To repeal section 376.406, RSMo 1994, and section 167.181, RSMo Supp. 1995, and to enact in lieu thereof three new sections for the purpose of improving access to immunization for children.

Be it enacted by the General Assembly of the State of Missouri, as follows:

Section A. Section 376.406, RSMo 1994, and section 167.181, RSMo Supp. 1995, are repealed and three new sections enacted in lieu thereof, to be known as sections 167.181, 376.406 and 376.407, to read as follows:

167.181. 1. The department of health, after consultation with the department of elementary and secondary education, shall promulgate rules and regulations governing the immunization against poliomyelitis, rubella, rubeola, mumps, tetanus, pertussis, [and] diphtheria and hepatitis B, to be required of children attending public, private, parochial or parish schools. The immunizations required and the manner and frequency of their administration shall conform to recognized standards of medical practice. The department of health shall supervise and secure the enforcement of the required immunization program.

2. It is unlawful for any student to attend school unless he has been immunized as required under the rules and regulations of the department of health, and can provide satisfactory evidence of such immunization; except that if he produces satisfactory evidence of having begun the process of immunization, he may continue to attend school as long as the immunization process is being accomplished in the prescribed manner. It is unlawful for any parent or guardian to refuse or neglect to have his child immunized as required by this section, unless the child is properly exempted.

3. This section shall not apply to any child if one parent or guardian objects in writing to his school administrator against the immunization of the child, because of religious beliefs or medical contraindications. In cases where any such objection is for reasons of medical contraindications, a statement from a duly licensed physician must also be provided to the school administrator.

4. Each school superintendent, whether of a public, private, parochial or parish school, shall cause to be prepared a record showing the immunization status of every child enrolled in or attending a school under his jurisdiction. The name of any parent or guardian who neglects or refuses to permit a nonexempted child to be immunized against diseases as required by the rules and regulations promulgated hereunder shall be reported by the school superintendent to the department of health.

5. The immunization required may be done by any duly licensed physician or by someone under his direction. If the parent or guardian is unable to pay, the child shall be immunized at public expense by a physician or nurse at or from the county, district, city public health center or a school nurse or by a nurse or physician in the private office or clinic of the child s personal physician with the costs of immunization paid through the state medicaid program, private insurance or in a manner to be determined by the department of health subject to state and federal appropriations, and after consultation with the school superintendent and the advisory committee established in section 192.630, RSMo.

6. Funds for the administration of this section and for the purchase of vaccines for children of families unable to afford them shall be appropriated to the department of health from general revenue or from federal funds if available.

7. No rule or portion of a rule promulgated under the authority of this section shall become effective unless it has been promulgated pursuant to the provisions of section 536.024, RSMo.

376.406. 1. All individual and group health insurance policies providing coverage on an expense incurred basis, individual and group service or indemnity type contracts issued by a nonprofit corporation, all contracts issued by any health maintenance organization organized or authorized to transact business in this state, and, to the extent not preempted by federal law, all self-insured group health benefit plans, of any type or description, which provide coverage for a family member of the insured, enrollee or subscriber shall, as to such family member s coverage, also provide that the health insurance benefits applicable for children shall be payable with respect to a newly born child of the insured, enrollee or subscriber from the moment of birth.

2. The coverage for newly born children shall consist of the following:

(1) Coverage of injury or sickness including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities; and

(2) Routine and necessary immunizations for all newly born children of the insured enrollee or subscriber. For the purposes of this subdivision routine and necessary immunizations shall consist of those immunizations as recommended by the Immunization Practices Advisory Committee. The required benefits shall apply to immunizations administered to each newly born child from birth to thirty-six months of age and shall not be subject to any deductible, copayment or coinsurance requirements.

3. If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that notification of birth of a newly born child and payment of the required premium or fees must be furnished to the insurer, health maintenance organization or nonprofit service or indemnity corporation within thirty-one days after the date of birth in order to have the coverage continue beyond such thirty-one day period.

4. The contract issued by a health maintenance organization may provide that the benefits required pursuant to this section shall be covered benefits only if the services are rendered by a provider who is designated by and affiliated with the health maintenance organization except that the health maintenance organization shall, as a condition of participation, comply with the immunization requirements of state or federally funded health programs.

5. The requirements of this section shall apply to all insurance policies and subscriber contracts delivered or issued for delivery in this state [more than one hundred twenty days after August 13, 1974].

[5.] 6. For the purposes of this section, any review, renewal, extension, or continuation of any plan, policy, or contract or of any of the terms, premiums, or subscriptions of the plan, policy, or contract shall constitute a new delivery or issuance for delivery of the plan, policy or contract.

7. This section shall not apply to supplemental insurance policies, including accident-only policies, specified disease policies, hospital policies providing a fixed daily benefit only, Medicare supplement policies, and long-term care policies.

376.407. 1. As used in this section, the following terms shall mean:

(1) Health care provider , a person licensed to practice medicine and surgery by the state board of registration for the healing arts, a person who holds a temporary permit to practice medicine and surgery issued by the state board of registration for the healing arts, a person engaged in a postgraduate training program in medicine and surgery approved by the state board of registration for the healing arts, a medical care facility licensed by the department of health, a health maintenance organization issued a certificate of authority by the director of insurance, a licensed professional nurse, a licensed practical nurse and a registered physician s assistant. The term health care provider shall also include the following entities: a professional corporation organized pursuant to the professional corporation law of Missouri by persons who are health care providers, a Missouri limited liability company organized for the purpose of rendering professional services by its members who are health care providers, a partnership of persons who are health care providers or a Missouri not for profit corporation organized for the purpose of rendering professional services by persons who are health care providers;

(2) Minor , a child less than eighteen years of age;

(3) Parent , means:

(a) A minor s parent by birth or adoption;

(b) A minor s legal guardian; or

(c) Any person who under court order is authorized to give consent for a minor.

2. Subject to the provisions of this section, a parent may delegate in writing the parent s authority to consent to the immunization of a minor to any of the following individuals, not in order of priority:

(1) A grandparent of the minor, by birth or adoption;

(2) An adult brother or sister or half brother or half sister of the minor, by birth or adoption;

(3) An adult aunt or uncle of the minor, by birth or adoption;

(4) A stepparent of the minor; or

(5) Another adult who has care and control of the minor.

3. A grandparent, brother or sister, aunt or uncle or stepparent of a minor who is the primary caregiver of a minor and who may consent to the immunization of the minor pursuant to the provisions of subsection 2 of this section may delegate in writing the authority to consent to immunization of the minor to another person listed in subsection 2 of this section.

4. A health care provider may rely on a notarized document from another state, territory or country that contains substantially the same information as is required in any immunization consent rules and regulations of the department of health if the document is presented for consent by a person listed in subsection 2 of this section.

5. A person who consents to immunization of a minor under this section shall provide the health care provider with sufficient and accurate health information about the minor for whom the consent is given and, if necessary, sufficient and accurate health information about the minor s family to enable the person providing the consent and the health care provider to determine adequately the risks and benefits inherent in the proposed immunization and determine whether the immunization is advisable.

6. Subject to the provisions of subsections 6 to 9 of this section, the following individuals, not in order of priority, may consent to the immunization of a minor if a parent is not reasonably available and the authority to consent is not denied under subsection 7 of this section:

(1) A grandparent of the minor, by birth or adoption;

(2) An adult brother or sister or half brother or half sister of the minor, by birth or adoption;

(3) An adult aunt or uncle of the minor, by birth or adoption;

(4) A stepparent of the minor; or

(5) Another adult who has care and control of the minor.

7. A person may not consent to the immunization of a minor under subsection 6 of this section if:

(1) The person has actual knowledge that the parent has expressly refused to give consent to the immunization; or

(2) The parent has told the person that the person may not consent to the immunization of the minor or, in the case of a written authorization, has withdrawn the authorization in writing.

8. For purposes of this section, a parent is not reasonably available if:

(1) The location of the parent is unknown;

(2) A reasonable effort made by a person listed in subsection 6 of this section to locate and communicate with the parent for the purpose of obtaining consent has failed, and not more than ninety days have passed since the date that the effort was made; or

(3) The parent has been contacted by a person listed in subsection 6 of this section and requested to consent to the immunization of the minor, and the parent:

(a) Has not acted on the request; and

(b) Has not expressly denied authority to the person listed in subsection 6 of this section to consent to immunization of the minor.

9. A person authorized to consent to the immunization of a minor under subsection 6 of this section shall confirm in writing that the parent is not reasonably available, and the written confirmation shall be included in the minor s medical record.

10. The responsibility of a health care provider to provide information to a person consenting to the immunization of a minor as provided by this section is the same as the health care provider s responsibility to a parent.

11. Except for acts of willful misconduct or gross negligence, a person who consents to the immunization of a minor as provided by this section shall not be liable for damages arising from any such immunization administered by a person authorized by law to administer immunizations in this state.