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CA Warriors, in case you're not sure how #SB276 impacts you, what it all means, etc. I have information for you. (Thread)
1/ OVERVIEW

New medical exemptions in California are effectively dead as of January 1, 2021. If you already have an ME, DO NOT give your medical exemption to the government database that is being created. The database is for future ME forms that the CDPH will issue next year.
2/ MEs written before 2020 are grandfathered and should NOT be submitted to the government database. MEs written in the year 2020 are also not submitted to the government database, but ARE NOT grandfathered. New MEs written after 2020 will be extremely rare because
3/ the law requires they be (1) based on strict CDC/ACIP/AAP guidelines (more detail below re "standard of care"), and (2) submitted to the new government database.
4/ The new government database is essentially a tool to discourage physicians from writing new MEs. If the CDPH revokes five of that physician’s MEs in any calendar year beginning 2020, the physician is automatically referred to the Medical Board for investigation.
5/ For MEs written prior to Jan 1, 2020: The new law grandfathers MEs written before the 2020, and it is valid until the child reaches their next checkpoint year (TK, K, 7), at which point the child can only get back into school with a new ME that meets CDC/ACIP/AAP guidelines.
6/ “Medical exemptions issued prior to Jan 1, 2020 shall not be revoked unless the exemption was issued by a physician or surgeon that has been subject to disciplinary action by the Medical Board of California or the Osteopathic Medical Board of California.” CH&S sec120372(d)(4).
7/ Disciplinary action means that the physician has been actively disciplined following a complete medical board proceeding. Disciplinary action does not mean that the physician has simply been accused by the Medical Board.
8/ 2020 MEs can be written on a physician’s letterhead/form. 2020 MEs do not need to be written on any government form. 2020 MEs do not need to meet CDC/ACIP/AAP guidelines, but rather they follow the same standard as MEs issued in 2015-2019 (“not considered safe”).
9/ However, because 2020 MEs are neither grandfathered nor submitted to the government database, they are basically only useful for one year: 2020. The only children who will need 2020 MEs are children entering daycare or a checkpoint year (TK, K, 7) in 2020.
10/ Beginning January 1, 2021, the CDPH will require a standardized form for new MEs (“New Form MEs”). The new form will require that the New Form ME comply with CDC/ACIP/AAP guidelines for contraindications and precautions, which are obviously very hard to meet: link
11/ The new law also contains a provision that says, “Notwithstanding subparagraph (A), the department, based on the medical discretion of the clinically trained immunization staff member, may accept a medical exemption that is based on other contraindications or precautions,
12/ including consideration of family medical history, if the issuing physician and surgeon provides written documentation to support the medical exemption that is consistent with the relevant standard of care.” Expect the Medical Board to interpret this section narrowly.
13/ New Form MEs can be written as ‘temporary for 1-year’ or ‘permanent until the next grade span’. A permanent New Form ME must be re-written and re-submitted by the physician at checkpoint years (TK, K, 7) to remain valid.
14/ Under the new law, the CDPH and Medical Board are entitled to contact the physician to discuss New Form MEs, and to access the patient’s related medical records upon request. See Cal. Health & Safety Code section 120372(a)(2)(H),
15/ “An authorization for the department to contact the issuing physician and surgeon for purposes of this section and for the release of records related to the medical exemption to the department, the Medical Board of California, and the Osteopathic Medical Board of California.”
16/ The new law also specifies other requirements for the New Form ME, such as: (a) the physician has physically examined the child, (b) the physician is the primary care physician for the child, or else the reason why the primary care physician is not writing the new ME,
17/ (c) how long the physician has been treating the child, and (d) an authorization from the parents consenting to medical record sharing with the government.
18/ A child with demonstrated titers can qualify for a New Form ME under CDC/ACIP/AAP guidelines.
19/ GOV'T DATABASE AND PHYSICIAN SCRUTINY:

Sometime in the year 2020, the CDPH will launch their new government database for New MEs written January 1, 2021 and afterwards.
20/ Effective January 1, 2021, the database will be required for any family desiring to rely upon a New ME written January 1, 2021 and afterwards. OLD ME's SHOULD NOT BE REPORTED TO THE NEW DATABASE.
21/ The CDPH will use the new database to target the following for CDPH internal review and possible formal investigation of physicians and schools:

“(A) Schools with an overall immunization rate of less than 95 percent.
22/ “(B) Physicians who have submitted five or more medical exemptions in a calendar year beginning January 1, 2020.

“(C) Schools that do not provide reports of vaccination rates to the CDPH.”
23/ All New MEs that meet one of the above categories (A, B, or C) will be reviewed by the CDPH to determine if the New ME meets CDC/ACIP/AAP guidelines. The CDPH will then contact the physician who wrote the New ME to request additional information.
24/ If the CDPH decides to revoke the exemption, both physician and patient will be notified by CDPH in writing. The child can remain in school for 30-days per the Conditional Admission vaccine schedule, and the 30-days are extended further if the family appeals the revocation.
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