Menu of State Hospital Influenza
Vaccination Laws
This menu is one of a series of menus assessing vaccination requirements for patients and healthcare
workers in healthcare facilities. Healthcare facilities across the country are increasingly requiring healthcare
workers to be vaccinated for certain vaccine-preventable diseases to reduce disease outbreaks.
1
In some
instances, facilities are establishing these requirements under mandates set forth by state statutes or
regulations. Depending on the vaccination, the legal requirements might apply to either patients,
healthcare workers, or both, and can include the following types of provisions:
Assessment Requirements
The healthcare facility must assess a healthcare worker or patient’s vaccination status.
2
Administrative Requirements for Offering Vaccination
The healthcare facility must offer a vaccination to a healthcare worker or patient.
3
Administrative Requirements for Ensuring Vaccination
The healthcare facility must require a healthcare worker or patient to demonstrate proof of
vaccination or immunity against a specific vaccine preventable disease.
4
Surgical Mask Requirements
The healthcare worker must wear a surgical mask during influenza (flu) season if he or she has been
exempted from or declined flu vaccination.
5
Healthcare-associated infections, which can include flu,
6
are “infections that occur during the course of
healthcare delivery.”
7
In hospitals and other healthcare settings, flu can be spread by healthcare workers
passing germs from hands or clothes to other workers or to patients.
8
Eighteen states establish flu vaccination requirements for hospital healthcare workers, and 16 states
establish requirements for hospital patients. This menu assesses and gives examples of state laws that
expressly establish flu vaccination requirements for hospital healthcare workers and patients.
9
CDC recommends that adults receive the flu vaccine annually. To learn more, visit
CDC’s
Vaccine Information for Adults
webpage for information about this and other
recommended vaccines.
[Cite your source here.]
2
Hospital Healthcare Worker Flu Vaccination Laws
Eighteen states establish flu vaccination requirements for hospital healthcare workers.
10
These laws
establish requirements based on the hospital type and the type of vaccination requirements. In addition,
some state laws allow for vaccination exemptions.
Examples by Hospital Type
Hospitals are healthcare facilities that provide inpatient, diagnostic, and therapeutic services, for both
surgical and non-surgical conditions, 24 hours a day.
11
Seventeen states’ healthcare worker flu vaccination
laws refer to hospitals generally.
12
However, two states have laws that are specific to general acute care
hospitals.
13
All Hospitals
14
Maine law requires that hospitals “adopt and implement a policy that recommends and offers
annual immunization against seasonal influenza to all personnel who provide direct care to
residents of the facility.”
15
General Acute Care Hospital
16
Under California law, "[e]ach general acute care hospital shall require its employees to be
vaccinated, or if the employee elects not to be vaccinated, to declare in writing that he or she has
declined the vaccination.”
17
Examples by Requirement Type
Ten states establish flu vaccination assessment requirements for hospital healthcare workers.
18
Eleven
states require hospitals to offer flu vaccination to healthcare workers.
19
Eight states require hospitals to
ensure that healthcare workers are vaccinated against influenza.
20
Three states require hospital healthcare
workers to wear surgical masks during flu season if they have been exempted from or declined
vaccination.
21
Assessment
New York law requires that hospitals “document the influenza vaccination status of all personnel
for the current influenza season in each individual's personnel record or other appropriate
record.”
22
Under Utah law, hospitals must report “the total number of HCWs and the number of those
workers who are documented to have received an influenza vaccine for the current influenza
season.”
23
Administrative Offer
Per Nebraska law, “[e]ach general acute hospital shall . . . [a]nnually offer onsite influenza
vaccinations to all hospital employees.”
24
Administrative Ensure
Under Massachusetts law, hospitals “shall ensure that all personnel are vaccinated with seasonal
influenza vaccine unless an individual declines vaccination.”
25
3
Surgical Mask
Rhode Island law states that healthcare workers who are not immunized “be required during any
declared period in which flu is widespread—as part of his or her professional licensing obligation—
to wear a surgical face mask for the duration of each direct patient contact in the performance of
his or her duties at any health care facility.”
26
Examples by Exemption Type
States with flu vaccination requirements often explicitly permit exemptions from these requirements in
certain circumstances,
27
such as when vaccination is medically contraindicated or violates a person’s
religious or philosophical beliefs.
28
Eleven states permit medical exemptions for vaccination requirements,
29
four states permit religious exemptions, and ten states permit philosophical exemptions.
30
Medical
Per Maine law, “[a]n employee who does not meet the immunization/immunity requirement may
be permitted to attend work [if] . . . [t]he employee presents . . . a physician’s written statement
that immunization against one or more of these diseases is medically inadvisable.”
31
Religious
New Hampshire requires hospitals to “provide to its consenting employees annual immunizations
against influenza . . . subject to exemptions for medical contraindications and religious beliefs.”
32
Philosophical
Under Massachusetts law, hospitals “shall ensure that all personnel are vaccinated with seasonal
influenza vaccine unless an individual declines vaccination.”
33
Rhode Island law states that an “[a]nnual influenza vaccination is required for all health care
workers” and requires hospitals to track the “number of health care workers who decline annual
influenza vaccination for medical or personal reasons.”
34
Hospital Patient Flu Vaccination Laws
Sixteen states establish flu vaccination laws for hospital patients.
35
These laws establish requirements based
on the hospital and patient categories and the type of vaccination requirements. In addition, state laws
sometimes allow for vaccination exemptions.
Examples by Hospital Type
The patient flu vaccination laws in 14 states refer to hospitals generally.
36
However, two states have laws
that are specific to general acute care hospitals.
37
In addition, one state has flu vaccination laws that are
specific to patients at a university hospital;
38
another state has flu vaccination laws that are specific to
parents of patients in a neonatal unit of a hospital.
39
All Hospitals
40
Ohio law requires that “[e]ach hospital shall offer to each patient who is admitted to the hospital
. . . vaccination against influenza.”
41
CDC recommends that healthcare workers receive the flu vaccine annually. To learn
more, visit the CDC’s
Recommended Vaccines for Healthcare Workers webpage for
information about this and other recommended vaccines.
[Cite your source here.]
4
General Acute Care Hospital
42
Under Nebraska law, “[i]n order to prevent, detect, and control pneumonia and influenza
outbreaks in Nebraska, each general acute hospital . . . shall annually, beginning no later than
October 1 and ending on the following April 1, offer onsite vaccinations for influenza and
pneumococcal disease to all residents and to all inpatients prior to discharge.”
43
University Hospital
Illinois law requires that the University of Illinois Hospital develop “[p]rocedures for offering
immunization against influenza virus when available between September 1 and April 1” to patients
aged 65 years or older.
44
Hospital Neonatal Unit
Under New York law, “[i]t shall be the duty of each general hospital . . . with a neonatal intensive
care unit to offer, annually between September first and April first, to every parent or person in
parental relation who is reasonably anticipated to be a caregiver in the household of a newborn
being treated in the neonatal intensive care unit vaccination against influenza virus.”
45
Examples by Patient Type
Four states establish flu vaccination laws for all hospital patients.
46
Other states have vaccination laws for
patients particularly vulnerable to flu. Thirteen states establish flu vaccination laws for patients aged 65
years or older.
47
Two states establish flu vaccination laws for at-risk patients as identified by the hospital.
48
One state establishes flu vaccination laws for parents of patients in hospital neonatal units.
49
All Patients
Ohio law requires that “[e]ach hospital shall offer to each patient who is admitted to the
hospital . . . vaccination against influenza, unless a physician has determined that vaccination of the
patient is medically inappropriate.”
50
Patients Aged 65 Years or Older
Under Georgia law, “[p]rior to discharging any inpatient who is 65 years of age or older, a hospital
shall offer the inpatient vaccinations for the influenza virus and pneumococcal disease in
accordance with the recommendations of [CDC].”
51
Patients at Risk
Illinois requires that every hospital adopt a flu immunization policy that includes “[p]rocedures for
identifying patients age 65 or older and, at the discretion of the facility, other patients at risk” and
“[p]rocedures for offering immunization against influenza virus.”
52
Parents of Patients in Hospital Neonatal Unit
Under New York law, “[i]t shall be the duty of each general hospital . . . with a neonatal intensive
care unit to offer, annually between September first and April first, to every parent or person in
parental relation who is reasonably anticipated to be a caregiver in the household of a newborn
being treated in the neonatal intensive care unit vaccination against influenza virus.”
53
5
Hospital Patient Vaccination Requirements: Flu and Pneumococcal
Flu vaccination requirements are often established in conjunction with pneumococcal vaccination
requirements. The inner circle below indicates states with both flu and pneumococcal vaccination laws
for hospital patients. The outer circle indicates states with flu vaccination laws only.
For more information about hospital pneumococcal vaccination requirements, see the Public Health
Law Program’s Menu of State Hospital Pneumococcal Vaccination Laws.
Mississippi and
Missouri
California, Florida,
Georgia, Illinois,
Louisiana,
Nebraska, New
Hampshire, New
Jersey, New York,
Ohio,
Pennsylvania,
Tennessee, and
Texas
Examples by Requirement Type
Seven states have flu vaccination assessment requirements for certain hospital patient types.
54
Sixteen
states require hospitals to offer flu vaccination to hospital patients.
55
One state requires hospitals to ensure
patients are vaccinated for flu.
56
Assessment
Texas law requires “that the person administering the vaccine ask the elderly patient if they are
currently vaccinated against influenza.”
57
Administrative Offer
Florida law states that hospitals must “implement a program to offer immunizations against the
influenza virus and pneumococcal bacteria to all patients age 65 or older.”
58
Administrative Ensure
New Hampshire law requires hospitals to “immunize all consenting patients for influenza.”
59
Examples by Exemption Type
Thirteen states explicitly permit hospital patients to be exempted from receiving flu vaccination for medical
reasons.
60
One state permits a religious exemption
61
and four permit philosophical exemptions.
62
Medical
Louisiana law states that hospitals must offer flu vaccination “to all inpatients sixty-five years of age
and older, prior to discharge, unless contraindicated.”
63
Religious
New Hampshire law states that “[i]mmunization of all consenting patients shall be subject to
exemptions for medical contraindications and religious beliefs.”
64
Philosophical
Under California law, “[n]o person who has been offered the vaccine as required under this chapter
may receive either an influenza vaccine . . . if . . . [r]eceipt of the vaccine is against the resident's
personal beliefs.”
65
6
Acknowledgments and Disclaimers
This document was developed by Alexandra Bhatti, JD, MPH, contractor, Cherokee Nation Assurance, LLC;
Aila Hoss, JD, former contractor, Carter Consulting, Inc.; Dawn Pepin, JD, MPH, contractor, Cherokee Nation
Assurance, LLC; and Jennifer Black, JD, Emory Public Interest Fellow, with the Public Health Law Program
(PHLP) within CDC’s Office for State, Tribal, Local and Territorial Support. This document was produced in
collaboration with CDC’s National Center for Immunization and Respiratory Diseases. The authors would
like to thank Lindsay Culp, JD, MPH, Megan Lindley, MPH, and Matthew Penn, JD, MLIS, for their research
and editorial assistance.
For further technical assistance with this inventory, please contact [email protected]. PHLP provides
technical assistance and public health law resources to advance the use of law as a public health tool. PHLP
cannot provide legal advice on any issue and cannot represent any individual or entity in any matter. PHLP
recommends seeking the advice of an attorney or other qualified professional with questions regarding the
application of law to a specific circumstance. The findings and conclusions in this summary are those of the
authors and do not necessarily represent the official views of CDC.
This menu includes states laws collected from WestlawNext during January 14–19, 2015.
Published November 19, 2015 & updated October 2017.
Author’s note:
Updates include the change of Ensure Requirement definition from “requiring a healthcare facility to
ensure that a healthcare worker or patient has been vaccinated, unless vaccination is specifically exempted
or declined” to “the healthcare facility must require a healthcare worker or patient to demonstrate proof of
vaccination or immunity against a specific vaccine preventable disease”. This change did not alter the
coding results. Updates also include change in the interpretation of Offer Requirement such that an offer
includes conditions whereby a facility is required to offer, provide, make available, arrange for vaccination,
or similar language that results in the facility being responsible for providing the individual the opportunity
to receive the vaccination. This did change the coding results; offer requirements identified based on this
change are indicated by a dagger†.
Appendix 1
Hospital Healthcare Worker Influenza Vaccination Laws
State
Citation
Hospital Type
Requirement Type
Exemptions
All
Hospitals
66
General
Acute Care
67
Assessment
Administrative
Offer
Administrative
Ensure
Surgical
Mask
None
Specified
68
Medical
Religious
Philosophical
69
CA
West’s Ann. Cal. Health & Safety Code § 1288.7(a)
West’s Ann. Cal. Health & Safety Code §
1288.45(c)*
West’s Ann. Cal. Health & Safety Code § 1250(a)*
X
X
X
X
West’s Ann. Cal. Health & Safety Code § 1288.8(b)
West’s Ann. Cal. Health & Safety Code §
1288.45(c)*
West’s Ann. Cal. Health & Safety Code § 1250(a)*
X
X
X
Cal. Code Regs. tit. 8, §§ 5199(a)(1), (c)(6)(D),
(c)(7)(H), (h)(5)(D)(10)
Cal. Code Regs. tit. 8, App. C2
Cal. Code Regs. tit. 8, App. E
X
X
X
X
X
CO
6 Colo. Code Regs. 1011-1:II-10.6, 10.7, 10.8
6 Colo. Code Regs. 1011-1:IV-2.100(9)*
X
X
X
70
X
71
X
72
X
GA
Ga. Code Ann. § 31-7-18(b)
Ga Comp. R. & Regs. 111-8-40-.02(f)*
X
X
X
IL
Ill. Admin. Code tit. 77, § 956.30
Ill. Admin. Code tit. 77, § 956 App. A
Ill. Admin. Code tit. 77, § 956.10*
210 Ill. Comp. Stat. 85/3(A)*
X
X
X
X
X
ME
10-144 Me. Code R. Ch. 264, § 2(C), (D)
10-144 Me. Code R. Ch. 264, § 3
10-144 Me. Code R. Ch. 264, § 1(D)*
22 Me. Rev. Stat. Ann. § 1843(4)*
X
X
X
X
X
X
MD
Md. Code Regs. 10.07.01.34(F)(5)
Md. Code Regs. 10.07.01.01(B)(13)*
X
X
X
73
MA
105 Mass. Code Regs. 130.325(B),(C)
105 Mass. Code Regs. 130.020*
X
X
X
X
X
NE
Neb. Rev. St. § 71-467
Neb. Rev. St. § 71-412*
X
X
X
X
X
NH
N.H. Rev. Stat. Ann. § 151:9-b(IV)
N.H. Rev. Stat. Ann. § 151:2(I)(a)*
N.H. Rev. Stat. Ann. § 151-C:2(XX)*
X
X†
X
X
74
X
N.H. Rev. Stat. Ann. § 151:33(II)(b)
N.H. Rev. Stat. Ann. § 151:2(I)(a)*
N.H. Rev. Stat. Ann. § 151-C:2(XX)*
X
X
X
8
N.H. Code Admin. R. He-P 309.02(b)
N.H. Code Admin. R. He-P 309.01(h)*
N.H. Rev. Stat. Ann. § 151-C:2(XX)*
X
X
X
N.H. Code Admin. R. He-P 309.08(b)
N.H. Code Admin. R. He-P 309.01(h)*
N.H. Rev. Stat. Ann. § 151-C:2(XX)*
X
X
X
N.H. Code Admin. R. He-P 802.21(h)
N.H. Code Admin. R. He-P 802.03(ai)*
N.H. Rev. Stat. Ann. § 151-C:2(XX)*
X
X
X
75
†
X
X
76
NV
Nev. Admin. Code § 439.935
Nev. Rev. Stat. Ann. § 439.805*
Nev. Rev. Stat. Ann. § 449.012*
X
X
X
NY
10 N.Y. Comp. Codes R. & Regs. 2.59(c), (d), (f)
N.Y. Pub. Health Law § 2801(1) (McKinney)*
X
X
X
X
77
10 N.Y. Comp. Codes R. & Regs. 405.3(b)(10)(v)
N.Y. Pub. Health Law § 2801(1) (McKinney)*
X
X
78
X
X
X
79
OH
Ohio Admin. Code 3701-14-03
Ohio Admin. Code 3701-14-04
Ohio Admin. Code 3701-14-04, App. A
Ohio Admin. Code 3701-14-04, App. B
Ohio Admin. Code 3701-14-01(A)(8)*
Ohio Rev. Code Ann. § § 3727.01(B)(2)*
X
X
X
OK
Okla. Admin. Code § 310:667-5-4(e)
Okla. Admin. Code § 310:667-1-2*
Okla. Stat. tit. 63, § 1-701(1)*
X
X
X
X
OR
Or. Admin. R. 333-018-0127
Or. Admin. R. 333-018-0100(18)*
Or. Rev. Stat. Ann. § 442.015(15)*
X
X
X
X
RI
31 R.I. Code R. 1-22:3.5.4
31 R.I. Code R. 1-22:5.0
31 R.I. Code R. 1-22:1.0*
31 R.I. Code R. 1-22:2.0*
31 R.I. Code R. 1-22:1.6*
31 R.I. Code R. 1-22:2.1(a)*
31 R R.I. Code R. 4-18:1.27*
X
X
X
X
X
X
SC
S.C. Code Ann. Regs. 61-16 § 602(C)
S.C. Code Ann. Regs. 61-16 § 101(E)*
X
X
X
TN
Tenn. Comp. R. & Regs. 1200-08-01-.06(3)(f)
Tenn. Comp. R. & Regs. 1200-08-01-.01(37)*
X
X
X
80
X
X
UT
Utah Admin. Code R386-705
Utah Code Ann. 1953 § 26-21-2*
X
X
X
*Provision includes definition.
†Note that this was added as part of the broadened offer requirement change in the September 2017 update.
9
Appendix 2
Hospital Patient Influenza Vaccination Laws
State
Citation
Hospital Type
Patient Type
Requirement Type
Exemptions
All
Hospitals
81
University
Hospital
General
Acute
Care
82
Neonatal
Unit
All
Patients
65+
Years
of
Age
Patients
at Risk
Parents of
Neonatal
Assess-
ment
Adminis-
trative
Offer
Adminis-
trative
Ensure
None
Specified
83
Medical
Religious
Philosophical
84
CA
West’s Ann. Cal. Health &
Safety Code § 1288.8(b)
West’s Ann. Cal. Health &
Safety Code § 1288.45(c)*
West’s Ann. Cal. Health &
Safety Code § 1250(a)*
X
X
X
X
West’s Ann. Cal. Health &
Safety Code § 120392.9
West’s Ann. Cal. Health &
Safety Code § 120392.6
West’s Ann. Cal. Health &
Safety Code § 1250(a)*
X
X
X
X
X
FL
Fla. Stat. Ann. § 381.005(2)
Fla. Stat. Ann. § 395.002(12)*
X
X
X
X
85
GA
Ga. Code Ann. § 31-7-18(a)
Ga Comp. R. & Regs. 111-8-40-
.02(f)*
X
X
X
X
Ga Comp. R. & Regs. 111-8-40-
.20(f)
Ga Comp. R. & Regs. 111-8-40-
.02(f)*
X
X
X
X
86
IL
110 Ill. Comp. Stat. 330/8
X
X
X
X
X
210 Ill. Comp. Stat. 85/6.26
210 Ill. Comp. Stat. 85/3(A)*
X
X
X
X
X
Ill. Admin. Code tit. 77, §
250.330(a)(1)
Ill. Admin. Code tit. 77, §
250.100*
210 Ill. Comp. Stat. 85/3(A)*
X
X
X
X
X
LA
La. Rev. Stat. Ann. §
40:2023(1)
La. Rev. Stat. Ann. §
40:2102(A)*
X
X
X
X
MS
Miss. Code Ann. § 41-9-39(1)
Miss. Code Ann. § 41-9-3(a)*
X
X
X
X
10
MO
Mo. Ann. Stat. § 197.168
Mo. Ann. Stat. § 197.020*
X
X
X
X
NE
Neb. Rev. St. § 71-468
Neb. Rev. St. § 71-412*
X
X
X
X
NH
N.H. Rev. Stat. Ann. § 151:9-
b(I)
N.H. Rev. Stat. Ann. §
151:2(I)(a)*
N.H. Rev. Stat. Ann. § 151-
C:2(XX)*
X
X
X
X†
X
X
87
X
N.H. Rev. Stat. Ann. §
151:33(II)(b)
N.H. Rev. Stat. Ann. §
151:2(I)(a)*
N.H. Rev. Stat. Ann. § 151-
C:2(XX)*
X
X
X
X
N.H. Code Admin. R. He-P
309.02(b)
N.H. Code Admin. R. He-P
309.01(h)*
N.H. Rev. Stat. Ann. § 151-
C:2(XX)*
X
X
X
X
N.H. Code Admin. R. He-P
309.08(b)
N.H. Code Admin. R. He-P
309.01(h)*
N.H. Rev. Stat. Ann. § 151-
C:2(XX)*
X
X
X
X
N.H. Code Admin. R. He-P
802.21(h)
N.H. Code Admin. R. He-P
802.03(ai)*
N.H. Rev. Stat. Ann. § 151-
C:2(XX)*
X
X
X
X
88
†
X
X
89
X
NJ
N.J. Admin. Code 8:43G-14.6
N.J. Admin. Code 8:43G-1.2*
X
X
X
X
X
X
NY
N.Y. Pub. Health Law § 2805-
h(2) (McKinney)
N.Y. Pub. Health Law § 2801(1)
(McKinney)*
X
X
X
X
90
X
X
X
N.Y. Pub. Health Law § 2805-
h(3) (McKinney)
N.Y. Pub. Health Law § 2801(1)
(McKinney)*
X
X
X
X
X
X
OH
Ohio Rev. Code Ann. §
3727.19(B)
Ohio Rev. Code Ann. §
3727.01(B)(2)*
X
X
X
X
X
OR
Or. Rev. Stat. § 441.816
Or. Rev. Stat. § 442.015*
X
X
X
X
PA
35 Pa. Cons. Stat. Ann. § 634.3
35 Pa. Cons. Stat. Ann. §
634.2*
X
X
X
X
X
11
35 Pa. Cons. Stat. Ann. §
448.802a*
TN
Tenn. Code Ann. § 68-11-266
Tenn. Code Ann. § 68-11-
201(26)(A)*
X
X
X
X
Tenn. Comp. R. & Regs. 1200-
08-01-.06(3)(g)
Tenn. Comp. R. & Regs. 1200-
08-01-.01(37)*
X
X
X
X
TX
25 Tex. Admin. Code §
133.45(h)(1), (2)
25 Tex. Admin. Code §
133.2(19),(22)*
X
X
X
X
91
X
Tex. Health & Safety Ann.
Code § 161.0052(b)
Tex. Health & Safety Ann.
Code § 241.003(5),(7),(15)*
X
X
X
X
92
X
*Provision includes definition.
†Note that this was added as part of the broadened offer requirement change in the September 2017 update.
1
Alexandra Stewart et al. Mandatory Vaccination of Health-Care Personnel: Good Policy, Law, and Outcomes, 53
Jurimetrics J. 341 (April 2013).
2
MC Lindley, GA Horlick, AM Shefer, FE Shaw & Gorji, M. (2007). Assessing State Immunization Requirements for
Healthcare Workers and Patients. Am. j. of preventive med., 32(6), 459–65, 460.
3
Id.
4
Id.
5
See, e.g., 10 N.Y. Comp. Codes R. & Regs. 2.59; 31 R.I. Code R. 1-22:5.0.
6
Diseases and Organisms in Healthcare Settings, Centers for Disease Control and Prevention,
http://www.cdc.gov/HAI/organisms/organisms.html (last visited Oct. 9, 2015).
7
Tara Ramanathan and Matthew Penn, The Emergence of Law to Address Healthcare-Associated Infections, American
Health Lawyers Association Connections, 28 (Aug. 2012).
8
Prevention Strategies for Seasonal Influenza in Healthcare Settings, Centers for Disease Control and Prevention,
http://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm
(last visited Oct. 13. 2015).
9
CDC’s Public Health Law Program conducted a search for state statutes and regulations that establish express
influenza vaccination requirements for hospitals healthcare workers and patients using WestlawNext, a legal research
database. Searches were conducted in all states and the District of Columbia between January 14–19, 2015 and
updated between March 24-29, 2016. This assessment did not capture state requirements that incorporate CDC
vaccination recommendations by reference. Laws regarding childhood vaccinations, school vaccinations, immunization
registries, blood, tissue, and organ donor requirements, post-exposure vaccinations, physician standing orders, and
primary care providers and individual healthcare provider requirements to vaccinate patients were not within the
scope of this assessment. Laws establishing vaccination requirements as a condition for participation in a health plan
were also excluded.
10
California, Colorado, Georgia, Illinois, Maine, Maryland, Massachusetts, Nebraska, Nevada, New Hampshire, New
York, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Tennessee, and Utah. See appendix 1 for citations. Note,
Colorado law states that “[i]f a licensed healthcare entity demonstrates that it has vaccinated a targeted percentage of
its employees in a given year, using its own methodology, it shall be exempt from the [administrative and surgical
mask] requirements.” 6 Colo. Code Regs. 1011-1:II-10.6.
11
For definitions of “hospital” in state law, see, e.g., West’s Ann. Cal. Health & Safety Code § 1250; Fla. Stat. Ann.
§ 395.002(12); Ga. Comp. R. & Regs. 111-8-40-.02(f); La. Rev. Stat. Ann. §
40:2102(A). Laws regarding psychiatric
h
ospitals were excluded from the assessment. See, e.g., N.Y. Comp. Codes R. & Regs. tit. 14, § 509.4.
12
California, Colorado, Georgia, Illinois, Maine, Maryland, Massachusetts, Nevada, New Hampshire, New York, Ohio,
Ok
lahoma, Oregon, Rhode Island, South Carolina, Tennessee, and Utah. See appendix 1 for citations. The legal
provisions in the “all hospitals” category include laws which reference hospitals generally. Therefore, in some states
the “all hospitals” provisions may also be applicable to specialty and general acute care hospitals, but have been
c
oded only as “all hospitals.” See, e.g., Utah Admin. Code R386-705, which establishes healthcare worker vaccination
assessment requirements, and Utah Code Ann. 1953 § 26-21-2, which includes definitions of both general acute care
and specialty hospitals. Citations defining “hospital” in state law are provided in the appendices for reference. Note,
Colorado law states that “[i]f a licensed healthcare entity demonstrates that it has vaccinated a targeted percentage of
its employees in a given year, using its own methodology, it shall be exempt from the [administrative and surgical
mask] requirements.” 6 Colo. Code Regs. 1011-1:II-10.6.
13
California and Nebraska. See appendix 1 for citations. The provisions in this category specifically reference “general
acute care hospitals” thus these provisions may not apply to other types of specialty hospitals. States that define
hospitals as providing acute care or treating acute illness did not meet the threshold of a “general acute car
e
h
ospital.” See, e.g., 22 Me. Rev. Stat. Ann. § 1843(4); S.C. Code Ann. Regs. 61-16 § 101(E); Tenn. Comp. R. & Regs.
1200-08-01-.01(37). Where available, citations defining “general acute hospital” in state law are provided for
reference in the appendices.
14
See endnote 12 for description of “all hospitals” category.
15
10-144 Me. Code R. Ch. 264, § 2(C).
16
See endnote 13 for description of “general acute care hospitals” category.
17
West's Ann. Cal. Health & Safety Code § 1288.7(a).
13
18
California, Colorado, Maine, New Hampshire, Nevada, New York, Ohio, Oregon, Rhode Island, and Utah. See
appendix 1 for citations. N.M. Stat. Ann. § 24-29-5 was considered a voluntary assessment requirement and thus
excluded from the assessment.
19
California, Colorado, Georgia, Illinois, Maine, Maryland, Nebraska, New Hampshire, Oklahoma, South Carolina, and
Tennessee. See appendix 1 for citations. Note, Colorado law states that “[i]f a licensed healthcare entity demonstrates
that it has vaccinated a targeted percentage of its employees in a given year, using its own methodology, it shall be
exempt from the [administrative and surgical mask] requirements.” 6 Colo. Code Regs. 1011-1:II-10.6.
20
California, Colorado, Massachusetts, Nebraska, New Hampshire, New York, Rhode Island, and Tennessee. See
appendix 1 for citations. Note, Colorado law states that “[i]f a licensed healthcare entity demonstrates that it has
vaccinated a targeted percentage of its employees in a given year, using its own methodology, it shall be exempt from
the [administrative and surgical mask] requirements.” 6 Colo. Code Regs. 1011-1:II-10.6.
21
Colorado, New York, and Rhode Island. See appendix 1 for citations. Note, Colorado law states that “[i]f a licensed
healthcare entity demonstrates that it has vaccinated a targeted percentage of its employees in a given year, using its
own methodology, it shall be exempt from the [administrative and surgical mask] requirements.” 6 Colo. Code Regs.
1011-1:II-10.6.
22
N.Y. Comp. Codes R. & Regs. tit. 10, § 2.59(c).
23
Utah Admin. Code r. R386-705.
24
Neb. Rev. St. § 71-467(1).
25
105 Mass. Code Regs. 130-325(B).
26
31 R.I. Admin. Code 1-22:5.0.
27
See, e.g., N.H. Rev. Stat. Ann. § 151:9-b(IV); 105 Mass. Code Regs. 130-325(B). Please note that even where not
explicitly exempted by law it is likely that patients with a medically contraindicated condition are not required to a
vaccination.
28
Philosophical exemptions include exemptions based on philosophical or personal beliefs or allowing the right to
decline an immunization.
29
California, Colorado, Illinois, Maine, Massachusetts, Nebraska, New Hampshire, Oklahoma, Oregon, Rhode Island,
and Tennessee. See appendix 1 for citations. Note, Colorado law states that “[i]f a licensed healthcare entity
demonstrates that it has vaccinated a targeted percentage of its employees in a given year, using its own
methodology, it shall be exempt from the [administrative and surgical mask] requirements.” 6 Colo. Code Regs. 1011-
1:II-10.6.
30
California, Illinois, Maine, Maryland, Massachusetts, Nebraska, Oklahoma, Oregon, Rhode Island, and Tennessee.
31
10-144 Me. Code R. Ch. 264, § 3.
32
N.H. Rev. Stat. Ann. § 151:9-b(IV).
33
105 Mass. Code Regs. 130-325(B).
34
31 R.I. Admin. Code 1-22:3.5.4.
35
California, Florida, Georgia, Illinois, Louisiana, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New
York, Ohio, Oregon, Pennsylvania, Tennessee, and Texas. See appendix 2 for citations.
36
Florida, Georgia, Illinois, Louisiana, Mississippi, Missouri, New Hampshire, New Jersey, New York, Ohio, Oregon,
Pennsylvania, Tennessee, and Texas. See appendix 2 for citations. See endnote 12 for description of “all hospitals”
category.
37
California and Nebraska. See appendix 2 for citations. See endnote 13 for description of “general acute care
hospitals” category.
38
Illinois. See appendix 2 for citation.
39
New York. See appendix 2 for citation.
40
See endnote 12 for description of “all hospitals” category.
41
Ohio Rev. Code Ann. § 3727.19(B).
42
See endnote 13 for description of “general acute care hospitals” category.
43
Neb. Rev. Stat. § 71-468.
44
110 Ill. Comp. Stat. 330/8.
45
N.Y Pub. Health Law § 2805-h(3) (McKinney).
46
California, Nebraska, New Hampshire, and Ohio. See appendix 2 for citations.
47
California, Florida, Georgia, Illinois, Louisiana, Mississippi, Missouri, New Jersey, New York, Oregon, Tennessee, and
Texas. See appendix 2 for citations.
48
Illinois and New York. See appendix 2 for citations.
14
49
New York. See appendix 2 for citation.
50
Ohio Rev. Code Ann § 3727.19(B).
51
Ga. Code Ann. § 31-7-18(a). See also, Ga. Comp. R. & Regs. 111-8-40-.20.
52
210 Ill. Comp. Stat. 85/6.26(a).
53
N.Y. Pub. Health Law § 2805-h(3) (McKinney).
54
California, New Hampshire, New Jersey, New York, Pennsylvania, Tennessee, and Texas. See appendix 2 for
citations.
55
California, Florida, Georgia, Illinois, Louisiana, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New
York, Ohio, Oregon, Pennsylvania, Tennessee, and Texas. See appendix 2 for citations.
56
New Hampshire. See appendix 2 for citations.
57
25 Tex. Admin. Code § 133.45(h).
58
Fla. Stat. Ann. § 381.005(2).
59
N.H. Code Admin. R. He-P 802.21(h).
60
California, Georgia, Illinois, Louisiana, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New York, Ohio,
Oregon, and Texas. See appendix 2 for citations. Please note that even where not explicitly exempted by law it is likely
that patients with a medically contraindicated condition are not required to a vaccination.
61
New Hampshire. See appendix 2 for citations.
62
California, New Jersey, New York, and Ohio. See appendix 2 for citations.
63
La. Rev. Stat. Ann. § 40:2023.
64
N.H. Rev. Stat. Ann. § 151:9-b(II).
65
West’s Ann. Cal. Health & Safety Code § 120392.6.
66
See endnote 12 for description of “all hospitals” category.
67
See endnote 13 for description of “general acute care hospitals” category.
68
Please note that even where not explicitly exempted by law it is likely that patients with a medically contraindicated
condition are not required to a vaccination.
69
Philosophical exemptions include exemptions based on philosophical or personal beliefs or allowing the right to
decline an immunization.
70
Colorado law states that “[i]f a licensed healthcare entity demonstrates that it has vaccinated a targeted percentage
of its employees in a given year, using its own methodology, it shall be exempt from the [administrative and surgical
mask] requirements.” 6 Colo. Code Regs. 1011-1:II-10.6.
71
Colorado law states that “[i]f a licensed healthcare entity demonstrates that it has vaccinated a targeted percentage
of its employees in a given year, using its own methodology, it shall be exempt from the [administrative and surgical
mask] requirements.” 6 Colo. Code Regs. 1011-1:II-10.6.
72
Colorado law states that “[i]f a licensed healthcare entity demonstrates that it has vaccinated a targeted percentage
of its employees in a given year, using its own methodology, it shall be exempt from the [administrative and surgical
mask] requirements.” 6 Colo. Code Regs. 1011-1:II-10.6.
73
Md. Code Regs. 10.07.01.34(F)(5) states that "[r]easons for refusal of the influenza vaccine by an employee shall be
documented by the infection control or employee health program." PHLP considered this as establishing a right to
decline.
74
N.H. Rev. Stat. Ann. § 151:9-b(IV) states that “each hospital, residential care facility, adult day care facility, and
assisted living facility licensed under this chapter shall provide to its consenting employees annual immunizations
against influenza.” PHLP did not consider the phrase “all consenting” as a right to decline. These provisions should be
read with N.H. Code Admin. R. He-P 802.21(h).
75
N.H. CODE ADMIN. R. He-P 802.21(h) requires that the “licensee [hospitals] shall immunize all consenting personnel
for influenza and pneumococcal disease. . . .” PHLP considered this to be an administrative offer because the influenza
vaccination would be provided to patients that consent. These provisions should be read with N.H. REV. STAT. ANN. §
151:9-b(I).
76
N.H. Code Admin. R. He-P 802.21(h) states that “[t]he licensee shall immunize all consenting patients for influenza
and pneumococcal disease and all consenting personnel for influenza.” PHLP did not consider the phrase “all
consenting” as a right to decline. These provisions should be read with N.H. Rev. Stat. Ann. § 151:9-b(IV).
77
Given that New York law requires unvaccinated healthcare workers to wear a surgical mask, this indicates there is
likely some sort of exemption or declination allowance although it is not explicitly listed in the provisions reviewed.
15
78
10 N.Y. Comp. Codes R. & Regs. 405.3(b)(10)(v) state that “[t]he hospital shall require the following of all
personnel . . . documentation of vaccination against influenza.” PHLP considered the phrase “documentation of
vaccination” as an assessment requirement.
79
Given that New York law requires unvaccinated healthcare workers to wear a surgical mask, this indicates there is
likely some sort of exemption or declination allowance although it is not explicitly listed in the provisions reviewed.
80
Tenn. Comp. R. & Regs. 1200-08-01-.06(3)(f) requires that hospitals “offer of influenza vaccination to all staff and
independent practitioners or accept documented evidence of vaccination from another vaccine source or facility.”
PHLP considered this an administrative ensure requirement.
81
See endnote 12 for description of “all hospitals” category.
82
See endnote 13 for description of “general acute care hospitals” category.
83
Please note that even where not explicitly exempted by law it is likely that patients with a medically contraindicated
condition are not required to a vaccination.
84
Philosophical exemptions include exemptions based on philosophical or personal beliefs or allowing the right to
decline an immunization.
85
Fla. Stat. Ann. § 381.005(2) requires that “each hospital . . . shall implement a program to offer immunizations
against the influenza virus and pneumococcal bacteria to all patients age 65 or older . . . subject to the clinical
judgment of the responsible practitioner.” PHLP did not consider the phrase “subject to the clinical judgment of the
responsible practitioner” to be a medical exemption.
86
Ga Comp. R. & Regs. 111-8-40-.20 does not specifically outline a medical exemption, however, it does include a
requirement for assessment of contraindications. For the purposes of the assessment, this was included as a medical
exemption.
87
N.H. Rev. Stat. Ann. § 151:9-b(I) requires that “[a]ll hospitals . . . shall document evidence of immunization against
influenza, for all consenting patients.” PHLP did not consider the phrase “all consenting” as a right to decline. These
provisions should be read with N.H. Code Admin. R. He-P 802.21(h).
88
N.H. CODE ADMIN. R. He-P 802.21(h) requires that the “licensee [hospitals] shall immunize . . . all consenting
patients for influenza in accordance with RSA 151:9-b. . . .” PHLP considered this to be an administrative offer because
the influenza vaccination would be provided.
89
N.H. Code Admin. R. He-P 802.21(h) states that “[t]he licensee shall immunize all consenting patients for influenza
and pneumococcal disease and all consenting personnel for influenza.” PHLP did not consider the phrase “all
consenting” as a right to decline. These provisions should be read with N.H. Rev. Stat. § 151:9-b(I).
90
N.Y. Pub. Health Law § 2805-h(2) (McKinney) states that “it shall be the duty of the administrative officer or other
person in charge of each general hospital to offer each admitted person age sixty-five or older vaccination against
influenza virus. Such officer or person need not offer the vaccination to persons who have already received such
vaccine or for whom it is otherwise inappropriate.” PHLP considered the phrase "need not offer the vaccination to
persons who have already received" as an assessment requirement.
91
25 Tex. Admin. Code § 133.45(h)(2) requires that hospitals develop an influenza vaccination policy for elderly
patients in which the “influenza vaccine shall be made available.” PHLP considers the phrase “made available” to be an
administrative offer requirement.
92
Tex. Health & Safety Ann. Code § 161.0052(b) requires that hospitals “inform each elderly person admitted to the
hospital for a period of 24 hours or more that the pneumococcal and influenza vaccines are available.” PHLP considers
the term “available” in this instance to be an administrative offer requirement.
