APPENDIX 1 State Summary Tables

APPENDIX 1 State Summary Tables

X SUMMARY TABLE Element 1: Affected HCW Health Care Worker means all persons, whether paid or unpaid, including but not limited to employees, staff, contractors, clinicians, emergency medical technicians, ambulance drivers, volunteers, students, trainees, clergy, home health care providers, dietary and housekeeping staff, and others whose occupational activities involve direct or indirect contact with patients or contaminated material in a healthcare, home healthcare, or clinical laboratory setting. Element 2: Affected Employer Employer means a person or entity that has control over the wages, hours and working conditions of Health Care Workers in settings that include, but are not limited to acute care hospitals, adult day programs or facilities, ambulatory surgical facilities, child day care facilities, correctional facilities, home health care agencies, hospices, intermediate care facilities, long-term care facilities, nursing homes, outpatient clinics, physicians offices, rehabilitation centers, residential health care facilities, skilled nursing facilities, urgent care centers, dialysis centers, and occupational health centers. Element 3: Employer Obligations a) In accordance with this section, each Health Care Employer in this state shall establish influenza vaccination requirements as follows: 1) require that all Health Care Workers receive influenza vaccinations as a precondition to employment and on an annual basis, in accordance with the latest recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) no later than [ ] of each year. To the extent that the ACIP recommendations may differ from the terms of this section, the ACIP recommendations shall control; 2) notify all Health Care Workers of the immunization requirements of this section; 3) provide all Health Care Workers with education about the benefits of influenza vaccine and potential consequences of influenza illness; 4) provide or arrange for influenza vaccination, at no cost to Health Care Workers, either at the facility or at an alternate location chosen by the Health Care Worker, by [ ] of each year; 5) determine whether Health Care Workers hired after [ ] of each year, have received the required influenza vaccination. If the Health Care Worker has not received the influenza vaccination, the Health Care Employer shall provide or arrange for influenza vaccination, at no cost to Health Care Workers. The Health Care Worker may receive the vaccination either at the facility or at an alternate location chosen by the Health Care Worker, before employment or within one week of employment; 6) maintain completed and signed Certificates of Influenza Immunization for ALABAMA ALA CODE 22-21-10 (2001); Flu... vaccination program Employee. An individual who is a part-time or full-time employee of the long term care facility. ALA CODE 22-21-10 (2001); Flu... vaccination program Long term care facility. The term includes a skilled nursing facility, intermediate care facility, specialty care assisted living facility or dementia care facility, or an assisted living facility licensed under this chapter. ALA CODE 22-21-10 (2001); Flu... vaccination program Each long term care facility in this state shall conduct an immunization program which gives... employees the opportunity to be immunized against influenza virus. A long term care facility shall document the annual immunization against influenza virus for each employee... Upon finding that... an employee has not been immunized against influenza virus, or if the long term care facility is unable to verify that the individual has received the required immunizations, the long term care facility shall provide or arrange for immunization. For an individual who... is newly employed by the long term care facility after November 30, but before March 30 of the following year, the long term care facility shall determine the individual's status for the influenza virus. No individual or employee, shall be required to receive vaccine under this section if the individual refuses the vaccine after being fully informed of the health risks of not being immunized. ALA. Admin. Code r. 420-5-4-.04 (1975) Personnel And Training Vaccines. Assisted living facilities shall immunize employees in accordance with current recommended Appendix 1 Page 1

one year; b) A Health Care Employer shall not require a Health Care Worker to receive an influenza vaccine if: 1) the Health Care Worker presents to the Health Care Employer a licensed health care provider s written statement indicating that the Health Care Worker has a condition contraindicated for immunization; 2) the Health Care Worker presents to the Health Care Employer a written based upon a sincere religious belief; ALABAMA CDC guidelines. Any particular vaccination requirement may be waived or delayed by the State Health Officer in the event of a vaccine shortage. ALA. Admin. Code r. 420-5-20-.04 (2000); Personnel And Training 3. Vaccines. Specialty care assisted living facilities shall immunize employees in accordance with current recommended CDC guidelines. Any particular vaccination requirement may be waived or delayed by the State Health Officer in the event of a vaccine shortage. 3) the Health Care Worker presents to the Health Care Employer a written based upon a philosophical belief; 4) the Health Care Worker signs a statement certifying receipt of information about the risks and benefits of influenza vaccine, including but not limited to the symptoms, transmission, and potential impact of influenza on patient and personal health; or 5) an authorized State Health Official determines that there is an insufficient supply of vaccine given the number of workers to be vaccinated or the vaccine is not reasonably available. c) Each Health Care Employer shall collect aggregate data on Health Care Worker influenza vaccination status for the period beginning [ ] and ending [ ] of each year. The Health Care Employer must report the data to an authorized State Health Official by [ ] of the same year in a manner determined by the authorized State Health Official. Required data will include, but not be limited to, number of Health Care Workers immunized by occupation, total number of Health Care Workers by occupation, and reason(s) Health Care Workers did not receive an influenza vaccination. d) determine the steps Health Care Workers who are not vaccinated pursuant to this section must take to reduce the risk of transmitting influenza to patients. Element 4: HCW Obligations In accordance with subsections a) and b) of this section, Health Care Workers Alabama law does not address this element. shall receive influenza vaccination or comply with exceptions and submit completed and signed Certificate of Influenza Immunization to Health Care Employer by [ ] of each year. Appendix 1 Page 2

Element 5: Exemption Policy A Health Care Employer shall not require a Health Care Worker to receive an influenza vaccine if: 1) the Health Care Worker presents to the Health Care Employer a licensed health care provider s written statement indicating that the Health Care Worker has a condition contraindicated for immunization; ALABAMA ALA CODE 22-21-10 (2001); Flu... vaccination program No individual... or employee shall be required to receive vaccine under this section... if the vaccine is (1) medically contraindicated... 2) the Health Care Worker presents to the Health Care Employer a written based upon a sincere religious belief; 3) the Health Care Worker presents to the Health Care Employer a written based upon a philosophical belief; (2) is against the individual's religious beliefs, or (3) if the individual refuses the vaccine after being fully informed of the health risks of not being immunized. 4) the Health Care Worker signs a statement certifying receipt of information about the risks and benefits of influenza vaccine, including but not limited to the symptoms, transmission, and potential impact of influenza on patient and personal health; or 5) an authorized State Health Official determines that there is an insufficient supply of vaccine given the number of workers to be vaccinated or the vaccine is not reasonably available. Element 6: Applicable Standards The influenza vaccinations shall be provided and updated in accordance with the latest recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). To the extent that the ACIP recommendations may differ from the terms of this section, the ACIP recommendations shall control. SOURCE: GWU/SPHHS/DHP, DEVELOPING A MODEL STATE LAW, SUMMER 2011 ALA. Admin. Code r. 420-5-4-.04 (1975) Personnel And Training Establish vaccination requirements for employees that are consistent with current recommendations from the Federal Centers for Disease Control and Prevention (CDC) and the Federal Occupational Safety and Health Administration (OSHA) (as a minimum will require annual influenza vaccinations). ALA. Admin. Code r. 420-5-20-.04 (2000); Personnel And Training Specialty care assisted living facilities shall immunize employees in accordance with current recommended CDC guidelines. ALA. Admin. Code r. 420-5-4-.04 (1975) Personnel And Training Assisted living facilities shall immunize employees in accordance with current recommended CDC guidelines. Appendix 1 Page 3

X SUMMARY TABLE Element 1: Affected HCW Health Care Worker means all persons, whether paid or unpaid, including but not limited to employees, staff, contractors, clinicians, emergency medical technicians, ambulance drivers, volunteers, students, trainees, clergy, home health care providers, dietary and housekeeping staff, and others whose occupational activities involve direct or indirect contact with patients or contaminated material in a healthcare, home healthcare, or clinical laboratory setting. Element 2: Affected Employer Employer means a person or entity that has control over the wages, hours and working conditions of Health Care Workers in settings that include, but are not limited to acute care hospitals, adult day programs or facilities, ambulatory surgical facilities, child day care facilities, correctional facilities, home health care agencies, hospices, intermediate care facilities, long-term care facilities, nursing homes, outpatient clinics, physicians offices, rehabilitation centers, residential health care facilities, skilled nursing facilities, urgent care centers, dialysis centers, and occupational health centers. a) In accordance with this section, each Health Care Employer in this state shall establish influenza vaccination requirements as follows: 1) require that all Health Care Workers receive influenza vaccinations as a precondition to employment and on an annual basis, in accordance with the latest recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) no later than [ ] of each year. To the extent that the ACIP recommendations may differ from the terms of this section, the ACIP recommendations shall control; ARKANSAS ARK. CODE ANN. 007-15-002 (2000) Any individual who is employed or accepts employment at any nursing home facility, as a condition of employment, must agree to receive an annual influenza immunization. Employees may be exempt, if they qualify for medical or religious reasons. ARK. CODE ANN. 20-10-1303 (2003); Definitions (3) (A) "Nursing home facilities" means facilities that include any building, structure, agency, institution, or place for the reception, accommodation, board, care, or treatment of two (2) or more individuals who because of physical or mental infirmity are unable to sufficiently or properly care for themselves and for which reception, accommodation, board, care, or treatment a charge is made. (B) "Nursing home" shall not include the offices of private physicians and surgeons, residential health care facilities, hospitals, institutions operated by the federal government, any other similar facility where individuals reside, or any facility which is conducted by and for those who rely exclusively upon treatment by prayer alone for healing in accordance with the tenets or practices of any recognized religious denomination; Element 3: Employer Obligations ARK. CODE ANN. 007-15-002 (2000) Nursing homes must maintain a current log or list of... employees in their facility and document that each has been immunized. The log must include, at a minimum, the individual's name, date of birth, type of vaccine and date administered. Additionally, the reason or reasons vaccine were not administered to any resident or employee must be documented on the log or list. A copy of this log must be submitted to the Office of Long- Term Care by December 1, of each year. 2) notify all Health Care Workers of the immunization requirements of this section; 3) provide all Health Care Workers with education about the benefits of influenza vaccine and potential consequences of influenza illness; 4) provide or arrange for influenza vaccination, at no cost to Health Care Workers, either at the facility or at an alternate location chosen by the The Office of Long-Term Care will monitor and enforce the rules and regulations to assure compliance with the law. ARK. CODE ANN 20-10-1304 (2003); Implementation As a condition of their employment, require all employees to participate in immunization programs conducted while they are employed at the facility... Appendix 1 Page 4

Health Care Worker, by [ ] of each year; 5) determine whether Health Care Workers hired after [ ] of each year, have received the required influenza vaccination. If the Health Care Worker has not received the influenza vaccination, the Health Care Employer shall provide or arrange for influenza vaccination, at no cost to Health Care Workers. The Health Care Worker may receive the vaccination either at the facility or at an alternate location chosen by the Health Care Worker, before employment or within one week of employment; ARKANSAS Document and report annually immunizations against influenza virus for... full-time and part-time employees. ARK. CODE ANN. 007-15-002 (2000) All nursing home facilities shall require all... full or part-time employees to be immunized against influenza disease... 6) maintain completed and signed Certificates of Influenza Immunization for one year; b) A Health Care Employer shall not require a Health Care Worker to receive an influenza vaccine if: 1) the Health Care Worker presents to the Health Care Employer a licensed health care provider s written statement indicating that the Health Care Worker has a condition contraindicated for immunization; 2) the Health Care Worker presents to the Health Care Employer a written statement indicating that the worker opposes the administration of the vaccine based upon a sincere religious belief; 3) the Health Care Worker presents to the Health Care Employer a written statement indicating that the worker opposes the administration of the vaccine based upon a philosophical belief; 4) the Health Care Worker signs a statement certifying receipt of information about the risks and benefits of influenza vaccine, including but not limited to the symptoms, transmission, and potential impact of influenza on patient and personal health; or 5) an authorized State Health Official determines that there is an insufficient supply of vaccine given the number of workers to be vaccinated or the vaccine is not reasonably available. c) Each Health Care Employer shall collect aggregate data on Health Care Worker influenza vaccination status for the period beginning [ ] and ending [ ] of each year. The Health Care Employer must report the data to an authorized State Health Official by [ ] of the same year in a manner determined by the authorized State Health Official. Required data will include, but not be limited to, number of Health Care Workers immunized by occupation, total number of Health Care Workers by occupation, and reason(s) Health Care Workers did not receive an influenza vaccination. d) determine the steps Health Care Workers who are not vaccinated pursuant to this section must take to reduce the risk of transmitting influenza to patients. Appendix 1 Page 5

ARKANSAS Element 4: HCW Obligations In accordance with subsections a) and b) of this section, Health Care ARK. CODE ANN. 007-15-002 (2000) Workers shall receive influenza vaccination or comply with exceptions and Any individual who is employed or accepts employment submit completed and signed Certificate of Influenza Immunization to at any nursing home facility, as a condition of Health Care Employer by [ ] of each year. employment, must agree to receive an annual influenza immunization. Employees may be exempt, if they qualify for medical or religious reasons. Element 5: Exemption Policy A Health Care Employer shall not require a Health Care Worker to receive an influenza vaccine if: 1) the Health Care Worker presents to the Health Care Employer a licensed health care provider s written statement indicating that the Health Care Worker has a condition contraindicated for immunization; 2) the Health Care Worker presents to the Health Care Employer a written statement indicating that the worker opposes the administration of the vaccine based upon a sincere religious belief; 3) the Health Care Worker presents to the Health Care Employer a written statement indicating that the worker opposes the administration of the vaccine based upon a philosophical belief; 4) the Health Care Worker signs a statement certifying receipt of information about the risks and benefits of influenza vaccine, including but not limited to the symptoms, transmission, and potential impact of influenza on patient and personal health; or 5) an authorized State Health Official determines that there is an insufficient supply of vaccine given the number of workers to be vaccinated or the vaccine is not reasonably available. ARK. CODE ANN. 20-10-1305 (2003); Exemptions All... full-time or part-time employees of nursing home facilities shall be immunized... with the following exemptions: (1) No individual shall be required to receive... an influenza virus vaccine... if the vaccine is medically contraindicated... ARK. CODE ANN. 007-15-002 (2000) Medical: Only a letter stating the vaccine or vaccines for which an individual is exempt is to be accepted as a valid medical exemption by the Nursing Home. Statements from a private physician are not to be accepted by the Nursing Home without this letter. Religious: A notarized statement is required from a Pastor or church official that the individual is a member or adherent of a recognized church or religious denomination whose tenets are opposed to immunization. Element 6: Applicable Standards The influenza vaccinations shall be provided and updated in accordance Arkansas law does not address this element. with the latest recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). To the extent that the ACIP recommendations may differ from the terms of this section, the ACIP recommendations shall control. SOURCE: GWU/SPHHS/DHP, DEVELOPING A MODEL STATE LAW, SUMMER 2011 Appendix 1 Page 6

X SUMMARY TABLE Element 1: Affected HCW Health Care Worker means all persons, whether paid or unpaid, including but not limited to employees, staff, contractors, clinicians, emergency medical technicians, ambulance drivers, volunteers, students, trainees, clergy, home health care providers, dietary and housekeeping staff, and others whose occupational activities involve direct or indirect contact with patients or contaminated material in a healthcare, home healthcare, or clinical laboratory setting. Element 2: Affected Employer Employer means a person or entity that has control over the wages, hours and working conditions of Health Care Workers in settings that include, but are not limited to acute care hospitals, adult day programs or facilities, ambulatory surgical facilities, child day care facilities, correctional facilities, home health care agencies, hospices, intermediate care facilities, long-term care facilities, nursing homes, outpatient clinics, physicians offices, rehabilitation centers, residential health care facilities, skilled nursing facilities, urgent care centers, dialysis centers, and occupational health centers. CALIFORNIA CAL. CODE REGS. tit. 8 5199 (2009); Aerosol Transmissible Diseases Health care worker. A person who works in a health care facility, service or operation, or who has occupational exposure in a public health service CAL. HEALTH & SAFETY CODE 1288.7 (2007); Required actions of general acute care hospitals (a) "General acute care hospital" means a health facility having a duly constituted governing body with overall administrative and professional responsibility and an organized medical staff that provides 24-hour inpatient care, including the following basic services: medical, nursing, surgical, anesthesia, laboratory, radiology, pharmacy, and dietary services. A general acute care hospital may include more than one physical plant maintained and operated on separate premises as provided in Section 1250.8. A general acute care hospital that exclusively provides acute medical rehabilitation center services, including at least physical therapy, occupational therapy, and speech therapy, may provide for the required surgical and anesthesia services through a contract with another acute care hospital. In addition, a general acute care hospital that, on July 1, 1983, provided required surgical and anesthesia services through a contract or agreement with another acute care hospital may continue to provide these surgical and anesthesia services through a contract or agreement with an acute care hospital. The general acute care hospital operated by the State Department of Developmental Services at Agnews Developmental Center may, until June 30, 2007, provide surgery and anesthesia services through a contract or agreement with another acute care hospital. Notwithstanding the requirements of this subdivision, a general acute care hospital operated by the Department of Corrections and Rehabilitation or the Department of Veterans Affairs may provide surgery and anesthesia services during normal weekday working hours, and not provide these services during other hours of the weekday or on weekends or holidays, if the general acute care hospital otherwise meets the requirements of this section. Appendix 1 Page 7

Element 3: Employer Obligations a) In accordance with this section, each Health Care Employer in this state shall establish influenza vaccination requirements as follows: 1) require that all Health Care Workers receive influenza vaccinations as a precondition to employment and on an annual basis, in accordance with the latest recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) no later than [ ] of each year. To the extent that the ACIP recommendations may differ from the terms of this section, the ACIP recommendations shall control; 2) notify all Health Care Workers of the immunization requirements of this section; 3) provide all Health Care Workers with education about the benefits of influenza vaccine and potential consequences of influenza illness; 4) provide or arrange for influenza vaccination, at no cost to Health Care Workers, either at the facility or at an alternate location chosen by the Health Care Worker, by [ ] of each year; 5) determine whether Health Care Workers hired after [ ] of each year, have received the required influenza vaccination. If the Health Care Worker has not received the influenza vaccination, the Health Care Employer shall provide or arrange for influenza vaccination, at no cost to Health Care Workers. The Health Care Worker may receive the vaccination either at the facility or at an alternate location chosen by the Health Care Worker, before employment or within one week of employment; 6) maintain completed and signed Certificates of Influenza Immunization for one year; b) A Health Care Employer shall not require a Health Care Worker to receive an influenza vaccine if: 1) the Health Care Worker presents to the Health Care Employer a licensed health care provider s written statement indicating that the Health Care Worker has a condition contraindicated for immunization; 2) the Health Care Worker presents to the Health Care Employer a written based upon a sincere religious belief; 3) the Health Care Worker presents to the Health Care Employer a written based upon a philosophical belief; 4) the Health Care Worker signs a statement certifying receipt of information about the risks and benefits of influenza vaccine, including but not limited to the symptoms, transmission, and potential impact of influenza on CALIFORNIA CAL. HEALTH & SAFETY CODE 1288.7 (2007); Required actions of general acute care hospitals Annually offer onsite influenza vaccinations, if available, to all hospital employees at no cost to the employee. Each 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. CAL. HEALTH & SAFETY CODE 1288.8 (2007); HAI surveillance and prevention program; Databases; Development of program by hospitals (b) On and after January 1, 2008, each general acute care hospital shall implement and annually report to the department on its implementation of infection surveillance and infection prevention process measures that have been recommended by the federal Centers for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee, as suitable for a mandatory public reporting program. Initially, these process measures shall include the CDC guidelines for central line insertion practices, surgical antimicrobial prophylaxis, and influenza vaccination of patients and healthcare personnel. In consultation with the advisory committee, the department shall make this information public no later than six months after receiving the data. Appendix 1 Page 8

patient and personal health; or CALIFORNIA 5) an authorized State Health Official determines that there is an insufficient supply of vaccine given the number of workers to be vaccinated or the vaccine is not reasonably available. c) Each Health Care Employer shall collect aggregate data on Health Care Worker influenza vaccination status for the period beginning [ ] and ending [ ] of each year. The Health Care Employer must report the data to an authorized State Health Official by [ ] of the same year in a manner determined by the authorized State Health Official. Required data will include, but not be limited to, number of Health Care Workers immunized by occupation, total number of Health Care Workers by occupation, and reason(s) Health Care Workers did not receive an influenza vaccination. d) determine the steps Health Care Workers who are not vaccinated pursuant to this section must take to reduce the risk of transmitting influenza to patients. Element 4: HCW Obligations In accordance with subsections a) and b) of this section, Health Care Workers shall receive influenza vaccination or comply with exceptions and submit completed and signed Certificate of Influenza Immunization to Health Care Employer by [ ] of each year. Element 5: Exemption Policy A Health Care Employer shall not require a Health Care Worker to receive an influenza vaccine if: 1) the Health Care Worker presents to the Health Care Employer a licensed health care provider s written statement indicating that the Health Care Worker has a condition contraindicated for immunization; 2) the Health Care Worker presents to the Health Care Employer a written based upon a sincere religious belief; 3) the Health Care Worker presents to the Health Care Employer a written based upon a philosophical belief; 4) the Health Care Worker signs a statement certifying receipt of information about the risks and benefits of influenza vaccine, including but not limited to the symptoms, transmission, and potential impact of influenza on patient and personal health; or 5) an authorized State Health Official determines that there is an insufficient supply of vaccine given the number of workers to be vaccinated or the vaccine is not reasonably available. CAL. HEALTH & SAFETY CODE 1288.7 (2007); Required actions of general acute care hospitals... if the employee elects not to be vaccinated, to declare in writing that he or she has declined the vaccination. CAL. HEALTH & SAFETY CODE 1288.7 (2007); Required actions of general acute care hospitals... if the employee elects not to be vaccinated, to declare in writing that he or she has declined the vaccination. Appendix 1 Page 9

CALIFORNIA Element 6: Applicable Standards The influenza vaccinations shall be provided and updated in accordance with CAL. HEALTH & SAFETY CODE 1288.7 (2007); the latest recommendations of the Advisory Committee on Immunization Required actions of general acute care hospitals Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). To... in accordance with the Centers for Disease Control the extent that the ACIP recommendations may differ from the terms of this guidelines... section, the ACIP recommendations shall control. SOURCE: GWU/SPHHS/DHP, DEVELOPING A MODEL STATE LAW, SUMMER 2011 Appendix 1 Page 10

X SUMMARY TABLE Element 1: Affected HCW Health Care Worker means all persons, whether paid or unpaid, including but not limited to employees, staff, contractors, clinicians, emergency medical technicians, ambulance drivers, volunteers, students, trainees, clergy, home health care providers, dietary and housekeeping staff, and others whose occupational activities involve direct or indirect contact with patients or contaminated material in a healthcare, home healthcare, or clinical laboratory setting. Element 2: Affected Employer Employer means a person or entity that has control over the wages, hours and working conditions of Health Care Workers in settings that include, but are not limited to acute care hospitals, adult day programs or facilities, ambulatory surgical facilities, child day care facilities, correctional facilities, home health care agencies, hospices, intermediate care facilities, long-term care facilities, nursing homes, outpatient clinics, physicians offices, rehabilitation centers, residential health care facilities, skilled nursing facilities, urgent care centers, dialysis centers, and occupational health centers. Element 3: Employer Obligations a) In accordance with this section, each Health Care Employer in this state shall establish influenza vaccination requirements as follows: 1) require that all Health Care Workers receive influenza vaccinations as a precondition to employment and on an annual basis, in accordance with the latest recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) no later than [ ] of each year. To the extent that the ACIP recommendations may differ from the terms of this section, the ACIP recommendations shall control; 2) notify all Health Care Workers of the immunization requirements of this section; 3) provide all Health Care Workers with education about the benefits of influenza vaccine and potential consequences of influenza illness; 4) provide or arrange for influenza vaccination, at no cost to Health Care Workers, either at the facility or at an alternate location chosen by the Health Care Worker, by [ ] of each year; 5) determine whether Health Care Workers hired after [ ] of each year, have received the required influenza vaccination. If the Health Care Worker has not received the influenza vaccination, the Health Care Employer shall provide or arrange for influenza vaccination, at no cost to Health Care Workers. The Health Care Worker may receive the vaccination either at the facility or at an alternate location chosen by the Health Care Worker, before employment or within one week of employment; DISTRICT OF COLUMBIA D.C. Mun. Regs. Tit. 22 B2017 (2008); Health Examination... Immunization against communicable disease shall be required of all employees and all other persons who routinely come in contact with patients or patient areas. D.C. Mun. Regs. Tit. 22 B299 (2000); Definitions Health Care Facility- A clinic, freestanding ambulatory care facility, freestanding laboratory, hospital, nursing home, or therapeutic radiological center. Health care provider or provider - a health care clinic, a physician, a health maintenance organization, a nurse, a hospital, a charitable organization that provides medical care or advice, or any other entity that provides medical care or advice. D.C. Mun. Regs. Tit. 22 B3222 (2002); Immunizations... each facility shall ensure that each employee has either received immunization against influenza virus or has refused such vaccination... The facility shall be required to maintain written evidence of each such immunization or refusal. The facility shall... for each employee hired between December 1 [st] and March 31 [st], determine, within... the start of employment, whether the... employee has received immunization against influenza virus... If the facility determines that an employee has not received such immunization, the facility shall instruct the employee to obtain the immunization and to provide documentation thereof, or of refusal, to the facility within seven (7) days of the determination.... each employee shall, no later than November 30 [th] of each calendar year or six (6) weeks after the vaccination becomes readily available in the District of Columbia, whichever is later, undergo immunization for influenza virus... Appendix 1 Page 11

DISTRICT OF COLUMBIA 6) maintain completed and signed Certificates of Influenza Immunization for one year; b) A Health Care Employer shall not require a Health Care Worker to receive an influenza vaccine if: 1) the Health Care Worker presents to the Health Care Employer a licensed health care provider s written statement indicating that the Health Care Worker has a condition contraindicated for immunization; 2) the Health Care Worker presents to the Health Care Employer a written based upon a sincere religious belief; 3) the Health Care Worker presents to the Health Care Employer a written based upon a philosophical belief; 4) the Health Care Worker signs a statement certifying receipt of information about the risks and benefits of influenza vaccine, including but not limited to the symptoms, transmission, and potential impact of influenza on patient and personal health; or 5) an authorized State Health Official determines that there is an insufficient supply of vaccine given the number of workers to be vaccinated or the vaccine is not reasonably available. c) Each Health Care Employer shall collect aggregate data on Health Care Worker influenza vaccination status for the period beginning [ ] and ending [ ] of each year. The Health Care Employer must report the data to an authorized State Health Official by [ ] of the same year in a manner determined by the authorized State Health Official. Required data will include, but not be limited to, number of Health Care Workers immunized by occupation, total number of Health Care Workers by occupation, and reason(s) Health Care Workers did not receive an influenza vaccination. d) determine the steps Health Care Workers who are not vaccinated pursuant to this section must take to reduce the risk of transmitting influenza to patients. Element 4: HCW Obligations In accordance with subsections a) and b) of this section, Health Care Workers shall receive influenza vaccination or comply with exceptions and submit completed and signed Certificate of Influenza Immunization to Health Care Employer by [ ] of each year. D.C. Mun. Regs. Tit. 22 B3222 (2002); Immunizations... employee may obtain the required immunization from a medical provider of his or her choice. If... the employee obtains such immunization from a provider other than the facility, the... employee shall provide the facility, no later than November 30 [th]or six (6) weeks after the vaccination becomes readily available in the District of Columbia, whichever is later, with Appendix 1 Page 12

DISTRICT OF COLUMBIA documentation of the immunization. The facility shall record such documentation within twenty-four (24) hours of its receipt. A Health Care Employer shall not require a Health Care Worker to receive an influenza vaccine if: 1) the Health Care Worker presents to the Health Care Employer a licensed health care provider s written statement indicating that the Health Care Worker has a condition contraindicated for immunization; 2) the Health Care Worker presents to the Health Care Employer a written based upon a sincere religious belief; 3) the Health Care Worker presents to the Health Care Employer a written based upon a philosophical belief; 4) the Health Care Worker signs a statement certifying receipt of information about the risks and benefits of influenza vaccine, including but not limited to the symptoms, transmission, and potential impact of influenza on patient and personal health; or 5) an authorized State Health Official determines that there is an insufficient supply of vaccine given the number of workers to be vaccinated or the vaccine is not reasonably available. Element 6: Applicable Standards The influenza vaccinations shall be provided and updated in accordance with the latest recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). To the extent that the ACIP recommendations may differ from the terms of this section, the ACIP recommendations shall control. D.C. Mun. Regs. Tit. 22 B2017 (2008); Health Examination Immunization against communicable disease shall be required of all employees and all other persons who routinely come in contact with patients or patient areas. Element 5: Exemption Policy D.C. Mun. Regs. Tit. 22 B3222 (2002); Immunizations... each facility shall ensure that each employee has either received immunization against influenza virus or has refused such vaccination... The facility shall be required to maintain written evidence of each such immunization or refusal. The facility shall... for each employee hired between December 1 [st] and March 31 [st], determine, within... the start of employment, whether the... employee has received immunization against influenza virus... If the facility determines that an employee has not received such immunization, the facility shall instruct the employee to obtain the immunization and to provide documentation thereof, or of refusal, to the facility within seven (7) days of the determination. D.C. Mun. Regs. Tit. 22 B3222 (2002); Immunizations Influenza... immunizations shall be provided and updated in accordance with the latest recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention. To the extent that the ACIP recommendations may differ from the terms of this Section, the ACIP recommendations shall control. D.C. Mun. Regs. Tit. 22 B2017 (2008); Health Examination Immunizations shall be in accordance with current standards and guidelines developed by the Centers for Disease Control and Prevention. SOURCE: GWU/SPHHS/DHP, DEVELOPING A MODEL STATE LAW, SUMMER 2011 Appendix 1 Page 13

X SUMMARY TABLE Element 1: Affected HCW Health Care Worker means all persons, whether paid or unpaid, including but not limited to employees, staff, contractors, clinicians, emergency medical technicians, ambulance drivers, volunteers, students, trainees, clergy, home health care providers, dietary and housekeeping staff, and others whose occupational activities involve direct or indirect contact with patients or contaminated material in a healthcare, home healthcare, or clinical laboratory setting. ILLINOIS ILL. ADMIN. CODE tit. 77 956.10 (2009); Definition Health care employee - All paid and unpaid persons working in health care settings who have the potential for exposure to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air. Health care employees include, but are not limited to, physicians, nurses, nursing assistants, therapists, technicians, emergency medical services employees, pharmacists, laboratory employees, and persons not directly involved in patient care (e.g., clerical, dietary, housekeeping, maintenance and volunteers) but potentially exposed to infectious agents that can be transmitted to and from health care employees. Element 2: Affected Employer Employer means a person or entity that has control over the wages, hours ILL. ADMIN. CODE tit. 77 956.10 (2009); and working conditions of Health Care Workers in settings that include, but Definition are not limited to acute care hospitals, adult day programs or facilities, Health care setting: A facility licensed under the ambulatory surgical facilities, child day care facilities, correctional facilities, Alternative Health Care Delivery Act; An ambulatory home health care agencies, hospices, intermediate care facilities, long-term surgical treatment center, as defined in the Ambulatory care facilities, nursing homes, outpatient clinics, physicians offices, Surgical Treatment Center Act; An assisted living rehabilitation centers, residential health care facilities, skilled nursing facility, a shared housing establishment, or a board and facilities, urgent care centers, dialysis centers, and occupational health care home, as defined in the Assisted Living and Shared centers. Housing Act; A community living facility, as defined in the Community Living Facilities Licensing Act; A life care facility, as defined in the Life Care Facilities Act; A long-term care facility, as defined in the Nursing Home Care Act; A freestanding emergency center, licensed under the Emergency Medical Services Systems Act; A home health agency, home services agency or home nursing agency, as defined in the Home Health, Home Services, and Home Nursing Agency Licensing Act; A hospice care program or voluntary hospice program, as defined in the Hospice Program Licensing Act; A hospital, as defined in the Hospital Licensing Act; Element 3: Employer Obligations a) In accordance with this section, each Health Care Employer in this state ILL. ADMIN. CODE tit. 77 956.30 (2009); shall establish influenza vaccination requirements as follows: Influenza Vaccination 1) require that all Health Care Workers receive influenza vaccinations as a precondition to employment and on an annual basis, in accordance with the latest recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) no later than [ ] of each year. To the extent that the ACIP... each health care setting shall ensure that all health care employees are provided education on influenza and are offered the opportunity to receive seasonal, novel and pandemic influenza vaccine... during the influenza season (between September 1 and March 1 of each Appendix 1 Page 14

recommendations may differ from the terms of this section, the ACIP recommendations shall control; 2) notify all Health Care Workers of the immunization requirements of this section; 3) provide all Health Care Workers with education about the benefits of influenza vaccine and potential consequences of influenza illness; 4) provide or arrange for influenza vaccination, at no cost to Health Care Workers, either at the facility or at an alternate location chosen by the Health Care Worker, by [ ] of each year; 5) determine whether Health Care Workers hired after [ ] of each year, have received the required influenza vaccination. If the Health Care Worker has not received the influenza vaccination, the Health Care Employer shall provide or arrange for influenza vaccination, at no cost to Health Care Workers. The Health Care Worker may receive the vaccination either at the facility or at an alternate location chosen by the Health Care Worker, before employment or within one week of employment; 6) maintain completed and signed Certificates of Influenza Immunization for one year; b) A Health Care Employer shall not require a Health Care Worker to receive an influenza vaccine if: 1) the Health Care Worker presents to the Health Care Employer a licensed health care provider s written statement indicating that the Health Care Worker has a condition contraindicated for immunization; ILLINOIS year), unless the vaccine is unavailable... Each health care setting shall notify all health care employees of the influenza vaccination provisions... and shall provide or arrange for vaccination of all health care employees who accept the offer of vaccination. Each health care setting shall provide all health care employees with education about the benefits of influenza vaccine and potential consequences of influenza illness. Each health care setting shall develop and implement a program that includes the following: 1) A plan to offer seasonal, pandemic or any other influenza vaccine; 2) The time frame within which health care employees will be offered vaccination; and 3) Any required documentation relating to the health care employee vaccination requirement of this Part. Each health care setting shall maintain a system to track the offer of vaccination to health care employees. Health care settings may choose to develop and implement more stringent influenza vaccination policies, strategies or programs designed to improve health care employee vaccination rates than those required by this Part and that are consistent with existing law and regulation. 2) the Health Care Worker presents to the Health Care Employer a written statement indicating that the worker opposes the administration of the vaccine based upon a sincere religious belief; 3) the Health Care Worker presents to the Health Care Employer a written statement indicating that the worker opposes the administration of the vaccine based upon a philosophical belief; 4) the Health Care Worker signs a statement certifying receipt of information about the risks and benefits of influenza vaccine, including but not limited to the symptoms, transmission, and potential impact of influenza on patient and personal health; or 5) an authorized State Health Official determines that there is an insufficient supply of vaccine given the number of workers to be vaccinated or the vaccine is not reasonably available. c) Each Health Care Employer shall collect aggregate data on Health Care Worker influenza vaccination status for the period beginning [ ] and ending [ ] of each year. The Health Care Employer must report the data to an authorized State Health Official by [ ] of Appendix 1 Page 15

the same year in a manner determined by the authorized State Health Official. Required data will include, but not be limited to, number of Health Care Workers immunized by occupation, total number of Health Care Workers by occupation, and reason(s) Health Care Workers did not receive an influenza vaccination. ILLINOIS d) determine the steps Health Care Workers who are not vaccinated pursuant to this section must take to reduce the risk of transmitting influenza to patients. Element 4: HCW Obligations In accordance with subsections a) and b) of this section, Health Care Workers shall receive influenza vaccination or comply with exceptions and submit completed and signed Certificate of Influenza Immunization to Health Care Employer by [ ] of each year. Element 5: Exemption Policy A Health Care Employer shall not require a Health Care Worker to receive an influenza vaccine if: 1) the Health Care Worker presents to the Health Care Employer a licensed health care provider s written statement indicating that the Health Care Worker has a condition contraindicated for immunization; 2) the Health Care Worker presents to the Health Care Employer a written statement indicating that the worker opposes the administration of the vaccine based upon a sincere religious belief; 3) the Health Care Worker presents to the Health Care Employer a written statement indicating that the worker opposes the administration of the vaccine based upon a philosophical belief; 4) the Health Care Worker signs a statement certifying receipt of information about the risks and benefits of influenza vaccine, including but not limited to the symptoms, transmission, and potential impact of influenza on patient and personal health; or 5) an authorized State Health Official determines that there is an insufficient supply of vaccine given the number of workers to be vaccinated or the vaccine is not reasonably available. Element 6: Applicable Standards The influenza vaccinations shall be provided and updated in accordance with the latest recommendations of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). To the extent that the ACIP recommendations may differ from the terms of this section, the ACIP recommendations shall control. ILL. ADMIN. CODE tit. 77 956.30 (2009); Influenza Vaccination... 2) Health care employees who decline vaccination for any reason indicated in subsection (c)(1) shall sign a statement declining vaccination and certifying that he or she received education about the benefits of influenza vaccine. ILL. ADMIN. CODE tit. 77 956.30 (2009); Influenza Vaccination Health care employees may decline to accept the offer of vaccination for reasons including the following: A) The vaccine is medically contraindicated, which means that administration of influenza vaccine to that person would likely be detrimental to the person's health; B) Vaccination is against the person's religious beliefs; C) The person has already been vaccinated; or D) For any other reasons documented by the person as the basis of the refusal. Illinois law does not address this element. SOURCE: GWU/SPHHS/DHP, DEVELOPING A MODEL STATE LAW, SUMMER 2011 Appendix 1 Page 16