
available for COVID-19 or Influenza.
SECTION 5. IMMUNIZATION DOSAGE
A. The following schedule contains the minimally required number of doses for the
immunization(s) listed in Section 2(A) of this rule:
1. Rubeola (Measles): Two doses of live measles vaccine given after the first
birthday, with a minimum of four weeks separating the two doses.
2. Mumps: Two doses of live mumps vaccine given after the first birthday.
3. Rubella (German Measles): Two doses of live rubella vaccine given after the
first birthday.
4. Varicella (Chickenpox): Two doses of live varicella vaccine given after the first
birthday, with a minimum of four weeks separating the two doses.
5. Hepatitis B: Fully completed series of either two or three doses of hepatitis B
vaccine. If a two-dose series, then the second dose must be given one month after
the first dose. If a three-dose series, the second dose must be given one month
after the first dose and five months must separate the second and third doses.
6. Influenza: Annual dose of inactivated influenza vaccine or live attenuated
influenza vaccine.
7. COVID-19: The number of recommended doses must be in accordance with
the COVID-19 immunization manufacturer’s Emergency Use Authorization or
labeling.
B. Any such immunization must meet the standards for biological products which are
approved by the United States Public Health Service.
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SECTION 6. EXCLUSIONS FROM THE HEALTHCARE SETTING
A. Exclusion by order of Public Health Official
A Public Health Official may order a Chief Administrative Officer to exclude from the
worksite an employee who has not been immunized when the employee’s continued
presence poses a clear danger to the health of others. The documented occurrence of a
single case of rubeola (measles), mumps, rubella (German measles) varicella
(chickenpox), or COVID-19 in a Designated Healthcare Facility or amongst its
employees may be interpreted as a clear danger to the health of others.
The Chief Administrative Officer must exclude that employee during the period of
danger, unless otherwise ordered by the Public Health Official.
B. The following periods are defined as the minimum "period of danger:" for each disease
listed below:
1 Measles: 15 days from the onset of symptoms from the last identified case
2. Mumps: 18 days from the onset of symptoms from the last identified case
3. Rubella: 23 days from the onset of symptoms from the last identified case
4. Varicella: 16 days from the onset of symptoms from the last identified case.
C. There is no defined minimum period of danger for influenza, Hepatitis B, or COVID-19.
SECTION 7. RECORD KEEPING, REPORTING, AND ENFORCEMENT
A. Designated Record Keeping
The Chief Administrative Officer in each Designated Healthcare Facility must be
responsible for the maintenance of employee immunization records. The Chief
Administrative Officer may designate a person to be responsible for record keeping.
B. Individual Health Records
Each Designated Healthcare Facility must adopt a uniform, health record for maintaining
information regarding the health status of each employee. The immunization status of
each employee with regard to each disease must be noted on the employee's health
record. The health record of each employee must include, at a minimum, the month and
year that each immunization was administered. Health records are to be retained a
minimum of six years after the date the employee provided services.
Where an exemption has been granted for a reason authorized by law, the documentation
supporting the exemption (including any information regarding the anticipated duration
of the exemption) must be on file with the employee health record. Where Proof of
Immunity has been accepted, a copy of the documentation must also be on file.
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C. List of Non-Immunized Employees
The Chief Administrative Officer or his/her designee in each Designated Healthcare
Facility must keep a listing for each disease of the employees who are not currently
immunized and have not provided Proof of Immunity. This list must include the names of
all employees with authorized exemptions from immunization as well as any who are
otherwise not known to be immune and must state the reason that the employee is not
immune. The purpose of the list is to provide an efficient means to rapidly contact non-
immunized employees in the event of disease outbreaks and exclude them from the
workplace as necessary.
D. Required Reports
The Chief Administrative Officer of each Designated Healthcare Facility is responsible
for completing the Maine CDC’s annual survey regarding the immunization status of all
employees by December 15 of each calendar year. The survey will include the following
information at a minimum:
1. Specific contact information identifying the facility;
2. The name of the Chief Administrative Officer;
3. The total number of employees; and
4. The number of employees identified by vaccine type as either being immunized,
having demonstrated serological proof of immunity, having an exemption in
accordance with law, having declined hepatitis B vaccine, or being out of
compliance.
The survey results may be constructed so as to reflect meaningful data by groupings
within the facility (e.g., pediatric unit). Each report must be signed by the Chief
Administrative Officer as a certification that the information is accurate.
E. Record Sampling and Review
The Department will conduct periodic reviews of annual survey results by selecting
samples of employee health records to compare against information reported by the
Designated Healthcare Facility and to assess for compliance with this rule. The
Department will share the results of this review with the Chief Administrative Officer of
the Designated Healthcare Facility and/or their designees(s) for the purpose of identifying
problems with recordkeeping or other compliance issues.
F. Compliance Rates
Compliance rates may also be made available to the public at the Department’s discretion
in accordance with 22 MRS §824.
G. Enforcement
If a Designated Healthcare Facility fails to correct violations identified by the Department
or otherwise fails to comply with the requirements of this rule, the Department may take
enforcement action pursuant to 22 MRS §804 or as otherwise provided by law.
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STATUTORY AUTHORITY:
22 MRS §802
EFFECTIVE DATE:
April 16, 2002 – filing 2002-115 (New)
NON-SUBSTANTIVE CORRECTIONS:
May 13, 2002 - corrected the spelling of DEPARTMENT in header, page 1
May 10, 2004 - spacing, capitalization and punctuation only
EFFECTIVE DATE:
October 6, 2009 to January 4, 2010 - filing 2009-531 (EMERGENCY)
December 8, 2009 – filing 2009-644
April 14, 2021 – filing 2021-198 (ROUTINE TECHNICAL)
August 12, 2021 – filing 2021-166 (EMERGENCY ROUTINE TECHNICAL)
November 10, 2021 – filing 2021-226 (ROUTINE TECHNICAL)
