ARKANSAS STATE BOARD OF HEALTH Center for Health

ARKANSAS STATE BOARD OF HEALTH

Center for Health Protection

Communicable Disease and Immunization Section

RULES AND REGULATIONS

FOR

NURSING HOME RESIDENT & EMPLOYEE IMMUNIZATION LAW

Promulgated Under the Authority of

Ark. Code Ann. § 20-10-1301 et seq.

Effective November 2015

Arkansas Department of Health

Little Rock, AR

Nathaniel Smith, MD, MPH, Director

RULES AND REGULATIONS PERTAINING TO THE NURSING HOME RESIDENT

AND EMPLOYEE IMMUNIZATION LAW PURSUANT TO

ACT 1524 OF 1999

SECTION I. AUTHORITY

The following Rules and Regulations pertaining to the Nursing Home Resident and Employee

Immunization Law are duly adopted and promulgated by the Arkansas Board of Health pursuant

to the authority expressly conferred by the laws of the State of Arkansas including, without

limitation, Act 1524 of 1999, the same being Ark. Code. Ann. §20-10-1301 - §20-10-1305.

SECTION II. PURPOSE

To protect the health of the citizens of Arkansas by assuring that nursing home residents are

immunized against influenza annually and pneumococcal disease and that employees are

immunized against influenza annually.

SECTION III. DEFINITIONS

For the purposes of these Regulations, the following words and phrases when used herein shall

be construed as follows:

1. “Document” means evidence from a person’s physician or health care provider in written

format indicating the date and place when the individual received the influenza virus

vaccine and the pneumococcal pneumonia vaccine;

2. “Medically contraindicated” means either that the influenza or pneumococcal vaccine

should not be administered to an individual because of a condition that individual has that

will be detrimental to the individual’s health if the individual receives either of the

vaccines;

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.

4. “Report” means to maintain a current list or roster of vaccine status for residents and

employees and by December 1 of each year to provide that list to the Office of Long

Term-Care.

SECTION IV. SPECIFIC REQUIREMENTS

All nursing home facilities shall require all residents and full or part-time employees to

be immunized against influenza disease. Additionally, all residents shall be immunized

against pneumococcal disease as a condition of residency in said facility.

1. Employees

Any individual who is employed or accepts employment at any nursing home

facility, as a condition of employment, must agree to receive an annual influ-

enza immunization. Employees may be exempt, if they qualify for medical

reasons. (See Exemptions)

2. Residents

Any resident of any nursing home shall be immunized against pneumococcal

disease and receive an annual influenza immunization. Residents, or their

responsible parties, have the right to refuse medical treatment, including

immunizations, for the resident. Refusal must be in writing and be on file in

resident’s permanent record. (See Documentation).

SECTION V. EXEMPTIONS

Medical Exemptions for Employees

The Arkansas Department of Health standard form for exemptions must be

submitted to the Communicable Disease and Immunization Section. The form

must be notarized and accompanied by a letter from a physician stating the

medical contraindication. Only an approval letter issued by the MEDICAL

DIRECTOR, Communicable Disease and Immunization Section, 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 the ADH

approval letter. Approved medical exemption letters are to be filed in the

employee’s personnel file.

Requests for exemption forms or inquiries about exemptions should be forwarded to the Arkansas

Department of Health, Communicable Disease and Immunization Section, 4815 W. Markham,

MS48, Little Rock, AR 72205, or call (501) 537-8969 or 1-800-574-4040.

Residents

Nursing home residents or their legal guardian may refuse immunizations for any reason,

philosophical or religious, including that the immunization conflicts with the religious tenets and

practices of a recognized church or religious denomination of which the resident or guardian is an

adherent or member. The nursing home must document the refusal of immunizations in the

resident’s chart.

SECTION VI. DOCUMENTATION

Permission to administer influenza and pneumococcal vaccine to the residents and influenza

vaccine to employees is the responsibility of each nursing home and must be initiated during

admission to the facility. Appropriate Vaccine Information Statements with information on risks

and benefits are to be provided to the resident/resident’s responsible party or employee prior to

receiving vaccines. Consent for vaccination must be in writing and signed by either the resident

and/or responsible party. The signed consent shall be kept in the resident’s permanent record.

Employee consent must also be in writing and placed within the employee’s personnel file.

Nursing homes must maintain a current log or list of residents and 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, date administered, vaccine manufacturer, vaccine lot

number, name of vaccine administrator, and date of the Vaccine Information Statement.

Additionally, the reason vaccine was not administered to any resident (including the right to

refuse treatment) or employee must be documented on the log or list.

A copy of this log must be reported to the Office of Long-Term Care by December 1 of each

year. Nursing homes are required to retain a copy of the log for a period of fifteen (15) months

after December 1 of the submission year. These log forms may be obtained from the Arkansas

Department of Health by calling 501-537-8969 or 1-800-574-4040.

SECTION VII. RESPONSIBILITIES AND IMPLEMENTATION

The Arkansas Department of Health shall provide sufficient quantities of vaccine, supplies, and

the staff necessary to immunize the residents and staff members in all nursing home facilities that

lack coverage for immunizations through Medicare, Medicaid, or other health insurance. Area

Health Office or Local health unit staff members will co-ordinate immunization activities with

nursing home staff members to assure that all residents and employees receive all required doses

of vaccine. However, during the outbreak of a pandemic disease, the Department may enforce

vaccine priorities necessary to limit the loss of life among citizens and to contain the spread of

disease.

The Office of Long-Term Care will monitor and enforce the rules and regulations to assure

compliance with the law. Any nursing home which does not enforce the provisions of this act will

be in violation of Ark. Code Ann. § 20-10-1301 et seq. and will be subject to the punishment set

down in Ark. Code Ann. § 20-10-1304(c) for that violation.

SECTION VIII. SEVERABILITY

If any provision of these Rules and Regulations or the application thereof to any person or

circumstances is held invalid, such invalidity shall not affect other provisions or applications of

these Rules and Regulations which can give effect without the invalid provisions or applications,

and to this end the provisions hereto are declared severable.

SECTION IX. REPEAL

All regulations and parts of regulations in conflict herewith are hereby repealed.

CERTIFICATION

This is to certify that the foregoing Rules and Regulations for the Immunization Requirements for

Nursing Home Residents and Employees in Arkansas were adopted by the Arkansas State Board

of Health at a regular session of the Board held in Oppello, Arkansas, on the 22nd of October,

2015.

_________________________

Nathaniel Smith, MD, MPH

Director, Arkansas Department of Health

Secretary, Arkansas Board of Health