SubChapter G - AIDS Testing, Communicable Diseases and Poisoning

Effective Date: 
Thursday, July 9, 2020
Doc Status: 
Complete

Part 63 - HIV/AIDS Testing, Reporting and Confidentiality of HIV-Related Information

Effective Date: 
Wednesday, May 17, 2017
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, section 2786 and Article 21, Title III (section 2139)

Section 63.1 - Definitions

63.1 Definitions

(a) "HIV-infection" means infection with the human immunodeficiency viruses that are the cause of AIDS or as the term may be defined from time to time by the Centers for Disease Control and Prevention of the United States Public Health Service.

(b) "AIDS" means acquired immune deficiency syndrome, as may be defined from time to time by the Centers for Disease Control and Prevention of the United States Public Health Service.

(c) "HIV-related illness" means any clinical illness that may result from or be associated with HIV infection.

(d) "HIV-related test or HIV-related testing" means any laboratory test, tests or series of tests approved for the diagnosis of HIV. (e) "Rapid HIV test or testing" means any HIV-related test or tests approved for detecting antibodies or antigens to HIV, that produce results in sixty minutes or less, and encompasses a supplemental test to confirm the HIV-related test if the screening test is reactive. The sixty minutes does not include the time needed for confirmation or delivery of results to the patient.

(f) "Capacity to consent" means an individual's ability, determined without regard to the individual's age, to understand and appreciate the nature and consequences of a proposed health care service, treatment, or procedure, or of a proposed disclosure of confidential HIV-related information, and to make an informed decision concerning the service, treatment, procedure or disclosure.

(g) "Protected individual" means a person who is the subject of an HIV related test or who has been diagnosed as having HIV infection, AIDS or HIV-related illness.

(h) "Confidential HIV-related information" means any information, in the possession of a person who provides health or social services or who obtains the information pursuant to a release of confidential HIV-related information, concerning whether an individual has been the subject of an HIV-related test, or has HIV infection, HIV-related illness or AIDS, or information which identifies or reasonably could identify an individual as having one or more of such conditions, including information pertaining to such individual's contacts.

(i) "Health or social service" means any care, treatment, clinical laboratory test, counseling or educational service for adults or children, and acute, chronic, custodial, residential, outpatient, home or other health care; public assistance, including disability payments available pursuant to the Social Security Act; employment-related services, housing services, foster care, shelter, protective services, day care, or preventive services; services for the mentally disabled; probation services; parole services; correctional services; detention and rehabilitative services; and the activities of the Health Care Worker HIV/HBV Advisory Panel (see Public Health Law Article 27-DD), all as defined in section 2780(8) of the Public Health Law.

(j) "Health facility" means a hospital as defined in section 2801 of the Public Health Law, blood bank, organ procurement organization, tissue bank, clinical laboratory, or facility providing care or treatment to persons with a mental disability.

(k) "Health care provider" or "provider" means any physician, nurse, licensed or certified provider of diagnostic medical services, including a nurse practitioner, a midwife and physician assistant, provider of services for the mentally disabled or other person involved in providing medical, nursing, counseling, or other health care or mental health service including those associated with, or under contract to, a health maintenance organization or medical services plan. Diagnostic providers include physicians, nurse practitioners, physician assistants and midwives who are authorized to order diagnostic tests and to make clinical diagnoses. (l) "Primary care" means the medical fields of family medicine, general pediatrics, primary care, internal medicine, primary care obstetrics, or primary care gynecology, without regard to board certification or setting where primary care is provided.

(m) "Contact" means an identified spouse or sex partner of the protected individual or a person identified as having shared hypodermic needles or syringes with the protected individual, or a person whom the protected individual may have exposed to HIV under circumstances that present a risk of transmission of HIV, as noted in section 63.8(m) of this Part. (n) "Contact tracing" shall mean the process of notifying known contacts of protected individuals as reported by the physician or as disclosed by the protected individuals themselves, and of seeking the cooperation of protected individuals to name contacts, as described in section 63.8 of this Part. For the purposes of this Part, the terms "contact notification", "partner notification", "partner assistance" and "partner counseling and referral services" shall be synonymous with "contact tracing". In all cases of contact tracing authorized in this Part, the name or other identifying information regarding the protected person shall not be disclosed to contacts and the name of contacts shall not be disclosed to other contacts.

(o) "Person" includes any natural person, partnership, association, joint venture, trust, public or private corporation or state or local government agency.

(p) "Release of confidential HIV-related information" means a written authorization for disclosure of confidential HIV-related information which is signed by the protected individual, or if the protected individual lacks capacity to consent, a person authorized pursuant to law to consent to health care for the individual. Such release shall be dated and shall specify to whom disclosure is authorized, the purpose for such disclosure and the time period during which the release is to be effective. A general authorization for the release of medical or other information shall not be construed as a release of confidential HIV-related information, unless such authorization specifically indicates its dual purpose as a general authorization and an authorization for the release of confidential HIV-related information and complies with this definition.

(q) "Insurance institution" means any corporation, association, partnership, reciprocal exchange, interinsurer, fraternal benefits society, agent, broker or other entity in the business of providing health, life and disability coverage including, but not limited to, any health maintenance organization, medical service plan, or hospital plan which: (1) is engaged in the business of insurance; (2) provides health services coverage plans; or (3) provides benefits under, administers, or provides services for, an employee welfare benefit as defined in 29 U.S.C. 1002(1). (r) "Municipal health commissioner" shall mean, for purposes of this Part, a county health commissioner, except, in New York City, the term shall mean the New York City health commissioner. Such county health commissioner and New York City health commissioner shall conduct reporting, counseling and contact notification activities consistent with guidelines acceptable to the commissioner in compliance with Article 21, Title III and Article 27-F of the Public Health Law. (s) "District health officer" shall mean, for the purposes of this Part, the commissioner or his/her designee. (t) For the purposes of this Part, "commissioner" shall mean the New York State Commissioner of Health. (u) For the purposes of this Part, "authorized public health official" shall mean New York State Commissioner of Health, a municipal health commissioner or a district health officer, or their designee.
 

Effective Date: 
Wednesday, February 22, 2012
Doc Status: 
Complete

Section 63.2 - Application

63.2 Application. These regulations apply to physicians and other persons authorized by law to order laboratory tests or to make medical diagnoses, laboratories, blood banks, tissue banks and organ procurement organizations, to persons who receive confidential HIV-related information in the course of providing any health or social service and to persons who receive confidential HIV-related information pursuant to a release. These regulations do not apply to information which was received by the Commissioner under Subpart 24-1 of this Title and protected from disclosure pursuant to Public Health Law section 206(1)(j). These regulations do not apply to insurance institutions and insurance support organizations, except as noted in section 63.6(a)(9), (10) and (12) of this Part. Health care providers associated with or under contract to a health maintenance organization or other medical services plan are subject to these regulations.
 

Effective Date: 
Thursday, June 1, 2000
Doc Status: 
Complete

Section 63.3 - HIV-related testing

63.3 HIV-related testing.

(a) Except as noted in subdivision (c) of this section, no physician or other person authorized pursuant to law may order an HIV-related test without first having advised the individual, or, when the individual lacks capacity to consent, a person authorized to consent to health care for such individual, that an HIV-related test will be performed. The physician, or other person authorized pursuant to law, may not order the HIV-related test over the objection of the individual, or person authorized to consent to health care for such individual, except as authorized or required by law. A physician or other person authorized pursuant to law to order an HIV-related test to be used for the individual’s care shall provide to the laboratory the name, addresses, and date of birth of the individual who is the source of the specimen and other such information as specified by the commissioner except in the case of anonymous testing as provided for in this Part. Certification of consent does not have to be provided to the laboratory.

(b) The advisement, and any objection to testing, shall be noted in the individual’s medical record. Before ordering an HIV-related test, the physician or other person authorized by law to order such test, or such person’s representative, shall make the following information available:

(1) HIV causes AIDS and can be transmitted through sexual activities and by needle-sharing, by pregnant women to their fetuses, and through breastfeeding infants;

(2) there is treatment for HIV that can help an individual stay healthy;

(3) individuals with HIV or AIDS can adopt safe practices to protect infected and uninfected people in their lives from becoming infected or multiply infected with HIV;

(4) testing is voluntary and can be done anonymously at a public testing center;

(5) the law protects the confidentiality of HIV-related test results;

(6) the law prohibits discrimination based on an individual's HIV status and services are available to help with such consequences; and

(7) the law requires that an individual be advised before an HIV-related test is performed, and that no test shall be performed over the individual’s objection except as authorized or required by law.

(c) Advising that an HIV-related test is being performed is not required in the following situations:

(1) for court-ordered testing pursuant to Civil Practice Law and Rules, section 3121;

(2) when testing without consent is otherwise specifically authorized or required by State or Federal law, including under Public Health Law section 2994-g;

(3) for testing related to procuring, processing, distributing or use of a human body or human body part, including organs, tissues, eyes, bones, arteries, blood, semen or other body fluids for use in medical education, medical research or therapy, or for transplantation to persons, provided that if the test results are communicated to the tested person, post-test information for negative results or counseling for positive, indeterminate/inconclusive and preliminary positive results is required;

(4) for research if the testing is performed in a manner by which the identity of the test subject is not known and may not be retrieved by the researcher;

(5) for testing of a deceased person to determine cause of death or for epidemiological purposes;

(6) for comprehensive newborn testing pursuant to PHL section 2500-f; and

(7) for anonymous testing of a person who is the source of an occupational exposure under Section 63.8(n) of this Part, who is deceased, comatose, or otherwise unable to provide consent, and no person authorized to consent on behalf of the source patient is immediately available, as provided in Public Health Law section 2781(6)(e).

(d) The Commissioner may appoint and designate, from time to time, persons to review regulated facilities to determine compliance with this Part.

(e) With respect to positive and indeterminate/inconclusive results, and for preliminary positive results obtained pursuant to Subpart 58-8 of this Title, in addition to explaining the test result to the person lawfully authorized to consent to health care, the person who orders the test shall be responsible, directly or through a representative, for ensuring post-test counseling, referrals and linkage to care as appropriate. Blood banks and tissue banks may report results as specified in Subparts 58-2 and 52-3 of this Title, respectively. When confirmed positive results are being provided, with the consent of a person who tests positive, or if such person lacks the capacity to consent, with the consent of the person authorized to consent to health care for such person, the person ordering the test or his or her representative shall provide or arrange for an appointment for follow-up care for HIV. In situations in which a person other than the test subject is lawfully authorized to consent to health care, results, post-test counseling and referrals should also be provided to the test subject, to the extent the person responsible for ordering the test deems that the test subject will benefit from counseling. For persons who test positive, post-test counseling shall address:

(1) strategies for coping emotionally with the test results;

(2) discrimination issues relating to employment, housing, public accommodations, health care, public benefits and social services;

(3) the importance of taking precautions to prevent HIV transmission to others;

(4) the ability to release or revoke the release of confidential HIV-related information;

(5) HIV reporting requirements for the purposes of epidemiologic monitoring of the HIV/AIDS epidemic;

(6) the importance of contacts' being notified to prevent transmission, and allowing early access of exposed persons to HIV testing, health care, and prevention services, and a description of notification options and assistance available to the protected individual;

(7) an assessment of the risk of domestic violence in conformance with a domestic violence screening protocol developed by the commissioner pursuant to law;

(8) the requirement that known contacts, including a known spouse, will be reported and that protected persons will also be requested to cooperate in contact notification efforts of known contacts and may name additional contacts they wish to have notified with the assistance of the provider or authorized public health officials;

(9) non-disclosure of the protected individual's name or other information about them during the contact notification process;

(10) the provider's responsibility for making an appointment for newly diagnosed persons to receive follow-up HIV medical care;

(11) the availability of medical services and the location and telephone numbers of treatment sites, information on the use of HIV chemotherapeutics for propyhlaxis and treatment and peer group support, access to prevention, education and support services and assistance, if needed, in obtaining any of these services;

(12) prevention of perinatal transmission; and 

(13) the importance of remaining in care to maintain good health and reduce the likelihood of transmission to others, and that if protected individuals appear not to be receiving HIV medical care, health care providers, entities engaged in care coordination or local and state health departments may contact them to help address any challenges or barriers that may be affecting their ability to initiate and remain in care.

(f) In the case of a test not indicating evidence of HIV infection, the person who orders the test shall be responsible, directly or though a representative, for providing the result to the subject of the test, or for a person lacking capacity to consent, the person authorized to consent for the health care for the subject. The person ordering the test or his or her representative must also provide, in a manner that may consist of oral or written reference to materials previously provided, information concerning the risks of participating in high risk sexual or needle-sharing behavior. The negative result and required information may be provided in-person, by mail, electronic messaging, or telephone provided that patient confidentiality is reasonably protected.

(g) Every individual age 13 and older (or younger than thirteen if there is evidence or indication of risk activity) who receives health services as an inpatient or in the emergency department of a general hospital defined in subdivision ten of section twenty-eight hundred one of the Public Health Law or who receives primary care services in an outpatient department of such hospital or in a diagnostic and treatment center licensed under article twenty-eight of the Public Health Law or from a physician, physician assistant, nurse practitioner, or midwife providing primary care in any office, clinic, facility or other setting shall in accordance with subdivision (a) of this section be offered an HIV-related test unless the health care practitioner providing such services reasonably believes that: (1) the individual is being treated for a life threatening emergency; or (2) the individual has previously been offered or has been the subject of an HIV-related test (except that a test shall be offered if otherwise indicated); or (3) the individual lacks capacity to consent to an HIV-related test.

(h) Nothing in this Part or Part 58 of this Title shall be construed to prohibit a person from directly ordering an HIV test on a specimen taken from his/her own body and directly receiving the results of such HIV test. The test must be performed by a New York State licensed laboratory using a specimen collection kit which has been approved for home HIV specimen collection by the U.S. Food and Drug Administration and which is available without a prescription, or as provided by Section 576-b of the Public Health Law.

Effective Date: 
Wednesday, May 17, 2017
Doc Status: 
Complete

Section 63.4 - Filing of reports

63.4 Filing of reports.

(a)(1) All determinations or diagnoses of Human Immunodeficiency Virus (HIV) infection, HIV-related illness and Acquired Immune Deficiency Syndrome (AIDS) shall be reported to the commissioner by physicians and other persons authorized to order diagnostic tests or make medical diagnoses or their agents as soon as possible but no later than 14 days after the provider's receipt of a positive laboratory result or after diagnosis, whichever is sooner.

(2) All determinations of HIV infection, HIV-related illness and AIDS shall be reported to the commissioner by blood banks as defined in Article 5, Title V of the Public Health Law, by tissue banks and organ procurement organizations as defined by Article 43-B of the Public Health Law as soon as possible but no later than 14 days after receipt of a confirmed positive laboratory result. Such banks and organizations shall report confirmed positive HIV antibody test results and reactive nucleic acid test results.

(3) Pathologists, coroners and medical examiners or other persons determining from examination of a corpse or from the history of the events leading to death, that at the time of death the individual was apparently affected with HIV infection, HIV-related illness or AIDS shall also make such report to the commissioner within 14 days after receipt of a test result or determination.

(4) Laboratories performing tests for screening, diagnosis or monitoring of HIV infection for New York State residents and/or New York State health care providers shall report to the Commissioner cases of determinations or diagnoses of HIV infection, HIV-related illness and AIDS on a schedule to be specified by the Commissioner. Laboratories shall report the following: any reactive test result from an antigen or antibody test performed as an initial screen for HIV infection and the results from all supplemental tests performed to verify HIV infection, all HIV nucleic acid (RNA or DNA) test results, all CD4 lymphocyte counts and percents unless the test was known to be performed for reasons other than HIV infection or HIV-related illness, HIV subtype and antiviral drug resistance testing in a format designated by the Commissioner, and the results of other tests as may be determined by the Commissioner to indicate a diagnosis of HIV infection, HIV-related illness or AIDS.

(b) Reports, including names and addresses of the protected individual, all contact and locating information and other information including demographic, and identifying information as may be specified by the commissioner, shall be made in a manner and format as prescribed by the commissioner.  For the requesting provider and facility, the following information shall be included: provider and facility name, complete provider and facility address and telephone number, and provider and facility National Provider Identification.  Information reported shall also include names and addresses, if available, of contacts, including spouses, known to the physician or other person authorized to order diagnostic tests or make medical diagnoses, or provided to them by the protected individual, and the date each contact was notified if contact notification has already been done; and information, in relation to each reported contact, required by an approved domestic violence screening protocol. After receiving the report, the commissioner or designated representative may request the individual making the report or the person who ordered the diagnostic tests to provide additional information as may be required for the epidemiologic investigation, case finding and analysis of HIV infection, HIV-related illness and Acquired Immune Deficiency Syndrome (AIDS) and to implement Public Health Law Article 21, Title III. Notwithstanding this subdivision, test results from New York State approved anonymous test sites shall not be reported to the commissioner unless the test subject chooses to supply identification and convert the anonymous test result to a confidential test result.

(c) Confidentiality. Such reports and additional information maintained by the commissioner or designated representative, including all information generated by contact notification and domestic violence screening activities, shall be kept confidential as required by Public Health Law, Article 21, Title III, and shall not be disclosed except when in the judgment of the public health official, necessary to other authorized public health officials for conducting accurate and complete epidemiological monitoring of the HIV/AIDS epidemic and for conducting contact notification activities, except that information may be disclosed to public health officials in other jurisdictions when necessary to notify the contact or for purposes of de-duplication; no information about the protected individual will be released to any person in the contact notification process. Reports and information may be used in the aggregate in programs approved by the commissioner (1) for the improvement of the quality of medical care provided to persons with HIV/AIDS; (2) with patient identifiers when used within the state or local health department by public health disease programs to assess co-morbidity or completeness of reporting and to direct program needs, in which case patient identifiers shall not be disclosed outside the state or local health department; or (3) when used for purposes of linkage to and retention in care, in which case the protected individual’s individually identifiable health information may be shared among state health departments, local health departments, health care providers as defined in section 63.1(k) of this Part, and entities engaged in care coordination that have a clinical, diagnostic, or public health interest in the patient. For purposes of this section, care coordination shall mean managing, referring to, locating, coordinating, and monitoring health care services for the individual to assure that all medically necessary health care services are made available to and are effectively used by the individual in a timely manner, consistent with patient autonomy. Care coordination shall be conducted by or with the participation of the individual’s health care provider to the extent possible.

Effective Date: 
Wednesday, May 17, 2017
Doc Status: 
Complete

Section 63.5 - Disclosure pursuant to a release

63.5 Disclosure pursuant to a release.

(a) No confidential HIV-related information, including such information as related to domestic violence screening, shall be disclosed pursuant to a general release except to insurance companies as noted in section 63.6(a)(9) of this Part. Disclosure is permitted pursuant to a release of confidential HIV-related information. The release must be signed by the protected individual, or if the protected individual lacks capacity to consent, by a person specified in section 63.6(a)(1) of this Part.

(b) All written disclosures of confidential HIV information must be accompanied by a statement prohibiting redisclosure. The statement shall include the following language or substantially similar language: "This information has been disclosed to you from confidential records which are protected by state law. State law prohibits you from making any further disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. Any unauthorized further disclosure in violation of state law may result in a fine or jail sentence or both. A general authorization for the release of medical or other information is not, except in limited circumstances set forth in this part, sufficient authorization for further disclosure. Disclosure of confidential HIV information that occurs as the result of a general authorization for the release of medical or other information will be in violation of the state law and may result in a fine or a jail sentence or both."

(c) If oral disclosures are necessary, they must be accompanied or followed as soon as possible, but no later than 10 days, by the statement required by subdivision (b).

(d) The statement required by subdivisions (b) and (c) of this section is not required for disclosures made in accordance with paragraphs (1), (4) or (9) of subdivision (a) of section 63.6 of this Part, for releases made by a physician or their agent or public health officer to a contact; or for releases made by a physician or their agent to a person authorized pursuant to law to consent to the health care of the protected person when the person has been counseled and has refused to disclose and the disclosure is medically necessary. For disclosures of confidential HIV-related information from the patient's medical record to persons who are permitted to access this information pursuant to sections 63.6(a)(3), (5), (6), (7), and (10) (e) and (f) of this Part, it shall be sufficient for the statement required by subdivisions (b) and (c) of this section to appear as part of the medical record when a medical record is disclosed.
 

Effective Date: 
Wednesday, February 22, 2012
Doc Status: 
Complete

Section 63.6 - Confidentiality and disclosure

63.6 Confidentiality and disclosure.

(a) No person who obtains confidential HIV-related information in the course of providing any health or social service or pursuant to a release of confidential HIV-related information may disclose or be compelled to disclose such information, except to the following:

(1) the protected individual or, when the protected individual lacks capacity to consent, a qualified person under section 18 of the Public Health Law, a person the protected individual has authorized to access records relating to the provision of health care under General Obligations Law Article 5, Title 15, or person authorized pursuant to law to consent to health care for the individual;

(2) any person to whom disclosure is authorized pursuant to a release of confidential HIV-related information in accordance with section 63.5(a);

(3) an agent or employee of a health facility or health care provider if (i) the agent or employee is authorized to access medical records; (ii) the health facility or health care provider itself is authorized to obtain the HIV-related information; and (iii) the agent or employee provides health care to the protected individual, or maintains or processes medical records for billing or reimbursement;

(4)(i) a health care provider or health facility when knowledge of the HIV-related information is necessary to provide appropriate care or treatment to the protected individual or a child of the individual; (ii) a health care provider or health facility when knowledge of HIV-related information is necessary to provide appropriate care or treatment to a contact or exposed individual, provided the requirements in section 63.8(m) of this Part are followed for disclosures involving exposures in risk situations; (iii) in circumstances when consent for health care is necessary, disclosure may also be made to a person authorized to consent to health care for such contact or for such protected individual, provided that if disclosure is to a person authorized to consent to the health care of a contact or to a contact when such contact has been exposed to HIV under circumstances which present a risk of transmission, the requirements in subdivision (m) of section 63.8 must be followed;

(5) a health facility or health care provider, in relation to the procurement, processing, distributing or use of a human body or a human body part, including organs, tissues, blood, semen, or other body fluids, for use in medical education, research, therapy, or for transplantation to individuals;

(6) health facility staff committees, or accreditation or oversight review organizations authorized to access medical records, provided that such committees or organizations may only disclose confidential HIV-related information: (i) back to the facility or provider of a health or social service; (ii) to carry out the monitoring, evaluation, or service review for whcih it was obtained; or (iii) to a federal, state or local government agency for the purposes of and subject to the conditions provided in paragraph (e) of this section;

(7) a federal, state, county or local health officer when such disclosure is mandated by federal or state law, including reporting and contact notification processes authorized pursuant to Article 21, Title III, or pursuant to Article 27-F;

(8) authorized agencies as defined by Social Services Law, Section 371 and corporations incorporated or organized to receive children for adoption or foster care, in connection with foster care or adoption of a child. Such agency shall be authorized to redisclose such information only pursuant to the provisions of Article 27-F of the Public Health Law or in accordance with the provisions of Social Services Law Section 373-A and regulations promulgated thereunder;

(9) third party reimbursers or their agents to the extent necessary to reimburse health care providers, including health facilities, for health services, provided that, an otherwise appropriate authorization for such disclosure has been secured;

(10) an insurance institution, for other than the purpose set forth in paragraph (9) of this subdivision, provided the insurance institution secures a dated and written authorization that indicates that health care providers, health facilities, insurance institutions, and other persons are authorized to disclose information about the protected individual, the nature of the information to be disclosed, the purposes for which the information is to be disclosed and which is signed by: (i) the protected individual; (ii) if the protected individual lacks the capacity to consent, such other person authorized pursuant to law to consent for such individual; or (iii) if the protected individual is deceased, the beneficiary or claimant for benefits under an insurance policy, a health services plan, or an employee welfare benefit plan as authorized in Article 27-F of the Public Health Law;

(11) to a funeral director upon taking charge of the remains of a deceased person when such funeral director has access in the ordinary course of business to HIV-related information on the death certificate of the deceased individual, as authorized by Public Health Law Section 4142;

(12) any person to whom disclosure is ordered by a court of competent jurisdiction pursuant to Public Health Law Section 2785;

(13) an employee or agent of the Division of Probation and Correctional Alternatives, Division of Parole, Commission of Correction, or any local probation department, to the extent the employee or agent is authorized to access records containing such information in order to carry out functions, powers and duties with respect to the protected person and in accordance with regulations promulgated pursuant to Public Health Law Article 27-F;

(14) a medical director of a local correctional facility in accordance with regulations promulgated pursuant to Article 27-F to the extent the medical director is authorized to access records to carry out his/her functions relating to the protected person. Redisclosure by the medical director is prohibited except as permitted under Public Health Law Article 27-F, Article 21, Title III and implementing regulations; (15) an employee or agent of the New York City Board of Corrections so that the board may continue to access records of inmates who die while in the custody of the New York City Department of Corrections when necessary for the board to carry out its duties, functions, and powers with respect to the protected individual, pursuant to the New York City charter; or

(16) a law guardian, appointed to represent a minor pursuant to the social services law or the family court act, for the purpose of representing that minor. If the minor has the capacity to consent, the law guardian may not redisclose confidential HIV related information without the minor's permission. If the minor lacks capacity to consent, the law guardian may redisclose confidential HIV-related information for the purpose of representing the minor; 

(17) an executor or administrator of an estate of a deceased person as needed to fulfill his or her responsibilities/duties as an executor or administrator; or

(18) qualified researchers for medical research purposes upon the approval of a research protocol by a human research review committee established and approved under the provisions of article 24-A of the Public Health Law or by an institutional review board established and approved under applicable provisions of federal law, for the purpose of reviewing and monitoring research involving human subjects, provided that in no event shall any qualified researcher disclose information tending to identify the subjects of the research.

(b) A state, county or local health officer may disclose confidential HIV-related information when:

(1) disclosure is specifically authorized or required by federal or state law including, but not limited to Public Health Law, Article 21, Title III and Public Health Law, Article 27-F; or

(2) disclosure is made pursuant to a release of confidential HIV related information; or

(3) disclosure of information regarding a contact is requested by a physician pursuant to section 63.8 of this Part; or if the contact resides outside the jurisdiction of the authorized public health official, the official shall inform the public health official in the contact's jurisdiction in order to confidentially inform such contact; or

(4) disclosure is authorized by court order pursuant to the provisions of Public Health Law Section 2785.

(c) A physician or his/her agent may disclose the confidential HIV-related information to a contact and to a public health officer for the purpose of making a disclosure to the contact.

(d) A physician or his/her agent may, upon the consent of a parent or guardian, disclose confidential HIV-related information to a state, county, or local health officer for the purpose of reviewing the medical history of a child to determine the fitness of the child to attend school.

(e) Confidential HIV-related information of a protected person may be disclosed to authorized employees or agents of a governmental agency pursuant to the regulations of the governmental agency when the person providing health or social services is regulated, supervised or monitored by the governmental agency or when the governmental agency administers the health program or a social service program and when such employees or agents have access to records in the ordinary course of business and when access is reasonably necessary for regulation, supervision, monitoring, administration or provision of services. Such authorized employees or agents may include attorneys authorized by a government agency when access occurs in the ordinary course of providing legal services and is reasonably necessary for supervision, monitoring, administration or provision of services. Such authorized employees or agents may also include public health officers as needed for conducting epidemiological or surveillance investigations pursuant to applicable law, rule or regulation . Such surveillance or investigational data shall also be disclosed by the public health officer to the State Department of Health as required by the State Sanitary Code or this Part .

(f) Confidential HIV-related information of a protected person may be disclosed to authorized employees or agents of a provider of health or social services when such provider is either regulated, supervised or monitored by a governmental agency or when a governmental agency administers the provider's health or social service program, and when such employees or agents have access to records in the ordinary course of business and when access is reasonably necessary for regulation, supervision, monitoring, administration or provision of services. Such authorized employees or agents may include attorneys authorized by persons providing health services when access occurs in the ordinary course of providing legal services and is reasonably necessary for supervision, monitoring, administration or provision of services.

(g) A physician or his/her agent may disclose confidential HIV-related information pertaining to a protected individual to a person, known to the physician or his/her agent , authorized pursuant to law to consent to the health care for the protected individual when the physician reasonably believes that:

(1) disclosure is medically necessary in order to provide timely care and treatment for the protected individual; and

(2) after appropriate counseling as to the need for such disclosure the protected individual will not inform a person authorized by law to consent to health care; provided, however, that the physician shall not make such disclosure if, in the judgment of the physician:

(i) the disclosure would not be in the best interest of the protected individual; or

(ii) the protected individual is authorized pursuant to law to consent to such care and treatment. A physician's decision to disclose pursuant to this paragraph, and the basis for that decision shall be recorded in the medical record.

(h) No person to whom confidential HIV information has been disclosed shall disclose the information to another person except as authorized by law, (including, but not limited to, disclosure authorized by PHL Article 21, Title III), except that this provision shall not apply to:

(1) the protected individual;

(2) a natural person who is authorized pursuant to law to consent to health care for the protected individual;

(3) a protected individual's foster parent, subject to Department of Social Services regulations, for the purpose of providing care, treatment or supervision to the protected individual; or

(4) a prospective adoptive parent, subject to Department of Social Services regulations, with whom a child has been placed for adoption.

(i) Nothing in this section shall limit a person's or agency's responsibility or authority to report, investigate, or redisclose child protective and adult protective services information in accordance with title six of article six and titles one and two of article nine-b of the Social Services Law, or to provide or monitor the provision of child and adult protective or preventive services.

(j) Confidential HIV-related information shall not be disclosed to a health care provider or health care facility for the sole purpose of implementing infection control precautions when such provider or facility is regulated under the Public Health Law and required to implement such precautions with all individuals pursuant to this Title. This restriction shall not limit access to HIV-related information by a facility's infection control personnel for purposes of fulfilling their designated responsibilities in the facility.

(k) Confidential HIV-related information shall not be released pursuant to a subpoena. A court order pursuant to Public Health Law section 2785 is required for release of confidential HIV-related information.

(l) Confidential HIV related information shall be disclosed upon the request of the Health Care Worker HIV/HBV Advisory Panel (see Public Health Law Article 27-DD) to the Panel or its designee(s) only when the Panel considers the information reasonably necessary for the evaluation and monitoring of a worker who has voluntarily sought the Panel's review.
 

Effective Date: 
Wednesday, May 17, 2017
Doc Status: 
Complete

Section 63.7 - Documentation of HIV-related information and disclosures

63.7 Documentation of HIV-related information and disclosures.

(a) Confidential HIV-related information shall be recorded in the medical record such that it is readily accessible to provide proper care and treatment.

(b) All disclosures of confidential HIV-related information must be noted in the record, except:

(1) only initial disclosures to insurance institutions must be noted;

(2) notation is not required for disclosure to agents or employees of health facilities or health care providers authorized under section 63.6(a)(3);

(3) notation is not required for persons engaged in quality assurance, program monitoring or evaluation, nor for governmental payment agents acting pursuant to contract or law.

(c) Confidential HIV-related information shall be noted, as appropriate, in a certificate of death, autopsy report or related documents prepared pursuant to Public Health Law, Article 41 or other laws relating to documentation of cause of death.

(d) The protected person shall be informed of disclosures of HIV information upon request of the protected person.

(e) Confidential HIV-related information shall not be disclosable pursuant to Public Officers Law, Article 6 (the Freedom of Information Law).
 

Effective Date: 
Thursday, June 1, 2000
Doc Status: 
Complete

Section 63.8 - Contact notification

63.8 Contact notification.

(a) When contact notification is conducted based on the mandated reporting of cases of HIV infection, HIV-related illness and AIDS and the reporting of known contacts of such cases, and/or provided by the protected individual, all information collected in the course of these contact notification activities, including screening to assess risk of domestic violence, shall be kept confidential as required by Public Health Law, Article 21, Title III, and shall not be disclosed except when in the judgment of the public health official necessary to other authorized public health officials for conducting accurate and complete epidemiological monitoring of the HIV/AIDS epidemic and for conducting contact notification activities except that contact names and locating information may be disclosed to public health officials in other jurisdictions when necessary to notify the contact; no information about the protected individual will be released to any person in this process. Disclosures and notifications shall be made as follows:

(1) Physicians and other persons required to report as provided for in section 63.4 of this Part must indicate on the reporting form whether they have conducted post-test counseling and an assessment of the risk of domestic violence in conformance with a domestic violence screening protocol developed by the commissioner, whether they plan to undertake contact notification activities, have completed notification of contacts or are making a referral for partner notification assistance to authorized public health officials. If the physician or other mandated reporter chooses to conduct notification, the results of those activities, including information specified by the commissioner on forms supplied by the commissioner, or their equivalent, must be forwarded to the appropriate authorized public health official, pursuant to section 63.4.

(2) The commissioner shall forward initial reports from physicians and other mandated reporters, including the names and addresses of the reported case and of the known contacts, and/or contacts provided by the protected person, the status of provider initiated contact notification activities and the determination of risk of domestic violence, if any, to the authorized public health official in the county where the reported case resides.

(3) Consistent with guidelines acceptable to the commissioner in conformance with Article 21 of the Public Health Law, authorized public health officials, upon determination that the reported case, reported contacts, or any other case merits contact notification in order to protect the public health, shall make a good faith effort to seek the cooperation of the protected individual to name contacts they wish to have notified, to notify the known contacts and to inform the public health official in the jurisdiction where any additional contacts reside, when necessary to notify such contacts. No information about the protected individual will be released to any person in this process.

(b) Authorized public health officials shall consider the following as important factors in determining the priority for which cases merit contact notification in order to protect the public health:

(1) reported contacts, including spouses known to the reporting physician or other diagnostic provider, or who the protected individual wishes to have notified, unless the provider certifies that these known contacts have already been notified;

(2) protected individuals who are newly diagnosed with HIV infection; and

(3) protected individuals who were previously diagnosed with HIV infection, and who show evidence of: being out of medical care; not being virally suppressed; recent sexually transmitted diseases; or having recently moved into New York State.

(c) In cases which merit contact notification, if an indication of risk of domestic violence has been identified, pursuant to a protocol acceptable to the commissioner, the authorized public health official, in consultation with the reporting physician, must be satisfied in his/her professional judgment that reasonable arrangements, efforts or referrals to address the safety of affected persons have been made if and when the notification is to proceed. Such consultation shall also consider information, if available, requested from the protected person, or from a domestic violence service provider pursuant to a signed release.

(d) Authorized public health officials shall conduct contact notification activities consistent with guidelines acceptable to the commissioner which will recognize the special needs of adolescents, individuals in residential and institutional settings, and other vulnerable populations.

(e) Authorized public health officials will respond to all requests from HIV infected individuals and their health care providers for assistance in notifying contacts.

(f) When contact notification is conducted by authorized public health officials, such officials shall:

(1) confirm that post-test counseling of the protected person is completed;

(2) when communication with the protected person is necessary, communicate with the protected person in a confidential, private and safe manner to seek cooperation in contact notification activities, to verify the information about the identity or location of known contacts, to conduct or confirm a screen for domestic violence and if applicable, to make referrals regarding domestic violence, prior to any notification of contacts. If communication cannot be made in a
confidential, private and safe manner, it shall be deferred until these requirements can be met; and

(3) in circumstances where the protected individual cannot be contacted for post-test counseling or declines to be assessed for risk of domestic violence in relation to known contacts, the authorized public health official shall make the determination of whether to proceed with notification of known contacts, in consultation with the reporting physician.

(g) All persons notifying contacts shall provide counseling or make referrals or appointments for counseling and testing as appropriate. Such counseling must address coping emotionally with potential exposure to HIV, domestic violence issues, an explanation regarding the nature of HIV infection and HIV-related illness, availability of anonymous and confidential testing, information on preventing exposure or transmission of HIV infection, information regarding discrimination problems that might occur as a result of disclosure of HIV-related information, and legal protections against such disclosures. All notifications shall be in person, except where circumstances reasonably prevent doing so, e.g., at the request of the contact.

(h) If a protected person is now deceased, contacts (e.g., spouse) are known to the physician and the physician believes the protected person had not informed such contacts, the physician or his/her agent may notify such contacts or shall request the authorized public health official to notify the contacts, without identifying the protected individual to the contact.

(i) A physician or authorized public health official shall have no obligation to identify or locate any contact, except as provided pursuant to Public Health Law Article 21, Title III. No criminal sanction or civil liability shall arise against a physician, his/her employer or designated agent, health facility, health care provider or authorized public health official for the disclosure of confidential HIV-related information to a contact or to a person consenting to health care for the contact when in compliance with Article 27-F, or for the failure to disclose such information to a contact or to a person consenting to health care for the contact.

(j) Municipal health commissioners must provide HIV contact notification services and shall forward to the department, summary data and all identifiable information related to notification activities upon completion of such activity unless otherwise determined by the commissioner. Information identifying the contact collected in the course of contact notification activities by authorized public health officials shall not be maintained at the state or local level for longer than administratively necessary. The Department or local health department shall establish a records retention and disposition schedule for destruction of these records.

(k) For the purposes of notifying contacts under Public Health Law section 2782(1)(d), blood transfusion and organ and tissue transplantation present a risk of HIV transmission. Notifying contacts potentially exposed to HIV through tissues, organs, or transfused blood under a federally mandated recipient notification program or guidelines acceptable to the commissioner shall be sufficient to meet the notification requirements of Article 21, Title III and Article 27-F. Blood banks, organ procurement organizations, and tissue banks may disclose the HIV status of a donation to a donor's provider for the purposes of notifying known contacts of a donor.

(l) When contact notification is initiated by a physician not related to reporting mandates or Article 21, Title III, but based on authority to notify an identified spouse, sex partner, hypodermic needle and syringe partner under Public Health Law section 2782(4), physicians or their agents and authorized public health officials may conduct contact notification as follows:

(1) a physician or his/her agent may, without the protected person's consent, notify such contact or report such contact to the authorized public health official for the purpose of notifying a contact when:

(i) the physician believes disclosure is medically appropriate and a significant risk of infection may exist to the contact; and

(ii) the protected person has been counseled to notify his/her contacts or the physician has taken all reasonable efforts to attempt to counsel the person; and

(iii) domestic violence screening in accordance with the screening protocol has been applied;

(2) the physician must inform the protected person of the physician's intent to notify such contacts and of their responsibility to report the case and such contacts to the commissioner, and inform the protected person that he/she may express a preference whether contact notification shall be made by the physician or authorized public health official, and that the protected individual's name or other information about them is not disclosed to any person during the contact notification process;

(3) if the protected person's preference is for the authorized public health official to notify contacts or if the protected person's preference is for the physician to notify contacts but the physician chooses not to do so, he/she shall notify the protected person of his/her decision to contact the authorized public health official and shall forward names and addresses of the case and contacts to the authorized public health official, who shall take reasonable measures to notify such contacts. If the protected person's preference is for the physician to notify contacts and the physician elects to do so, the physician or his/her agent may then notify contacts; and

(4) the physician must report to the authorized public health official regarding the success or failure of such efforts, including the names and addresses of the cases and contacts. If contacts have not been notified or notification cannot be verified by the physician or his/her agent, public health officers shall take reasonable measures to inform the contact as set forth in subdivisions (b) through (g) of section 63.8.

(m) When the requirements of this section have been met, physicians and other diagnostic providers may disclose HIV-related information, without a release of confidential HIV-related information, to physicians or other diagnostic providers of persons whom the protected individual may have exposed to HIV under the circumstances noted below that present a risk of transmission of HIV, except that disclosures related to exposures of emergency response employees governed by federal law shall continue to be governed by such law:

(1) the incident must involve exposure to blood, semen, vaginal secretions, breast milk, tissue or the following body fluids: cerebrospinal, amniotic, peritoneal, synovial, pericardial and pleural; and

(2) a person has contact with the body substances, as noted in paragraph (1) above, of another to mucus membranes (e.g., eyes, nose, mouth), non-intact skin (e.g., open wound, skin with a dermatitis condition, abraded areas) or to the vascular system. Examples of such contact may include needlesticks, puncture wound injuries and direct saturation or permeation of non-intact skin by potentially infectious substances. These circumstances shall not include those delineated in subdivision (d) of section 63.10; and

(3) the exposure incident occurred to staff, employees or volunteers in the performance of employment or professional duties:

(i) in a medical or dental office; or

(ii) in a facility regulated, authorized or supervised by the Department of Health, Office of Mental Health, Office for People With Developmental Disabilities, Office of Children and Family Services, Office of Alcoholism and Substance Abuse Services, Department of Corrections and Community Supervision; or

(iii) involved an emergency response employee, paid or volunteer, including an emergency medical technician, a firefighter, a law enforcement officer (e.g., police, probation, parole officer) or local correctional officer or medical staff; and

(4) an incident report documenting the details of the exposure, including witnesses to the incident, if any, is on record with supervisory staff; and

(5) a request for disclosure of HIV status is made to the provider of the source or to the medical officer designated by the facility by the exposed person or by the provider of the exposed person as soon as possible after the alleged exposure if a decision relating to the initiation or continuation of post-exposure prophylactic treatment is being considered; and

(6) documentation of the request is placed in the medical record of the exposed person; and

(7) if the provider of the source or the medical officer designated by the facility determines that a risk of transmission has occurred or is likely to have occurred in the reasonable exercise of his/her professional judgment, the provider or medical officer may release the HIV status of the source, if known. The provider or medical officer may consult with the municipal health commissioner or district health officer to determine whether a risk of transmission exists. If consultation occurs, both the provider and the local health officer must be in agreement if the HIV information is to be disclosed. In the disclosure process the name of the source shall not be provided to the exposed person. Redisclosure of the HIV status of the source is prohibited except when made in conformance with Public Health Law Article 21, Title III.

(n) In cases of anonymous testing of an occupational exposure source patient who is deceased, comatose or otherwise unable to provide consent, and no person authorized to consent on behalf of the source person is immediately available, as provided for in Public Health Law Section 2781(6)(e), the results of such anonymous test, but not the identity of the source person, shall be disclosed only to the attending health care professional of the exposed person solely for the purpose of assisting the exposed person in making appropriate decisions regarding post-exposure medical treatment. The results of the test shall not be disclosed to the source person or placed in the source person’s medical record.

Effective Date: 
Wednesday, May 17, 2017
Doc Status: 
Complete

Section 63.9 - Health care provider and health facility policy and procedures

63.9 Health care provider and health facility policy and procedures. Each health care provider and health facility employing persons or contracting with persons to perform any activity related to such provider's or facility's rendering of health services shall develop and implement policies and procedures to maintain the confidentiality of confidential HIV related information. Such policies and procedures shall assure that such information is disclosed to employees or contractors only when appropriate under this Part. Such policies and procedures shall include:

(a) initial employee education inservice education of employees regarding the legal prohibition against unauthorized disclosure in Public Health Law Article 27-F and provisions of Article 21, Title III. Updates should be provided to all employees in cases of changes to relevant laws or regulations. A list of all employees who have had such training must be maintained by health care providers and health facilities. Health care providers and health facilities contracting with others for services in which HIV-related information may be disclosed to such contractors, must document evidence that such contractors have been informed of the confidentiality and disclosure requirements of this Part;

(b) maintenance of a list of job titles and the specific employee functions within those titles for which employees are authorized to access such information. This list shall describe the limits of such access to information and must be provided to the employees during employee education sessions;

(c) a requirement that only full-time or part-time employees, contractors and medical, nursing or health-related students who have received such education on HIV confidentiality, or can document that they have received such education or training, shall have access to confidential HIV-related information while performing the authorized functions listed under paragraph (2).

(d) protocols for ensuring that records, including records which are stored electronically, are maintained securely and used for the purpose intended;

(e) procedures for handling requests by other parties for confidential HIV-related information;

(f) protocols prohibiting employees/agents/contractors from discriminating against persons having or suspected of having HIV infection; and

(g) review of the policies and procedures on at least an annual basis.
 

Effective Date: 
Wednesday, February 22, 2012
Doc Status: 
Complete

Section 63.10 - Significant risk

63.10 Significant risk.

(a) The three factors necessary to create a significant risk of contracting or transmitting HIV infection are: (1) the presence of a significant risk body substance; (2) a circumstance which constitutes significant risk for transmitting or contracting HIV infection; and (3) the presence of an infectious source and another person.

(b) "Significant risk body substances" are blood, semen, vaginal secretions, breast milk, tissue and the following body fluids: cerebrospinal, amniotic, peritoneal, synovial, pericardial, and pleural.

(c) Circumstances which constitute "significant risk of transmitting or contracting HIV infection" are:

(1) sexual intercourse (vaginal, anal, oral) which exposes another individual to blood, semen or vaginal secretions of an infected individual;

(2) sharing of needles and other paraphernalia used for preparing and injecting drugs between infected and other individuals;

(3) the gestation, birthing or breast feeding of an infant when the mother is infected with HIV;

(4) transfusion or transplantation of blood, organs, or other tissues from an infected individual to an another, provided such blood, organs or other tissues have not tested conclusively for antibody or antigen and have not been rendered non-infective by heat or chemical treatment;

(5) other circumstances not identified in paragraphs (1) through (4) of this subdivision during which a significant risk body substance (other than breast milk) of an infected individual contacts mucous membranes (e.g., eyes, nose, mouth), non-intact skin (e.g., open wound, skin with a dermatitis condition, abraded areas) or the vascular system of another person. Such circumstances include, but are not limited to needlestick or puncture wound injuries and direct saturation or permeation of these body surfaces by the infectious body substance.

(d) Circumstances that involve "significant risk" shall not include:

(1) exposure to urine, feces, sputum, nasal secretions, saliva, sweat, tears or vomitus that does not contain blood that is visible to the naked eye;

(2) human bites where there is no direct blood to blood, or blood to mucous membrane contact;

(3) exposure of intact skin to blood or any other body substance;

(4) occupational settings where individuals use scientifically accepted barrier techniques and preventive practices in circumstances which would otherwise pose a significant risk and such barriers are not breached and remain intact.

Effective Date: 
Wednesday, February 22, 2012
Doc Status: 
Complete

Section 63.11 - Separability

63.11 Separability. If any section, subsection, clause or provision of this Part shall be deemed by any court of competent jurisdiction to be unconstitutional, ineffective or otherwise legally invalid or unenforceable, in whole or in part, to the extent that it is not unconstitutional, ineffective or otherwise legally invalid or unenforceable, it shall be valid and effective and no other section, subsection, clause or provision shall, on account thereof, be deemed invalid or ineffective.

Effective Date: 
Wednesday, October 11, 2006
Doc Status: 
Complete

Part 64 - RESERVED

Part 65 - RESERVED

Part 66 - Immunizations and Communicable Diseases

Effective Date: 
Thursday, July 9, 2020
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 2164, 2165, 2168

SubPart 66-1 - School Immunization Requirements

Effective Date: 
Tuesday, December 31, 2019
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2164 and 2168

Section 66-1.1 - Definitions

Section 66-1.1 Definitions.

As used in this Subpart unless the context otherwise requires:

(a) School means and includes a public, private or parochial child-caring center, day-care agency providing day care of children as defined in this section, nursery school as defined in this section, kindergarten, and any elementary, intermediate or secondary class or school building.

(b) Child means and includes any person between the ages of two months and 18 years.

(c) Day care of children means:

(1) outside the City of New York, care provided to children away from the child's residence, for less than 24 hours per day in a licensed child day care center or a group family day care, for compensation or otherwise, for at least three hours a day.

(2) in the City of New York, any service which, during all or part of the day, regularly gives care to six or more children, not of common parentage, who are under six years of age, whether or not the care is given for compensation and whether or not it has a stated educational purpose. The total number of children receiving care shall be counted, including children or foster children of the owner or person in charge, in determining the applicability of this definition. The term shall not, however, include a service which gives care to children for five or less hours a week or a service which operates for one month a year or less.

(d) Nursery school means a place, other than one providing day care of children as defined in this section, in which organized instruction is provided for children prior to entering any public or non-public school.

(e) Health practitioner means any person authorized by law to administer an immunization. This includes a physician, nurse practitioner, nurse-midwife caring for a pregnant student, registered nurse, licensed practical nurse under the direction of a registered nurse, or physician's assistant.

(f) Fully immunized means that an adequate dosage and number of doses of an immunizing agent licensed by the United States Food and Drug Administration has been received commensurate with the child's age, or the child has been demonstrated to have immunity as defined in this section. 

(1) For those immunizations required by section 2164 of the Public Health Law only, the number of doses that a child shall have at any given age, and the minimum intervals between these doses, shall be in accordance with the Advisory Committee on Immunization Practices Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, issued by the Advisory Committee on Immunization Practices (ACIP) as referenced in Chapter 35 of the Laws of 2019 and posted on the Centers for Disease Control and Prevention website. Any child who completed an immunization series following minimum intervals prescribed in an ACIP Recommended Immunization Schedule pre-dating February 2019 shall continue to be deemed in compliance as long as the number of vaccine doses the child received conforms to the current ACIP Recommended Immunization Schedule. 

(i) For all vaccinations, except as provided in subparagraphs (ii) through (vii) of this paragraph, children shall be assessed upon school entry or attendance, and annually thereafter, and be fully immunized commensurate with their age. 

(ii) Any child who has satisfied the immunization requirements in effect in regulation on June 30, 2014, entering twelfth grade (or comparable age level grade equivalents) in the 2019-2020 school year only, shall be deemed in compliance with the immunization requirements set forth in this section, including those set forth in subparagraphs (iii) through (vi) of this paragraph, until such child graduates from school; provided, however, that such child shall comply with the meningococcal vaccination requirement set forth in subparagraph (vii) of this paragraph.  

(iii) Any child entering or attending kindergarten through twelfth grade must have received the following vaccine doses, with the minimum intervals between these doses as established by the Advisory Committee on Immunization Practices Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger:  

(a) Two adequate doses of measles containing vaccine, two adequate doses of mumps containing vaccine, and at least one adequate dose of rubella containing vaccine; and 

(b) Five adequate doses of diphtheria and tetanus toxoids and acellular pertussis vaccine. If, however, the fourth dose of diphtheria and tetanus toxoids and acellular pertussis vaccine was given at 48 months of age or older, only four adequate doses of vaccine are required. The final dose of vaccine must be received no sooner than 48 months of age. Doses given after age seven should start with one dose of Tdap.  

(iv) Four adequate doses of poliomyelitis vaccine. If, however, the third adequate dose of poliomyelitis vaccine was given at 48 months of age or older, only three adequate doses of vaccine are required. The final dose of vaccine must be received no sooner than 48 months of age. Beginning on or after September 1, 2016, children shall be assessed upon entry or attendance to child-caring centers, day-care agencies, nursery schools and pre-kindergarten programs and must be fully immunized against poliomyelitis commensurate with their age. 

(v) Two adequate doses of varicella vaccine.  

(vi) By entry to sixth grade or a comparable age level grade equivalent, any child 11 years of age or older must have received one dose of a booster immunization containing tetanus and diphtheria toxoids and acellular pertussis vaccine. 

(vii) For meningococcal vaccination, beginning on and after September 1, 2016, children shall be assessed upon entry or attendance to seventh grade, or a comparable age level grade equivalent, and must have received one adequate dose of vaccine upon such entry or attendance. Children shall be assessed upon entry or attendance to twelfth grade, or a comparable age level grade, and must have received two adequate doses of meningococcal vaccine upon such entry or attendance. If, however, the first dose of meningococcal vaccine was given at 16 years of age or older, then only one adequate dose of meningococcal vaccine is required for twelfth grade.

(2) If a child is not fully immunized, catch-up immunization must then take place according to the Advisory Committee on Immunization Practices Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger.

(g) Immunity means that:

(1) for measles, mumps, and rubella, a child has had a positive serologic test, as defined in subdivision (h) of this section, for those diseases, or laboratory confirmation of disease, as defined in subdivision (k) of this section;

(2) for varicella, a child has either had a positive serologic test, as defined in subdivision (h) of this section; laboratory confirmation of disease, as defined in subdivision (k) of this section; or had the disease as verified by a physician, nurse practitioner, or physician's assistant statement;

(3) for hepatitis B, a child has had a positive serologic test, as defined in subdivision (h) of this section; or

(4) for poliomyelitis, positive serologic tests, as defined in subdivision (h) of this section, for all three serotypes of poliomyelitis, performed prior to September 1, 2019. Serologic tests against poliomyelitis performed on or after September 1, 2019 will not be accepted in place of poliomyelitis vaccination.

(h) Serologic test means a blood test for Immunoglobulin G (IgG), or for hepatitis B, a blood test for hepatitis B surface antibody, as determined by the testing lab's criteria. Serology results reported as equivocal are not acceptable proof of immunity. A positive serologic test can be accepted in place of vaccination only for the following diseases: measles, mumps, rubella, varicella, and hepatitis B and all three serotypes of poliomyelitis found in the polio vaccines.

(i) Age appropriate means that vaccine doses administered within four calendar days of the recommended minimum age or interval will be considered valid.

(j) In process means that:

(1) a child has received at least the first dose in each immunization series required by section 2164 of the Public Health Law (except in the case of live vaccines in which a child should wait 28 days after one live vaccine administration before receiving another live vaccine, if the vaccines were not given on the same day) and has age appropriate appointments to complete the immunization series according to the Advisory Committee on Immunization Practices Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger; or

(2) a child has had blood drawn for a serologic test and is awaiting test results within 14 days after the blood draw; or

(3) a child's serologic test(s) are negative, and therefore the child in question has appointments to be immunized within 30 days of notification of the parent/guardian to complete, or begin completion, of the immunization series based on the Advisory Committee on Immunization Practices Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger.

(4) Children who are not fully immunized can only continue to attend school if they are in the process of completing the immunization series based on the Advisory Committee on Immunization Practices Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger. If a child does not receive subsequent doses of vaccine in an immunization series according to the age appropriate ACIP catch-up schedule, including at appropriate intervals, the child is no longer in process and must be excluded from school within 14 days after the minimum interval identified by the ACIP catch-up schedule, if not otherwise exempt in accordance with section 66-1.3 of this Subpart.

(k) Laboratory confirmation of disease means, for measles, mumps, rubella or varicella, a positive laboratory test, either culture or polymerase chain reaction, detecting either the virus or viral-specific nucleic acid in a clinical specimen from the child or, for measles or rubella, a positive blood test for Immunoglobulin M (IgM) where such positive laboratory test is not otherwise explained by recent vaccination.

(l) May be detrimental to the child’s health means that a physician has determined that a child has a medical contraindication or precaution to a specific immunization consistent with ACIP guidance or other nationally recognized evidence-based standard of care.

(m) Attend or admit means enrolled in, or admitted to, a school for the purpose of participating in or receiving services at such school, including but not limited to special education or related services, participating in intra-scholastic or interscholastic sports, or other school-sponsored events or activities; or being transported on a school bus or vehicle with other school children; except where such services, transportation, events, or activities are open to the general public.

 

Effective Date: 
Tuesday, December 31, 2019
Doc Status: 
Complete
Statutory Authority: 
Public Health Law Sections 2164 and 2168

Section 66-1.2 - Statewide Immunization Information System

66-1.2 Statewide Immunization Information System

(a) Definitions

(1) Statewide immunization information system shall mean the statewide (except New York City) computerized database of immunizations developed and maintained by the New York State Department of Health, known as the New York State Immunization Information System ("NYSIIS" or "system").

(2) Citywide Immunization Registry (CIR) shall mean the immunization information system maintained by the New York City Department of Health and Mental Hygiene, capable of collecting, storing and disclosing the electronic and paper records of vaccinations administered to persons less than 19 years of age and those persons 19 and older with consent in accordance with the New York City Health Code. For the purposes of this definition the term New York City Department of Health and Mental Hygiene shall mean such agency or any successor agency responsible for the CIR.

(3) Health care provider for the purposes of this section shall mean any person authorized by law to order an immunization or any health care facility licensed under Article 28 of the Public Health Law or any certified home health agency established under Section 3606 of the Public Health Law.

(4) Designees shall mean individuals, acting under the authority of a health care provider or another category of authorized user, who have been specifically delegated responsibility to access NYSIIS or the CIR and perform the functions permitted the primary authorized user.

(5) Emancipated minors shall mean those children less than 18 years of age who by virtue of a court decision declaring them emancipated, or who because they are otherwise emancipated under the law, are able to make their own decisions regarding health care services.

(6) Registrants shall mean all indivduals for whom an immunization or exemption to immunization or blood lead analysis is recorded in the system, at any time following January 1, 2008 for NYSIIS and January 1, 1994 for the CIR. Registrants also include individuals born in New York State (outside of New York City) on or after January 1, 2004 for NYSIIS or born in New York City on or after January 1, 1996 for the CIR.

(7) School, for the purposes of this section, shall mean any agency or entity required by law or regulation to verify immunization status for participants prior to or at selected times during enrollment, including licensed day care facilities. Such verification is an authorized delegation of public health authority for the purposes of fulfilling this public health mandate related to verification of immunization status.

(8) Authorized users of NYSIIS and the CIR shall mean the following categories of users, who are permitted access only to records of registrants falling within their administrative or clinical responsibilities. An authorized user in a category below may designate the ability to access the system to others where indicated.

(i) health care providers who order an immunization, and their designees, including Regional Health Information Organizations or other Health Information Technology entities as defined in subparagraph 2 of subdivision h of Section 504.9 of Title 18 of the New York Codes Rules and Regulations;

(ii) local health districts;

(iii) Commissioners of local social services districts and their designees;

(iv) the Commissioner of the Office of Children and Family Services and his/her designees;

(v) schools;

(vi) Third party payers;

(vii) WIC programs;

(viii) Colleges;

(ix) Professional and technical schools;

(x) Children’s overnight camps and summer day camps;

(xi) registered professional nurses; and

(xii) pharmacists authorized to administer immunizations pursuant to subdivision   two of section sixty-eight hundred one of the Education Law.

(b) Mandated Reporting

(1) Mandated reporters to NYSIIS and the CIR include any health care provider, as defined in section 66-1.2 who administers an immunization or conducts a blood lead analysis of a sample.

(2) Mandated reporters must report any immunization to a child less than 19 years of age to either NYSIIS or the CIR, depending on the location of administration of the vaccine.

(3) Article 28 facilities or certified home health agencies established under section 3606 of the Public Health Law in which providers are responsible for administration of vaccines may, when agreed to by the facility and the provider ordering the vaccination, assume reporting responsibility for the authorized individuals administering vaccines within their facilities.

(4) A person who administers but does not order immunizations is not responsible for reporting the immunizations to the system, unless acting as a designee of the health care provider who ordered the immunization and under whose supervision the vaccine was administered. The ordering health care provider remains responsible for supervising his/her designee and ensuring that appropriate and timely reporting occurs.

(5) When vaccines are administered based on non-patient specific orders, the health care provider ordering the immunizations shall ensure that required data elements for each vaccination are submitted to NYSIIS or the CIR, depending on the location of administration of the vaccine.

(c) Information required to be reported, methods of reporting, exceptions and timeliness of reporting

(1) Information required to be reported to NYSIIS or the CIR, to the extent available to the provider shall include: the patient's name (first, middle and last); date of birth; gender; race; ethnicity; address, including zip code; telephone numbers; birth order (if multiple birth); birth state/country; mother's maiden name; mother's or other responsible party's name (first, middle and last); Vaccines for Children program eligibility; Medicaid number; and vaccine administration date, type, lot number and manufacturer, except as noted in subdivision (3) below. A provider should report elements for any additional data fields in NYSIIS or the CIR when available.

(2) Methods of reporting. All data elements reported to the NYSIIS or the CIR must be submitted electronically except as provided in subdivision (3) below.

(i) Direct online entry of immunization information into NYSIIS. Authorized users with read/write access and their designees may submit information directly to the statewide system using their individual access accounts.

(ii) Health care providers with existing electronic information systems compatible with NYSIIS. Such providers may request, on an individual or group basis, permission to download information from current systems into a Department-prescribed file format for transfer directly to NYSIIS. The provider is responsible for the costs/programming needed to effect these data transfers, ensuring that transfers are completed on a timely basis and updating provider-specific data systems when changes are made to these systems.

(iii) Historical immunization information previously submitted to a regional registry. Health care providers who have submitted immunization records to one of the regional immunization registries (Healthy Shot or Immunization Registry and Information Source ("IRIS") may authorize submission of this regionally-archived immunization history information to the statewide system.

(iv) Submission of immunization information to NYSIIS or the CIR. Providers must submit immunization information to NYSIIS or the CIR, dependent upon the IIS operating in the area in which they practice, not the IIS appropriate to the patient's area of residence. Exchange of information between IIS's will be the responsibility of NYSIIS and the CIR.

(3) Exceptions to reporting requirements to NYSIIS.

(i) Hospitals participating in the Statewide Perinatal Data System are exempted from entering immunization information directly into NYSIIS for newborns during their initial hospital stay. Information submitted through the Statewide Perinatal Data System will populate NYSIIS required information fields. Hospitals located in New York State, outside of New York City, are required to report to NYSIIS all other immunizations administered to children less than 19 years of age while under their care.

(ii) A provider may submit incomplete immunization electronic files or may manually enter incomplete immunization information into the statewide system in fulfillment of requirements for submission of historical immunization information. Required information for immunizations administered after January 1, 2008, which is missing shall be entered when it becomes available to the provider.

(4) Timeliness of Reporting. Providers ordering immunizations must submit immunization information to NYSIIS or the CIR within 14 days of administration of the immunization. Providers must also submit information regarding immunizations not previously reported for each registrant.

For NYSIIS only:

(i) Providers must submit any missing information requested by NYSIIS within 14 days of the issuance of the request.

(ii) For individuals exempt from administration of vaccines, providers must submit patient information, including the reason that such immunization may be detrimental to the child’s health, as defined in subdivision (l) of section 66-1.1 of this Subpart, to the statewide immunization information system within 14 days following the in-person clinical interaction that occurs at or after what would normally have been the due date for administration of an age-appropriate immunization to that child, according to current national immunization recommendations.

(d) Allowable access levels and permitted uses of NYSIIS and/or CIR data by authorized users specific to the organization they are representing.

(1) Allowable access levels.

(i) Read/write access. Only health care providers providing services to the registrant and State and local Department of Health staff may compile reports, read immunization information, enter immunization information and change immunization information, with limitations as specified below. Health care providers who have been granted a time-limited deferral on electronic data submission to NYSIIS may access the information by phone or via written request.

(ii) Read-only access. Authorized users not listed in subparagraph (i) of this paragraph such as schools are permitted read-only access to NYSIIS and/or the CIR. Read-only access allows the user to view records of only those children under their administrative responsibility and to compile reports based on data aggregated from those records.

(2) Permitted uses of NYSIIS or CIR data. All requests for use of NYSIIS information by an authorized user which are not included in the allowable uses for that person as noted in subparagraphs (i) - (x) of this paragraph are prohibited without the approval of the Commissioner of the State Department of Health; or, for requests for CIR information, without the approval of the Commissioner of the New York City Department of Health and Mental Hygiene or his or her designee. Approval is contingent on ongoing adherence to the terms and conditions of the user agreements. Allowable uses of the data for particular categories of users include:

(i) Health care providers or their designees may access NYSIIS or CIR data for the provision of care and treatment, either temporary or longer term, to a particular registrant. The information can be used either on a patient-specific basis or to generate reports specific to their practice to determine immunizations received by a specific groups of registrants, review of practice coverage, generation of reminder and recall notices, quality improvement, vaccine inventory and accountability inclusive of Vaccines for Children (VFC) Program inventory and accountability, vaccine ordering, VFC re-enrollment, and printing a copy of the immunization record for the registrant or the registrant's parent or guardian, as appropriate.

(a) If other child health status or test results information becomes available through NYSIIS or the CIR that may be useful in determining the course of treatment for the child, such information will be made available on an as-needed and authorized basis to health care providers.

(ii) Schools may access NYSIIS or CIR data for verifying immunization history for students entering or registered in that school or school system or may run school-specific reports that aggregate available data. Access will be limited to data for registrants enrolling or already enrolled in a particular school or school system.

(iii) Commissioners of local social services districts and their designees may access NYSIIS or CIR data with regard to children in their legal custody. Such information may be used for quality assurance and accountability by local social services districts.

(iv) The Commissioner of the Office of Children and Family Services and his/her designees may access NYSIIS or CIR data with regard to children in his/her legal custody. Such information may be used for ensuring appropriate care and treatment of children for whom the Office of Children and Family Services maintains custody and responsibility.

(v) Local health departments may access immunization data in NYSIIS and the CIR for purposes of outreach, quality improvement and vaccine accountability, epidemiological studies and disease control within their own county. Local health department staff may be granted access to immunization information in NYSIIS and the CIR for registrants whose immunizations were administered within their own county and for registrants residing in the county whose immunizations were administered outside of the county.

(vi) Third party payers may access NYSIIS or CIR data for the purpose of performing quality assurance, accountability and outreach relating to enrollees covered by their plan. Third party payers must request information from the appropriate registries.

(vii) The Commissioner of Health and the Commissioner of the New York City Department of Health and Mental Hygiene and their designated staffs will have full read/write access to their respective systems/registries in order to fulfill file maintenance and improvement functions and may use the data in both NYSIIS and the CIR for purposes of outreach, quality improvement and vaccine accountability, research, epidemiological studies and disease control.

(a) The Commissioner of Health or the Commissioner of the New York City Department of Health and Mental Hygiene or his or her designee may provide, on request, registrant-specific information to other state or city immunization systems and systems maintained by the Indian Health Service and tribal nations recognized by the state or the United States on a routine basis pursuant to a written agreement with each system requiring such system to conform to national standards for maintaining the integrity of the data, protecting the confidentiality of personal information and using the data only for purposes permitted in this section.

(b) The Commissioner of Health or the Commissioner of the New York City Department of Health and Mental Hygiene may provide registrant-specific information to federal health officials, state or city immunization systems and systems maintained by the Indian Health Service and tribal nations recognized by the state or the United States and others identified by the Commissioner of each respective immunization information system, for activities necessary to protect public health, in accordance with any written agreement required by such Commissioner.

(c) The Commissioner of Health or the Commissioner of the New York City Department of Health and Mental Hygiene may provide institutes of higher education, medical research centers or other institutions engaged in epidemiological research or other public health research access to de-identified registrant information in NYSIIS or the CIR for research purposes if approved by the Commissioner of Health or the Commissioner of the New York City Department of Health and Mental Hygiene, as appropriate.

(viii) WIC programs for the purposes of verifying immunization and lead testing status for those seeking or receiving services, as well as referral for immunizations or lead tests as needed.

(ix) Colleges may access NYSIIS or CIR data for verifying immunization history for students entering or registered in that college or college system or may run college-specific reports that aggregate available data. Access shall be limited to data for registrants enrolling or already enrolled in a particular college or college system.

(x) Professional and technical schools may access NYSIIS or CIR data for verifying immunization history for students entering or registered in that professional or technical school or may run college-specific reports that aggregate available data. Access shall be limited to data for registrants enrolling or already enrolled in a particular professional or technical school.

(xi) Children’s overnight camps and summer day camps may access NYSIIS or CIR data for verifying immunization history for children attending that overnight camp or summer day camp or may run camp-specific reports that aggregate available data. Access shall be limited to data for registrants attending a particular overnight or summer day camp.

(xii) Any parent or guardian of a registrant less than 18 years of age or the registrant himself/herself if 18 years or older or an emancipated minor, may receive a copy of an immunization record at no cost from their local health department, the CIR or NYSIIS.

(e) Methods of Accessing Immunization Data.

Each person seeking access to NYSIIS and/or the CIR must submit a completed application for access.

(f) Maintenance of Security and Confidentiality.

(1) Each person accessing the statewide system must have a distinct password and system ID that conform to industry standards, and with level and type of access tied to the type of user, as defined in subsection (d).

(2) Each person must understand and agree to adhere to the confidentiality protocol developed by the Department or the NYCDOHMH prior to either submitting or obtaining data from NYSIIS or the CIR.

(g) Provision of NYSIIS information to registrant's family/guardian.

(1) Mandated reporters to NYSIIS must provide the parent or legal guardian of each registrant with a copy of an informational brochure or letter from the Department at the time of each registrant's initial entry into the statewide system by that provider.

(2) If the parent/guardian speaks a primary language other than English, mandated reporters to NYSIIS must make every attempt to provide statewide system-related information comparable to the Department's brochure in the primary language of the parent or guardian.

Effective Date: 
Tuesday, December 31, 2019
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2168

Section 66-1.3 - Requirements for school admission

66-1.3 Requirements for school admission.

A principal or person in charge of a school shall not admit a child to school unless a person in parental relation to the child has furnished the school with one of the following:

(a) A certificate of immunization, as described in section 66-1.6 of this Subpart, from a health care practitioner or from NYSIIS or the CIR, documenting that the child has been fully immunized according to the requirements of section 66-1.1 (f) of this Subpart.

(b) Documentation that the child is in process of receiving immunizations as defined in section 66-1.1(j) of this Subpart. A principal or person in charge of a school shall not refuse to admit a child to school, based on immunization requirements, if that child is in process.

(c) A signed, completed medical exemption form approved by the NYSDOH or NYC Department of Education from a physician licensed to practice medicine in New York State certifying that immunization may be detrimental to the child's health, containing sufficient information to identify a medical contraindication to a specific immunization and specifying the length of time the immunization is medically contraindicated. The medical exemption must be reissued annually. The principal or person in charge of the school may require additional information supporting the exemption.

 

Effective Date: 
Tuesday, December 31, 2019
Doc Status: 
Complete
Statutory Authority: 
Public Health Law Sections 2164 and 2168

Section 66-1.4 - Requirements for continued school attendance

66-1.4 Requirements for continued school attendance. A principal or person in charge of a school shall not permit a child to continue to attend such a school for more than 14 days unless a person in parental relation to the child has furnished the school with one of the documents specified in section 66-1.3 of this Subpart. Such 14 calendar day period may be extended to not more than 30 calendar days for an individual student who is transferring from out-of-state or from another country and can show a good faith effort to get the necessary evidence of immunization.
 

Effective Date: 
Tuesday, July 1, 2014
Doc Status: 
Complete

Section 66-1.5 - Immunization records from previous school

66-1.5 Immunization records from previous school. An immunization record forwarded from the child's previous school, which contains all of the information specified in subdivision (a) of section 66-1.3 of this Subpart may be accepted by the principal or person in charge of the school in lieu of a certificate of immunization.
 

Effective Date: 
Wednesday, September 26, 1990
Doc Status: 
Complete

Section 66-1.6 - Certificate of immunization

Section 66-1.6 – Certificate of Immunization

66-1.6 The certificate of immunization required in section 66-1.3(a) of this Subpart shall be prepared and signed by a health practitioner licensed in New York State and shall specify the products administered and the dates of administration. It may also show physician, nurse practitioner, or physician assistant-verified history of varicella disease and/or positive serologic tests for measles, mumps, rubella, varicella, and/or Hepatitis B and/or laboratory confirmation of disease for measles, mumps, rubella and/or varicella. Certificates of immunization issued prior to September 1, 2019 may also show positive serologic tests for all 3 serotypes of poliomyelitis contained in the polio vaccines. A record issued by NYSIIS, the CIR, an official immunization registry from another state, an electronic health record, and/or an official record from a foreign nation may be accepted as a certificate of immunization without a health practitioner’s signature.

Effective Date: 
Tuesday, December 31, 2019
Doc Status: 
Complete
Statutory Authority: 
Public Health Law Sections 2164 and 2168

Section 66-1.7 - School Survey

Section 66-1.7 School Survey

66-1.7 Every school, shall annually provide the Commissioner of Health, or in the city of New York the New York City Commissioner of Health, by a date determined by the applicable Commissioner, a summary regarding compliance with the provisions of this section. For all schools, excluding public schools within New York City, the summary will be provided in the form of the yearly school survey conducted by the Department of Health.

Effective Date: 
Tuesday, July 1, 2014
Doc Status: 
Complete

Section 66-1.8 - Immunization for children excluded from school

66-1.8 Immunization for children excluded from school. Whenever a child has been refused admission to, or continued attendance at, a school for lack of acceptable evidence of immunization, immunity or exemption as specified in section 66-1.3 of this Subpart, the principal, teacher, owner or person in charge of the school shall:

(a) notify the person in parental relation to the child of his/her responsibility to have the child immunized and of the public resources available for doing so;

(b) notify the local health authority of the name and address of the excluded child and of the immunization or immunizations which the child lacks; and

(c) provide, with the cooperation of the local health authority, for a time and place at which the required immunization or immunizations may be administered.
 

Effective Date: 
Tuesday, July 1, 2014
Doc Status: 
Complete

Section 66-1.9 - Obligation of local health authority

66-1.9 Obligation of local health authority. Upon being notified by a principal or person in charge of a school of the exclusion from school of one or more children for lack of acceptable evidence of immunization, it shall be the responsibility of the local health authority to either:

(a) cooperate with the school authorities to provide a time and place, within two weeks of the exclusion, at which the appropriate immunization or immunizations may be administered, by a health practitioner as defined in section 66-1.1(e); or

(b) notify the commissioner that the required immunizations will not be administered either by local health authority or school, and that the cost of doing so by the agents of the commissioner may be recovered from the amount of State aid to which the local health authority would otherwise be entitled.
 

Effective Date: 
Tuesday, July 1, 2014
Doc Status: 
Complete

Section 66-1.10 - Exclusion in event of disease outbreak

66-1.10 Exclusion in event of disease outbreak.

(a) For those diseases listed in PHL section 2164 only, in the event of an outbreak, as defined in section 2.2(d) of this Title, of a vaccine-preventable disease in a school, the commissioner, or his or her designee, or in the City of New York, the Commissioner of Health of the New York City Department of Health and Mental Hygiene, may order the appropriate school officials to exclude from attendance all students who either have been exempted from immunization under section 66-1.3(c) of this Subpart, or are in the process of receiving required immunizations pursuant to section 66-1.3(b) of this Subpart.

(b) The exclusion shall continue until the commissioner or his or her designee, or in the City of New York, the Commissioner of Health of the New York City Department of Health and Mental Hygiene, determines that the danger of transmission has passed.

(c) Schools must maintain a list of susceptible students who should be excluded from attendance in the event of an outbreak of vaccine preventable disease. This list must include all students who have been excused from immunization under section 66-1.3(c) of this Subpart and students who are in the process of completing immunization series or awaiting the results of serologic testing for any vaccine preventable disease specified under section 66-1.3(b) of this Subpart. The list shall be updated each time a new student enrolls in the school or a student's immunization status changes.
 

Effective Date: 
Tuesday, December 31, 2019
Doc Status: 
Complete
Statutory Authority: 
Public Health Law Sections 2164 and 2168

SubPart 66-2 - Immunization against measles, mumps and rubella for post secondary students

Effective Date: 
Wednesday, September 26, 1990
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 2165

Section 66-2.1 - Definitions

Section 66-2.1 Definitions.

(a) "Institution" means a college, university or other institution for higher education authorized to confer degrees.

(b) "Student" means any person born on or after January 1, 1957, who is registered to attend or attends classes at an institution whether full-time or part-time. "Part-time student" means a student enrolled for at least six, but less than twelve semester hours, or the equivalent, per semester or at least four but less than eight semester hours per quarter in an approved degree or registered certificate program in a degree- granting institution. "Full-time student" means a student enrolled for twelve or more semester hours, or the equivalent, per semester or eight or more semester hours per quarter.

(c) "Immunization" means an adequate dose or doses of an immunizing agent against measles, mumps and rubella which meets standards approved by the United States public health service for such biological products and which is approved by the state department of health under such conditions as may be specified by the public health council.

(d) "Health Practitioner" means any person authorized by law to administer an immunization.

(e) "Attendance" means the physical presence of the student at the institution and shall begin on the first scheduled day of classes for a student each semester.

(f) "School" means a public, private or parochial elementary, intermediate or secondary school building.

(g) "Certificate of Immunization" means that document, prepared by the health practitioner who administers an immunization, which specifies the products administered and the dates of administration (See Public Health Law 2165(5).) It may also show physician-verified history of disease and/or laboratory evidence of immunity. "Certificate of Immunization" shall also mean an immunization record submitted by the institution or school which the student previously attended, which specifies the products administered and the dates of administration and whose source was a certificate of immunization from a health practitioner.
 

Effective Date: 
Wednesday, September 23, 1992
Doc Status: 
Complete

Section 66-2.2 - Requirements for attendance at an institution

66-2.2 Requirements for attendance at an institution.

(a) No institution shall permit any student to attend such institution unless the student has furnished to the institution the documentation in subdivision (b), (c), (d), or (e).

(b) A certificate of immunization that shows the student has:

(1) either:

(i) received two doses of live measles virus vaccine, the first dose administered after the age of 12 months and the second dose administered more than 30 days after the first dose but after 15 months of age; or

(ii) been diagnosed by a physician as having had measles disease; or

(iii) demonstrated serological evidence of measles antibodies; or

(iv) if the student is unable to provide a certificate of immunization that satisfies the requirements in (i), (ii) or (iii) above, documentation that proves the student attended primary or secondary school in the United States after 1980 will be sufficient proof that the student received one dose of live measles virus vaccine. If such documentation is provided, then the student must also provide a certificate of immunization that documents a dose of measles vaccine was administered within one year prior to attendance at the post-secondary institution; and

(2) either:

(i) received a single dose of live rubella virus vaccine administered after the age of 12 months; or

(ii) demonstrated serological evidence of rubella antibodies; and

(3) either:

(i) received a single dose of live mumps virus vaccine administered after the age of 12 months; or

(ii) been diagnosed by a physician as having had mumps disease; or

(iii) demonstrated serological evidence of mumps antibodies;

(c) A certificate of immunization that shows the student is in the process of completing the requirements of subdivision (b) and:

(1) has received at least one dose of live measles virus vaccine as required in subdivision (b); and

(2) has complied with the requirements in subdivision (b) for mumps and rubella; and

(3) has an appointment to return to a health practitioner for the remainder of the immunizations specified in subdivision (b), if this appointment is scheduled no more than 90 days since administration of the first dose of measles virus vaccine.

(d) If any licensed physician, licensed midwife (caring for a pregnant student), or nurse practitioner certifies in writing that one or more of the required immunizations may be detrimental to the student's health or is otherwise medically contraindicated, the requirements of subdivisions (b) and (c) shall be waived until such immunization is determined no longer to be detrimental to the student's health or otherwise medically contraindicated. This statement must specify those immunizations which may be detrimental and the length of time they may be detrimental.

(e) A written and signed statement from the student or in the event that the student is a minor, from their parent or guardian, that they hold sincere and genuine religious beliefs which prohibit immunization of the student. When a religious exemption is claimed, the institution may require supporting documents.
 

Doc Status: 
Complete

Section 66-2.3 - Time requirements for compliance

66-2.3 Time requirements for compliance. No institution shall permit any student to attend such institution in excess of thirty days without complying with section 66-2.2, except that for a student from out of state or another country who can show a good faith effort to comply with section 66-2.2 may attend the institution for 45 days. Prior to August 1, 1991, the applicable thirty and forty-five day periods shall be extended to sixty and ninety days, respectively.
 

Effective Date: 
Wednesday, September 26, 1990
Doc Status: 
Complete

Section 66-2.4 - Immunization for students not in compliance

66-2.4 Immunization for students not in compliance. In the event that a student registers at an institution and has not provided the documentation listed in section 66-2.2 (b) or (c) the institution shall:

(a) notify the student of the necessity to be immunized, and that such immunizations may be administered by a health practitioner or public health officer in the county where the student resides or in which the institution is located; and

(b) notify the student that immunization is required for attendance at the institution unless the student provides valid reason for lack of immunization due to medical or religious exemption according to section 66-2.2 (d) or (e).
 

Effective Date: 
Wednesday, September 26, 1990
Doc Status: 
Complete

Section 66-2.5 - Obligation of local health officer

66-2.5 Obligation of local health officer. If any student is unable to pay for the services of a private health practitioner, such student may present himself or herself to the health officer of the county in which such student resides, or the county in which the institution is located who shall then administer the immunization without charge.
 

Effective Date: 
Wednesday, September 26, 1990
Doc Status: 
Complete

Section 66-2.6 - Exclusion of susceptibles in the event of a disease outbreak

66-2.6 Exclusion of susceptibles in the event of a disease outbreak.

(a) In the event of an outbreak of measles, mumps or rubella in an institution, the commissioner may order the appropriate officials of the institution to exclude from attendance all students without documentation of immunity as specified in section 66-2.2 (b) or (c) and those who have been excused from immunization under section 66-2.2 (d) or (e).

(b) The exclusion shall continue until the commissioner determines that the danger of transmission has passed or until the documentation specified in section 66-2.2 (b) or (c) has been submitted.
 

Effective Date: 
Wednesday, September 26, 1990
Doc Status: 
Complete

Section 66-2.7 - Annual assessment of the immunization level of students attending the institution

66-2.7 Annual assessment of the immunization level of students attending the institution. The institution shall provide annually to the commissioner, on a form provided by the commissioner, a summary report of the immunization status of students attending the institution to whom this regulation applies. This report must be submitted by December 15 of each year.
 

Effective Date: 
Wednesday, September 26, 1990
Doc Status: 
Complete

Section 66-2.8 - Requirements for continued attendance

66-2.8 Requirements for continued attendance. Prior to August 1, 1991, this subpart shall not apply to part-time students. This Subpart shall also not apply to or any student who attended the institution he or she is attending prior to August 1, 1989.
 

Effective Date: 
Wednesday, September 26, 1990
Doc Status: 
Complete

Section 66-2.9 - Penalties

66-2.9 Penalties. A penalty for violation or failure to comply with any provision of this subpart may be assessed. (See Public Health Law Section 206.)

Effective Date: 
Wednesday, September 26, 1990
Doc Status: 
Complete

SubPart 66-3 - COVID-19 Emergency Regulations

Effective Date: 
Thursday, July 9, 2020
Statutory Authority: 
Public Health Law, Sections 201 & 206 and Executive Order 202.14

Section 66-3.1 - Duration and Applicability

66-3.1 Duration and Applicability

The provision of this Subpart shall apply for the duration of any state disaster emergency declared pursuance to sections 28 and 29-a of the Executive Law related to the outbreak of COVID-19 in New York State.  To the extent any provision of this Subpart becomes inconsistent with any Executive Order, the remainder of the provisions in this Subpart shall remain in effect and shall be interpreted to the maximum extent possible as consistent with such Executive Orders.

Effective Date: 
Thursday, July 9, 2020
Statutory Authority: 
Public Health Law, Sections 201 & 206 and Executive Order 202.14

Section 66-3.2 - Face-Coverings

Section 66-3.2 Face-Coverings

(a)  Any person who is over age two and able to medically tolerate a face-covering shall be required to cover their nose and mouth with a mask or face-covering when in a public place and unable to maintain, or when not maintaining, social distance. 

(b) Any paying passenger of a public or private transportation carrier or other for-hire vehicle, who is over age two and able to medically tolerate a face covering, shall wear a mask or face-covering over the nose and mouth during any such trip; any employee of such public or private transportation carrier who is operating such public or private transport, shall likewise wear a mask or face-covering which covers the nose and mouth while there are any paying passengers in such vehicle.

(c) Any employee who is present in the workplace shall be provided and shall wear a mask or face-covering when in direct contact with customers or members of the public, or when unable to maintain social distance. Businesses must provide, at their expense, such face coverings for their employees.

(d) Business operators and building owners, and those authorized on their behalf shall deny admittance to any person who fails to comply with this section and shall require or compel such persons’ removal. Provided, however, that this regulation shall be applied in a manner consistent with the federal American with Disabilities Act, New York State or New York City Human Rights Law, and any other applicable provision of law.

(e) For purposes of this section:

(i) Face-coverings shall include, but are not limited to, cloth masks (e.g. homemade sewn, quick cut, bandana), surgical masks, N-95 respirators, and face shields.

(ii) A person shall be considered as maintaining social distancing when keeping at least six feet distance between themselves and any other persons, other than members of such persons’ household.

Effective Date: 
Thursday, July 9, 2020
Statutory Authority: 
Public Health Law, Sections 201 & 206 and Executive Order 202.14

Section 66-3.3 - Non-essential gatherings

66-3.3 Non-essential gatherings

(a) There shall be no non-essential gatherings of greater than ten individuals for any reason at any location in the state, including but not limited to parties, celebrations or other social events. This restriction may be modified by any Executive Order issued pursuant to Executive Law Section 28 and 29-A implementing the phased re-opening of New York businesses and the relaxation of social distancing rules by region.

(b) No person, business, or other entity, shall encourage or promote any non-essential gathering on any public property including, but not limited to, streets, sidewalks, parking lots, parks, playgrounds, or beaches, that would violate subdivision (a) of this section.

(c) All non-essential gatherings that are permitted pursuant to this section shall comply with social distancing protocols and cleaning and disinfection guidelines issued by the Department.

(d) Subdivision (a) of this section shall not apply to any essential business, as defined by the New York State Department of Economic Development d/b/a Empire State Development (ESD), pursuant to the authority provided in Executive 202.6, or as further defined in this Subpart.

Effective Date: 
Thursday, July 9, 2020
Statutory Authority: 
Public Health Law, Sections 201 & 206 and Executive Order 202.14

Section 66-3.4 - Business operations

66-3.4 Business operations

(a) All businesses and not-for-profit entities in the state shall utilize, to the maximum extent possible, any telecommuting or work from home procedures that they can safely utilize. Except as may otherwise be permitted by any Executive Order issued pursuant to Executive Law Section 28 and 29-A implementing the phased re-opening of New York businesses and the relaxation of social distancing rules by region, each employer shall reduce the in-person workforce at any work locations by 100%, provided that any essential business or entity providing essential services or functions shall not be subject to such in-person restrictions. An entity providing essential services or functions whether to an essential business or a non-essential business shall not be subjected to the in-person work restriction, but may operate at the level necessary to provide such service or function.

(b) Any business not otherwise described herein may be deemed essential after requesting an opinion from the Empire State Development Corporation, which shall review and grant such request, should it determine that it is in the best interest of the state to have the workforce continue at full capacity in order to properly respond to this disaster.

(c) Essential businesses include, but are not limited to, the following: essential health care operations including but not limited to any entity or individual licensed, certified, registered or otherwise approved pursuant to Articles 5, 28, 30, 35, 36 or 40 of the Public Health Law, or Articles 131, 131-B, 131-C, 137, 139, 140, 153, 154, 163, 164 or 165 of the Education Law, and any other research or laboratory services; essential infrastructure including utilities, telecommunication, airports and transportation infrastructure, and hotels and places of accommodation; essential manufacturing, including food processing and pharmaceuticals; essential retail including grocery stores and pharmacies; essential services including trash collection, mail, and shipping services; news media;  banks and related financial institutions; providers of basic necessities to economically disadvantaged populations; construction; vendors of essential services necessary to maintain the safety, sanitation and essential operations of residences or other essential businesses; vendors that provide essential services or products, including logistics and technology support, child care and services needed to ensure the continuing operation of government agencies and provide for the health, safety and welfare of the public.

(d) Except as may otherwise be permitted by any Executive Order issued pursuant to Executive Law Section 28 and 29-A implementing the phased re-opening of New York businesses and the relaxation of social distancing rules by region, all restaurants and bars shall cease serving patrons food or beverages on premises, and shall only serve food or beverages for off-premises consumption which may include take-out or delivery services.

(e) Except as may otherwise be permitted by any Executive Order issued pursuant to Executive Law Section 28 and 29-A implementing the phased re-opening of New York businesses and the relaxation of social distancing rules by region, all indoor common portions of retail shopping malls with in excess of 100,000 square feet of retail space available for lease shall remain closed. Any stores located within such shopping malls, which have their own external entrances open to the public, separate from the general mall entrance, and which are essential businesses may remain open, provided that any restaurant shall limit itself to take out or delivery food services, and that any interior entrances to common areas of the mall remain closed and locked.

Effective Date: 
Thursday, July 9, 2020
Statutory Authority: 
Public Health Law, Sections 201 & 206 and Executive Order 202.14

Section 66-3.5 - Penalties

66-3.5 Penalties

A violation of any provision of this Subpart is subject to all civil and criminal penalties as provided for by law. Individuals who violate this Subpart are subject to a maximum fine of $1,000 for each violation. For purposes of civil penalties, each day that there is a non-essential gathering or that a business operates in a manner inconsistent with the Subpart shall constitute a separate violation under this Subpart.

Effective Date: 
Thursday, July 9, 2020
Statutory Authority: 
Public Health Law, Sections 201 & 206 and Executive Order 202.14

Part 67 - Lead Poisoning Prevention And Control

Effective Date: 
Tuesday, October 1, 2019
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Sections 206(1)(n), 1370-a and 1110; article 13, title X

SubPart 67-1 - Screening and follow-up

Effective Date: 
Tuesday, October 1, 2019
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, section 206 and Title X of Article 13

Section 67-1.1 - Definitions

Section 67-1.1 Definitions. The following definitions apply to this Part:

(a) "Anticipatory guidance" means providing parents or guardians of children under the age of six and pregnant women with information regarding the major causes of lead poisoning and means of preventing lead exposure. Such guidance shall be pertinent to the environment of the child or pregnant woman.

(b) "Certificate of lead screening" means documentation prepared by the health care provider who ordered the blood lead test for the child indicating the date the test was performed. (c) "Child" shall refer to an individual from birth to less than eighteen years, unless otherwise specified.

(d) "Confirmed blood lead level" means a blood lead concentration measured on venous blood.

(e) "Elevated blood lead level" means a blood lead concentration equal to or greater than 5 micrograms per deciliter of whole blood.

(f) "Environmental management" means environmental investigation and exposure assessment, sampling for lead, environmental testing and reporting, notice and demand of discontinuance of conditions conducive to lead poisoning, environmental intervention and abatement, and enforcement in accordance with Subpart 67-2.

(g) "Follow-up" means actions by local health units and health care providers which, depending on the blood lead level and exposure history of the child, shall include as appropriate: risk reduction education, follow-up testing, confirmatory testing, diagnostic evaluation, medical management, environmental management and case management, in accordance with generally accepted medical standards and public health guidelines.

(h) "Health care provider" means any health care practitioner who is authorized to order a blood lead test and any facility licensed pursuant to Article 28 of the Public Health Law.

(i) "Lead screening" means measuring lead concentration in whole blood to identify elevated blood lead levels.
 

Effective Date: 
Tuesday, October 1, 2019
Doc Status: 
Complete

Section 67-1.2 - Lead screening and follow-up of children by health care providers

67-1.2 Lead screening and follow-up of children by health care providers.

(a) Lead screening and follow-up of children by primary health care providers.

(1) At each routine well-child visit, or at least annually if a child has not had routine well-child visits, primary health care providers shall assess each child who is at least six months of age but under six years of age, for high dose lead exposure using a risk assessment tool based on currently accepted public health guidelines. Each child found to be at risk for high dose lead exposure shall be screened or referred for lead screening.

(2) Primary health care providers shall provide the parent or guardian of each child under six years of age anticipatory guidance on lead poisoning prevention as part of routine care.

(3) Primary health care providers shall screen or refer each child for blood lead screening, at or around one and two years of age, preferably as part of routine well child care.

(4) The Commissioner of Health may provide recommended alternative schedules for other high risk groups as deemed necessary.

(5) Results of blood lead analysis performed in a health care practitioner's office pursuant to Public Health Law Section 579(1) that is certified by the Centers for Medicare and Medicaid Services under regulations implementing the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) must be reported to the Commissioner of Health and to the local health officer in whose jurisdiction the subject of the test resides. Such results shall be reported within fourteen business days of the date of analysis and on such forms as prescribed by the Commissioner of Health. Such reports must include the subject's name, date of birth, race, gender, address, county of residence, type of sample (venous or fingerstick) and blood lead level; the health care practitioner ordering the test, facility identifiers, the date of sample collection, and the date of analysis.

(6) Each primary health care provider who screens a child for elevated blood lead levels shall explain the blood lead test results and provide documentation of lead screening to the parent or guardian of the child or other person authorized to consent for the medical care of the child.

(7) Primary health care providers shall provide or make reasonable efforts to ensure the provision of follow-up testing for each child with an elevated blood lead level in accordance with currently accepted medical standards and public health guidelines.

(8) Primary health care providers shall provide or make reasonable efforts to ensure the provision of risk reduction education and nutritional counseling for each child with an elevated blood lead level equal to or greater than 5 micrograms per deciliter of whole blood.

(9) Primary health care providers shall confirm blood lead levels equal to or greater then 5 micrograms per deciliter of whole blood obtained on a capillary specimen from a child using a venous blood sample.

(10) For each child who has a confirmed blood lead level equal to or greater than 5 micrograms per deciliter of whole blood, primary health care providers shall provide or make reasonable efforts to ensure the provision of a complete diagnostic evaluation; medical treatment, if necessary; and referral to the appropriate local or State health unit for environmental management. A complete diagnostic evaluation shall include at a minimum: a detailed lead exposure assessment, a nutritional assessment including iron status, and a developmental screening.

(11) Primary health care providers shall communicate and coordinate as appropriate with local health units to ensure that each child with an elevated blood lead level receives appropriate follow-up, as prescribed above in paragraphs (6) through (10) of this Section.

(b) Lead screening and follow-up of children by non-primary care providers.

(1) A health care provider that provides services to a child who is at least 6 months of age but under 6 years of age and who is not the child's ongoing primary care provider, such as a hospital inpatient facility, an emergency service if the child's condition permits, or other facility or practitioner which provides services to the child on a one-time or walk-in basis, shall inquire if the child has been appropriately assessed and screened for elevated blood lead levels in accordance with the schedule prescribed in paragraphs (1) and (3) of subdivision 67-1.2(a).

(2) If the child has not received such appropriate lead screening, the health care provider shall screen the child for elevated blood lead levels, or refer the child to the child's primary health care provider or, if the child's primary care provider is unavailable or the child has no primary health care provider, to another primary health care provider, or to the local health unit to obtain a blood lead test.

(3) If screening is performed, the blood lead test result shall be sent to the child's primary care provider or to the local health unit to enable appropriate follow-up in accordance with paragraphs (a)(6) through (11) of this section.
 

Effective Date: 
Tuesday, October 1, 2019
Doc Status: 
Complete

Section 67-1.3 - Laboratory testing and specimen collection

67-1.3 Laboratory testing and specimen collection.

(a) All blood lead tests shall be performed by (i) a clinical laboratory approved for toxicology-blood lead under Article 5, Title V of the Public Health Law; (ii) a health care practitioner's office pursuant to Public Health Law Section 579(1) that is certified by the Centers for Medicare and Medicaid Services under regulations implementing the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA); or (iii) an entity exempt from the requirements of Public Health Law Article 5, Title V pursuant to Section 579(3) of that Title, that holds a certificate of registration issued by the department and is authorized to conduct blood lead analyses.

(b) Venous blood is the preferred specimen for blood lead analysis and should be used for lead measurement whenever practicable.

(c) Fingerstick blood specimens are acceptable for lead screening if appropriate collection procedures are followed to minimize the risk of environmental lead contamination. Instructions regarding appropriate collection procedures for fingerstick specimens may be obtained from laboratories approved for toxicology-blood lead under Article 5, Title V of the Public Health Law.
 

Effective Date: 
Saturday, June 20, 2009
Doc Status: 
Complete

Section 67-1.4 - Lead screening status of children who enroll in preschool or child

67-1.4 Lead screening status of children who enroll in preschool or child care.

(a) Prior to or within three months of initial enrollment, each child care provider, public and private nursery school and preschool, licensed, certified or approved by any State or local agency shall obtain a written statement signed by a health care provider that documents lead screening for any child at least one year of age but under six years of age, and retain such documentation until one year after the child is no longer enrolled.

(b) When no documentation of lead screening exists, the child shall not be excluded from attending nursery school, preschool or childcare, however, the child care provider, principal, teacher, owner or person in charge of the nursery school or preschool shall provide the parent or guardian of the child with information on lead poisoning and lead poisoning prevention and refer the parent or guardian to the child's primary health care provider or, if the child's primary care provider is unavailable or the child has no primary health care provider, to another primary care provider or to the local health unit to obtain a blood lead test.

(c) Each child care provider, public and private nursery school and pre-school licensed, certified or approved by any State or local agency is exempt from the requirement to obtain, prior to or within three months of initial enrollment of children under six years of age, evidence that said children have been screened for elevated blood lead levels until April 1, 1994.
 

Effective Date: 
Saturday, June 20, 2009
Doc Status: 
Complete

Section 67-1.5 - Lead screening and follow-up of pregnant women by prenatal providers

Part 67-1.5 Lead screening and follow-up of pregnant women by prenatal care providers.

(a) Prenatal health care providers shall provide each pregnant woman anticipatory guidance on lead poisoning prevention during pregnancy, and shall assess each pregnant woman at the initial prenatal visit for high dose lead exposure using a risk assessment tool. A risk assessment tool shall be recommended by the State Commissioner of Health.

(b) Prenatal health care providers shall screen or refer for blood lead screening each pregnant woman found to be at risk for current high dose lead exposure.

(c) Prenatal health care providers shall provide each pregnant women, who has a confirmed blood lead level equal to or greater than 10 micrograms per deciliter of whole blood, risk reduction counselling in accordance with guidelines recommended by the State Commissioner of Health.

(d) Prenatal care providers shall refer each pregnant woman, who has a confirmed blood lead level equal to or greater than 10 micrograms per deciliter of whole blood and who may have been occupationally exposed to lead, to an occupational health clinic for individual guidance.

(e) Prenatal care providers shall provide anticipatory guidance to each woman at her postpartum visit on the prevention of childhood lead poisoning.
 

Effective Date: 
Wednesday, December 22, 1993
Doc Status: 
Complete

Section 67-1.6 - Role of local health units.

67-1.6 Role of local health units.

(a) Local health units shall provide public and professional education and community outreach on lead poisoning prevention.

(b) Local health units shall provide blood lead screening or arrange for blood lead screening for each child who requires screening as provided in section 67-1.4 of this Subpart and whose parent or guardian is unable to obtain a lead test for their child because the child is uninsured or the child's insurance does not cover lead screening.

(c) Local health units shall establish a sliding fee schedule for blood lead screening of children from families with incomes in excess of 200% of the federal poverty level, pursuant to Section 606 of the Public Health Law, and shall collect fees for blood lead testing from third party payors, when available.

(d) Local health units shall provide environmental management as required under this Part.

(e) Local health units shall provide data to identify exposure patterns and high risk populations for strategic planning for lead poisoning prevention at the State and local level.

(f) Local health units shall institute measures to identify and track children with elevated blood lead levels to assure appropriate follow-up.

(g) Local health units who serve as a child's primary health care provider shall carry out activities in accordance with paragraphs (1) through (9) of section 67-1.2(a).
 

Effective Date: 
Wednesday, December 22, 1993
Doc Status: 
Complete

SubPart 67-2 - Environmental Assessment and Abatement

Effective Date: 
Wednesday, January 4, 1995
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Section 206(1)(n) and 1370-a

Section 67-2.1 - Purpose

Section 67-2.1 Purpose. The purpose of this regulation is to define requirements for the assessment and abatement of conditions conducive to lead poisoning.
 

Effective Date: 
Wednesday, January 4, 1995
Doc Status: 
Complete

Section 67-2.2 - Definitions

67-2.2 Definitions. As used in this Subpart, the following words and terms shall have the stated meaning:

(a) Abatement includes all actions necessary to discontinue a condition conducive to lead poisoning and may include encapsulation, replacement, enclosure, or removal.

(b) Accessible mouthable surfaces are those surfaces located within five feet of the floor or ground that form a protruding corner or similar edge, or protrude one-half inch or more from a flat wall surface, or are located so that a child may place his or her mouth on a protruding surface.

(c) Area of high risk means an area designated as such by the Commissioner or his designated representative and may consist of one or more dwellings in which a condition conducive to lead poisoning of children exists.

(d) Approved laboratory means the New York State Department of Health's Wadsworth Center for Laboratory and Research or a laboratory certified by the New York State Department of Health pursuant to the department's Environmental Laboratory Approval Program.

(e) Child care facilities means any facility licensed by the State Department of Social Services to offer or provide day care services or child care and any public or private schools attended by children six years of age or younger.

(f) Commissioner means the State Commissioner of Health.

(g) Condition conducive to lead poisoning means: (i) the presence of lead paint or other similar surface coating on any accessible mouthable surface or any other surface in a condition accessible for ingestion or inhalation, where peeling, cracking, blistering, flaking, chipping or powdering of such paint or similar surface coating material occurs or is likely to occur; and/or (ii) the presence of other environmental conditions which may result in significant lead exposure.

(h) Designated representative means the health commissioner or health officer of a city of 50,000 population or over, or the health commissioner or health officer of a county or part-county health district, the state regional health director or district director having jurisdiction, or any county health director having all the powers and duties prescribed in section 352 of the Public Health Law, or any individual so designated by the Commissioner pursuant to section 206(8) of the Public Health Law.

(i) Dwelling means all buildings or structures or portions thereof that are on or appurtenant to a property, which is occupied in whole or in part as the home, residence or sleeping place, of one or more human beings, including child care facilities for children under six years of age, kindergartens and nursery schools.

(j) Encapsulation means a method of abatement that makes lead paint inaccessible by covering or sealing surfaces with durable coatings specifically formulated to be elastomeric, long-lasting, and resistant to cracking, peeling, algae and fungus. Paint is not an encapsulant.

(k) Enclosure means a method of abatement that involves covering of surfaces with durable rigid materials affixed to the surface and sealed or caulked to prevent lead paint or other lead-containing material from such surfaces from becoming accessible to children.

(l) High efficiency particulate air (HEPA) filter means a filter capable of filtering at least 99.97%, by weight, of particles 0.3 microns or greater in diameter from air passed through the filter.

(m) Lead paint means paint, plaster or other surface coating material containing more than one-half of one percent of metallic lead based on the total weight of the contained solids or dried film of the paint or plaster or other similar surface coating material.

(n) Removal means a method of abatement that results in the dislocation, stripping or scraping of paint or plaster or other coating material from a surface.

(o) Replacement means a method of abatement that involves removing components such as doors, windows and trim that contain lead paint and installing new or deleaded components.

(p) Risk reduction efforts mean any temporary action designed to reduce a child's exposure to lead and may include, but are not limited to: encapsulation, temporary relocation, clean-up of paint chips and dust and on-going maintenance of intact paint.

(q) X-ray fluorescence (XRF) analyzer means any instrument which measures lead concentrations in milligrams per square centimeter by measuring emission of X-ray photons activated by a radioactive source within the instrument.

(r) ug/dL means micrograms per deciliter.

Effective Date: 
Wednesday, January 4, 1995
Doc Status: 
Complete

Section 67-2.3 - Environmental Investigation

67-2.3 Environmental Investigation. Whenever an area of high risk is designated or when a child has been referred for environmental management in accordance with Subpart 67-1.2(a)(9), the Commissioner or his designated representative shall coordinate follow-up activities as defined in section 67-1.1(e) and (f) of this Part and required by section 67-1.6 of this Part. An assessment of conditions conducive to lead poisoning shall be performed and should include an environmental investigation of (1) any dwelling; (2) any child care facility; and (3) any other area where the child spends a significant amount of time.
 

Effective Date: 
Wednesday, January 4, 1995
Doc Status: 
Complete

Section 67-2.4 - Sampling for lead

67-2.4 Sampling for lead.

(a) Paint or other similar surface coating that is peeling, cracking, blistering, flaking, chipping or powdering or is on an accessible mouthable surface may be sampled for lead by the following methods:

(1) At least one gram of paint or other surface coating should be collected from each surface for approved laboratory analysis, or

(2) A portable X-ray fluorescence analyzer may be used to determine the presence of lead paint. In conducting sampling by X-ray fluorescence the following determinations shall apply:

(i) Where substrate correction readings are obtained, a mean reading of 1.6 milligrams of lead per square centimeter or greater shall be considered as satisfactory evidence of lead paint. A mean, substrate corrected reading of less than 1.6 milligrams of lead per square centimeter but more than 0.4 milligrams of lead per square centimeter shall be considered as inconclusive and in such case a sample, as described in section 67-2.4 (a)(1) of this Subpart may be obtained. A mean substrate corrected reading of less than 0.4 milligrams of lead per square centimeter shall be considered as negative for lead paint.

(ii) If substrate correction readings cannot be obtained, a mean, uncorrected reading of greater than 2.0 milligrams of lead per square centimeter shall be considered as satisfactory evidence of lead paint. A mean reading of 2.0 milligrams of lead per square centimeter or less shall be considered as inconclusive and in such case a sample, as described in section 67-2.4(a)(1) of this Subpart, may be obtained.

(b) Any samples of painted surfaces, paint, water, dust, soil, food, consumer products and other potential lead sources collected during an environmental investigation must be analyzed by an approved laboratory as specified by the Commissioner. The sample results may be used to evaluate possible sources of lead exposure.

Effective Date: 
Wednesday, January 4, 1995
Doc Status: 
Complete

Section 67-2.5 - Environmental testing and reporting

67-2.5 Environmental testing and reporting. An approved laboratory shall examine paint and any other environmental samples according to generally accepted scientific methods specified by the Commissioner and shall report the results of all lead analyses to the designated representative in whose jurisdiction the samples were collected.
 

Effective Date: 
Wednesday, January 4, 1995
Doc Status: 
Complete

Section 67-2.6 - Notice and demand

67-2.6 Notice and demand. Whenever the Commissioner or his designated representative determines that a condition conducive to lead poisoning exists in a dwelling, a written notice and demand for discontinuance of such may be issued in accordance with of section 1373(2) of the Public Health Law.

(a) No person shall commence lead paint abatement in any designated area of high risk prior to issuance of a written notice and demand. Risk reduction efforts may proceed prior to receipt of a notice and demand.

(b) Upon receipt of a notice and demand for discontinuance of conditions conducive to lead poisoning, the owner of a dwelling is required to abate such conditions. The extent of abatement and method(s) used shall be determined by the Commissioner or his designated representative, in accordance with applicable laws or rules and regulations.

(c) It shall be the responsibility of the owner of the dwelling to comply with all federal, state and local laws governing building construction, housing, worker health and safety, and disposal of lead-containing wastes. The owner of the dwelling must provide, upon request, to the Commissioner or his designated representative, such documentation as shall show that the owner has fully complied with these laws.

(d) Any vacancy or change in occupancy of the dwelling before abatement has been completed shall not relieve the owner of that dwelling from compliance with the notice and demand.
 

Effective Date: 
Wednesday, January 4, 1995
Doc Status: 
Complete

Section 67-2.7 - Environmental intervention and abatement

67-2.7 Environmental intervention and abatement. The Commissioner or his designated representative shall require in the notice and demand, where necessary, pre-abatement and clean up actions as specified in 67-2.7(a) and (b) and any one or more of the actions listed in 67-2.7(c) through (j) as part of an abatement of a dwelling:

(a) Pre-abatement actions: (1) furniture, rugs, carpets, bedding, drapes, dishware and food shall either be removed or covered with plastic sheets a minimum thickness of six mils and sealed; (2) room openings must be sealed with plastic sheets that have a minimum thickness of six mils and (3) floors or in place carpet must be covered with two sheets of plastic a minimum thickness of six mil thick, secured to the wall or baseboard with duct tape.

(b) Clean-up shall be performed daily and consist of misting debris with water and carefully sweeping and placing it in double four mil or six mil plastic bags, followed by wet dusting or wet mopping of all surfaces in the work area. Final clean-up shall be performed a minimum of 2 hours after completion of active abatement and shall include, but not be limited to, an HEPA filtered vacuuming of all interior surfaces, including window sills, followed by a wet mopping of all surfaces with a heavy duty household cleaning solution, followed by a second HEPA filtered vacuuming. In some instances the Commissioner or his designated representative may determine that an alternative wet vacuum system may be used in place of the HEPA filter.

(c) When necessary, relocation of occupants to temporary housing until the abatement work specified has been completed.

(d) Placarding of the dwelling with the statement that human habitation is prohibited until the Commissioner or his designated representative determines that the dwelling has been abated.

(e) Prohibition of the presence of children and pregnant women in part or all of a dwelling during abatement activities.

(f) Encapsulation of lead painted surfaces with materials approved as an encapsulant of lead paint by the United States Environmental Protection Agency or the United States Department of Housing and Urban Development, or the American Society for Testing and Materials or the Commissioner.

(1) After repair of water leaks caused by structured or plumbing deficiencies.

(2) In accordance with manufacturer's instructions.

(3) After the removal of any chipping, peeling or flaking paint in accordance with Section 2.7 (i) of this Subpart.

(g) Enclosure of lead-containing surfaces with durable materials applied as follows:

(1) After repair of water leaks caused by structural or plumbing deficiencies.

(2) With materials that are fire resistant which may include gypsum board, aluminum, vinyl, plywood paneling a minimum of 5/32 inch thick good (1) grade, Formica, acrylic sheets, fiberglass, durable carpet, tile, Plexiglas.

(3) After the removal of any chipping, peeling or flaking paint in accordance with section 2.7 (i) of this subpart.

(h) Replacement of building components with lead-free materials.

(i) Removal of lead-containing surface coating materials by one or more of the following methods after which a lead free surface coating material shall be applied to the surface:

(1) Wet wire brushing or hand scraping with or without the aid of a non-flammable solvent or wet abrasive compound.

(2) Machine sanding, using a sander equipped with a high efficiency particle air filter device, to feather edges and prepare surfaces for repainting or sealing.

(3) When used with appropriate respiratory protection, a heat gun, which produces a temperature not exceeding 1,100 degrees Fahrenheit, with hand scraping.

(4) Off-site paint removal.

(5) Other procedures acceptable to the Commissioner.

(j) Abatement of exterior surfaces by any of the methods described in section 67-2.7 (a-i) of this Subpart or by confined abrasive blasting using a wet-misting technique or simultaneous vacuuming system. In addition, plastic sheets, a minimum thickness of six mils, must be placed on the ground as close to the dwelling foundation as obstructions will allow a minimum of six feet for each story in height before blasting begins, and left in place until cleanup is complete. All seams must be sealed with tape and outer edges raised to trap liquid waste.

Effective Date: 
Wednesday, January 4, 1995
Doc Status: 
Complete

Section 67-2.8 - Enforcement

67-2.8 Enforcement. When an owner of a dwelling fails to comply with a written notice and demand for discontinuance of a condition conducive to lead poisoning, the procedures for enforcement, including formal hearings, receivership and cooperation and assistance from those public officers, departments and agencies of the State and its political subdivisions, as provided in sections 1373, 1374 and 1375 of the Public Health Law, shall be followed.
 

Effective Date: 
Wednesday, January 4, 1995
Doc Status: 
Complete

SubPart 67-3 - Reporting of blood lead levels

Effective Date: 
Tuesday, October 1, 2019
Doc Status: 
Complete

Section 67-3.1 - Laboratory reporting of blood lead levels for public health follow-up

Section 67-3.1 Laboratory reporting of blood lead levels for public health follow up.

(a) For purposes of this Subpart, laboratory shall mean: (i) any laboratory that holds a permit issued in accordance with Public Health Law Article 5, Title V and is authorized to conduct blood lead analyses; or (ii) an entity exempt from the requirements of Public Health Law Article 5, Title V pursuant to Section 579(3) of that Title, that holds a certificate of registration issued by the department and is authorized to conduct blood lead analyses.

(b) Laboratories shall report the results of all blood lead analyses performed on residents of New York State to the Commissioner of Health and to the local health officers in whose jurisdictions the subjects of the tests reside. If the laboratory reports electronically to the Commissioner of Health in accordance with subdivision (e) below, the Department of Health shall notify the appropriate local health officer of the test results and the laboratory shall be deemed to have satisfied the reporting requirements of this section.

(c) Whenever a laboratory refers a blood lead sample to another laboratory for analysis, the laboratories may agree on which laboratory will report in compliance with this Subpart, but both laboratories will be accountable to insure that a report is made.

(d) All laboratories shall report electronically to the Commissioner of Health each blood lead analysis conducted. The report must include the subject's name, date of birth, race, gender, address, county of residence, type of sample (venous or fingerstick) and blood lead level; the health care practitioner ordering the test, laboratory identifiers, the date the sample was collected and the date of analysis. Reporting pursuant to this subdivision shall be done using an electronic telecommunication system consistent with the technical specifications established by the Department.

(e) Any laboratory not permitted in accordance with Public Health Law Article 5, Title V to perform blood lead analyses which accepts a blood lead sample and refers the sample elsewhere for analysis shall transmit to the laboratory performing the analysis all of the information that is required by subdivision (d) above.

(f) Time limits for reporting and special notification requirements of blood lead levels in children.

(1) Laboratories shall report the results of all blood lead tests as specified in this Subpart within five business days of the date of analysis.

(2) In addition to any other reporting required by this Subpart, all laboratories shall notify the provider ordering the blood lead test of the results of any analysis in a child less than eighteen years of age which is equal to or greater than 45 mcg/dL (micrograms per deciliter) within 24 hours of the analysis.

(g) Nothing in this Subpart shall be construed to relieve any laboratory from reporting results of any blood lead analysis to the physician, or other health care provider that ordered the test or to any other entity as required by state, federal, or local statutes or regulations or in accordance with accepted standards of practice except that reporting in compliance with this Subpart shall satisfy the blood lead reporting requirements of Public Health Law Article 13, Title 10 and Part 22 of this Title.
 

Effective Date: 
Saturday, June 20, 2009
Doc Status: 
Complete

Section 67-3.2 - Reporting of elevated blood lead results by health care providers

67-3.2 Reporting of elevated blood lead results by health care providers.

(a) All health care providers shall assure that all of the information specified in section 67-3.1 above is completed for all blood lead analyses ordered by the health care provider and that this information accompanies the sample to the testing laboratory.

(b) All health care providers shall notify the health officer having jurisdiction of the occurrence of any blood lead level above 45 mcg/dL (micrograms per deciliter) in a child less than eighteen years of age within 24 hours of having been notified of this result by the testing laboratory.

(c) For the purposes of this Subpart, health care provider shall mean any health care practitioner who is authorized to order a blood lead test and any facility licensed pursuant to Article 28 of the Public Health Law.
 

Effective Date: 
Saturday, June 20, 2009
Doc Status: 
Complete

Section 67-3.3 - REPEALED

Effective Date: 
Tuesday, October 1, 2019
Doc Status: 
Complete

Subpart 67-4 Lead Testing in School Drinking Water

Effective Date: 
Wednesday, May 9, 2018
Statutory Authority: 
Public Health Law, Sections 206(1)(n), 1370-a and 1110; article 13, title X

Section 67-4.1 - Purpose

Section 67-4.1 Purpose.  

This Subpart requires all school districts and boards of cooperative educational services, including those already classified as a public water system under 10 NYCRR Subpart 5-1, to test potable water for lead contamination and to develop and implement a lead remediation plan, where applicable. 

Effective Date: 
Wednesday, May 9, 2018
Statutory Authority: 
Public Health Law, Sections 1370-a and 1110

Section 67-4.2 - Definitions

Section 67-4.2 Definitions.  

As used in this Subpart, the following terms shall have the stated meanings:  

(a) Action level means 15 micrograms per liter (µg/L) or parts per billion (ppb). Exceedance of the action level requires a response, as set forth in this Subpart. 

(b) Building means any structure, facility, addition, or wing of a school that may be occupied by children or students. The terms shall not include any structure, facility, addition, or wing of a school that is lead-free, as defined in section 1417 of the Federal Safe Drinking Water Act.  

(c) Commissioner means the State Commissioner of Health. 

(d) Department means the New York State Department of Health. 

(e) Outlet means a potable water fixture currently or potentially used for drinking or cooking purposes, including but not limited to a bubbler, drinking fountain, or faucets.  

(f) Potable water means water that meets the requirements of 10 NYCRR Subpart 5-1. 

(g) School means any school district or board of cooperative educational services (BOCES). 

Effective Date: 
Wednesday, May 9, 2018
Statutory Authority: 
Public Health Law, Sections 1370-a and 1110

Section 67-4.3 - Monitoring

Section 67-4.3 Monitoring.  

(a) All schools shall test potable water for lead contamination as required in this Subpart. 

(b) First-draw samples shall be collected from all outlets, as defined in this Subpart. A first-draw sample volume shall be 250 milliliters (mL), collected from a cold water outlet before any water is used. The water shall be motionless in the pipes for a minimum of 8 hours, but not more than 18 hours, before sample collection. First-draw samples shall be collected pursuant to such other specifications as the Department may determine appropriate. 

(c) Initial first-draw samples.  

(1) For existing buildings in service as of September 6, 2016, schools shall complete collection of initial first-draw samples according to the following schedule: 

(i) for any school serving children or students in any of the levels prekindergarten through grade five, collection of samples is to be completed by September 30, 2016;  

(ii) for any school serving children or students in any of the levels grades six through twelve that are not also serving children or students in any of the levels prekindergarten through grade five, and all other applicable buildings, collection of samples is to be completed by October 31, 2016. 

(2) For buildings put into service after September 6, 2016, initial first-draw samples shall be performed prior to occupancy; provided that if the building is put into service between the effective date of this regulation but before October 31, 2016, the school shall have 30 days to perform first-draw sampling. 

(3) Any first-draw sampling conducted consistent with this Subpart that occurred after January 1, 2015 shall satisfy the initial first-draw sampling requirement.  

(d) Continued monitoring. Schools shall collect first-draw samples in accordance with subdivision (b) of this section again in 2020 or at an earlier time as determined by the commissioner. Schools shall continue to collect first-draw samples at least every 5 years thereafter or at an earlier time as determined by the commissioner.  All such sampling shall be conducted according to procedures as determined by the commissioner.  

(e) All first-draw samples shall be analyzed by a laboratory approved to perform such analyses by the Department’s Environmental Laboratory Approval Program (ELAP). 

Effective Date: 
Wednesday, May 9, 2018
Statutory Authority: 
Public Health Law, Sections 1370-a and 1110

Section 67-4.4 - Response

Section 67-4.4 Response.  

If the lead concentration of water at an outlet exceeds the action level, the school shall: 

(a) prohibit use of the outlet until:  

(1) a lead remediation plan is implemented to mitigate the lead level of such outlet; and  

(2) test results indicate that the lead levels are at or below the action level; 

(b) provide building occupants with an adequate supply of potable water for drinking and cooking until remediation is performed;  

(c) report the test results to the local health department as soon as practicable, but no more than 1 business day after the school received the laboratory report; and 

(d) notify all staff and all persons in parental relation to children or students of the test results, in writing, as soon as practicable but no more than 10 business days after the school received the laboratory report; and, for results of tests performed prior to September 6, 2016, within 10 business days after September 6, 2016, unless such written notification has already occurred. 

Effective Date: 
Wednesday, May 9, 2018
Statutory Authority: 
Public Health Law, Sections 1370-a and 1110

Section 67-4.5 - Public Notification

Section 67-4.5 Public Notification. 

(a) List of lead-free buildings. By October 31, 2016, the school shall make available on its website a list of all buildings that are determined to be lead-free, as defined in section 1417 of the Federal Safe Drinking Water Act. 

(b) Public notification of testing results and remediation plans. 

(1) The school shall make available, on the school’s website, the results of all lead testing performed and lead remediation plans implemented pursuant to this Subpart, as soon as practicable, but no more than 6 weeks after the school received the laboratory reports.  

(2) For schools that received lead testing results and implemented lead remediation plans in a manner consistent with this Subpart, but prior to September 6, 2016, the school shall make available such information, on the school’s website, as soon as practicable, but no more than 6 weeks after September 6, 2016. 

Effective Date: 
Wednesday, May 9, 2018
Statutory Authority: 
Public Health Law, Sections 1370-a and 1110

Section 67-4.6 - Reporting

Section 67-4.6 Reporting.  

(a) As soon as practicable but no later than November 11, 2016, the school shall report to the Department, local health department, and State Education Department, through the Department’s designated statewide electronic reporting system: 

(1) completion of all required first-draw sampling;  

(2) for any outlets that were tested prior to September 6, 2016, and for which the school wishes to assert that such testing was in substantial compliance with this Subpart, an attestation that: 

(i) the school conducted testing that substantially complied with the testing requirements of this Subpart, consistent with guidance issued by the Department;  

(ii) any needed remediation, including re-testing, has been performed;  

(iii) the lead level in the potable water of the applicable building(s) is currently below the action level; and  

(iv) the school has submitted a waiver request to the local health department, in accordance with Section 67-4.8 of this Subpart; and 

(3) a list of all buildings that are determined to be lead-free, as defined in section 1417 of the Federal Safe Drinking Water Act. 

(b) As soon as practicable, but no more than 10 business days after the school received the laboratory reports, the school shall report data relating to test results to the Department, local health department, and State Education Department, through the Department’s designated statewide electronic reporting system. 

Effective Date: 
Wednesday, May 9, 2018
Statutory Authority: 
Public Health Law, Sections 1370-a and 1110

Section 67-4.7 - Recordkeeping

Section 67-4.7 Recordkeeping.  

The school shall retain all records of test results, lead remediation plans, determinations that a building is lead-free, and waiver requests, for ten years following the creation of such documentation. Copies of such documentation shall be immediately provided to the Department, local health department, or State Education Department, upon request. 

Effective Date: 
Wednesday, May 9, 2018
Statutory Authority: 
Public Health Law, Sections 1370-a and 1110

Section 67-4.8 - Waivers

Section 67-4.8 Waivers. 

(a) A school may apply to the local health department for a waiver from the testing requirements of this Subpart, for a specific school, building, or buildings, by demonstrating in a manner and pursuant to standards determined by the Department, that:  

(1) prior to the publication date of these regulations, the school conducted testing that substantially complied with the testing requirements of this Subpart;  

(2) any needed remediation, including re-testing, has been performed; and 

(3) the lead level in the potable water of the applicable building outlets are currently below the action level. 

(b) Local health departments shall review applications for waivers for compliance with the standards determined by the Department. If the local health department recommends approval of the waiver, the local health department shall send its recommendation to the Department, and the Department shall determine whether the waiver shall be issued. 

Effective Date: 
Wednesday, May 9, 2018
Statutory Authority: 
Public Health Law, Sections 1370-a and 1110

Section 67-4.9 - Enforcement

Section 67-4.9 Enforcement. 

(a) Upon reasonable notice to the school, an officer or employee of the Department or local health department may enter any building for the purposes of determining compliance with this Subpart.  

(b) Where a school does not comply with the requirements of this Subpart, the Department or local health department may take any action authorized by law, including but not limited to assessment of civil penalties as provided by law. 

Effective Date: 
Wednesday, May 9, 2018
Statutory Authority: 
Public Health Law, Sections 1370-a and 1110

Part 68 - Poison Control Network

Effective Date: 
Wednesday, January 18, 2012
Doc Status: 
Complete
Statutory Authority: 
Public Health Law, Secs. 2500-d, 2807-j, 2807-l

Section 68.1 - New York State poison control network

Section 68.1 New York State poison control network. The New York State poison control network shall consist of general hospitals that have been designated by the commissioner as regional poison control centers.

Doc Status: 
Complete

Section 68.2 - Selection of regional poison control centers

68.2 Selection of regional poison control centers.

(a) The commissioner shall review poison control activities at general hospitals in New York State and shall designate no more than one such facility in each health systems agency (HSA) region as a regional poison control center, based upon the following criteria:

(1) record of compliance with the rules and regulations of this Title and expected compliance with the poison control provisions of this Part;

(2) location within the geographical distribution of persons to be served;

(3) the need for expanded poison control services in the area to be served;

(4) the extent to which current activities performed by the facility relate to the provision of poison control services; and

(5) the capacity of the provider to deliver and coordinate poison prevention information and poison treatment services in the region.

(b) Hospitals wishing to be considered for such designation shall file a request to the commissioner in a format prescribed by the department.
 

Doc Status: 
Complete

Section 68.3 - Standards for operation of a regional poison control center

68.3 Standards for operation of a regional poison control center.

(a) Services provided. A regional poison control center shall receive or have a reasonable expectation of receiving not less than 4,000 poison control calls per year and shall perform the following functions:

(1) serve the population of the designated service area;

(2) provide expert information and consultation services to professional personnel in the region on the diagnosis, treatment and management of any suspected or actual poisoning(s);

(3) provide information, emergency care, and referral services to the general public;

(4) assure that tertiary referral treatment centers willing to accept poison patients are identified for the region;

(5) coordinate, develop and monitor poison prevention and medical management programs for medical professionals and the general public in the region;

(6) periodically report and/or conduct investigations of new toxic risks and injuries, as indicated; and

(7) collect uniform data and engage in research activity to enhance poison prevention and control management.

(b) Staffing. Regional poison control centers shall be staffed by a physician medical director, qualified poison information specialists, an administrator or administrative director, a health educator, and other personnel deemed necessary to operate the poison control center within the requirements of this Part. The following personnel standards and qualifications shall be met:

(1) The medical director shall have completed sufficient training to qualify for certification in a medical primary care specialty, have certification or appropriate experience in medical toxicology and have a medical staff appointment at the hospital designated as the poison control center.

(i) The medical director shall provide training to and supervision of poison information specialists; be responsible for medical decisions and treatment protocols; and provide direct patient care, telephone supervision, or case consultation to the hospitalized poison patient, either as the attending physician or as a consultant.

(ii) The medical director shall spend not less than 20 hours per work week in poison control center activities.

(2) Poison information specialists shall be qualified to read, understand and interpret standard poison information resources and transmit that information in a logical, concise and understandable way to both health care professionals and consumers and to communicate information from standardized poison center treatment protocols approved by the medical director.

(3) An administrator or administrative director shall be employed who is qualified by training and experience to supervise operations, finance, personnel, data collection and analysis and other administrative functions of the poison control center.

(4) A health educator shall be employed who is qualified by training and/or experience to conduct outreach and to develop and provide training for both professional and public groups and organizations in basic elements of poison prevention and treatment, especially to underserved populations of the region.

(c) Operations. (1) Poison control center services shall be available to both the general public and health professionals 24 hours per day, 365 days per year.

(2) The center shall be easily accessible by telephone at no charge to the public from all areas within the designated region. The availability of poison control information by telephone shall be widely publicized throughout the region to both the public and health care providers.

(4) The following services shall be available at the telephone answering site: (i) current toxicology information;

(ii) a comprehensive set of current texts covering both general and specific aspects of acute poisoning management;

(iii) primary information resources and access to a major medical library or information system;

(iv) poison control center specialty consultants available on an on-call basis; and

(v) a list of general hospitals in the region capable of delivering comprehensive care for poison victims and willing to accept such patients for care.

(5) The center shall develop and maintain written policies and protocols for responding to calls from the public and health professionals that provide consistent prehospital evaluation and treatment of toxic exposures. The center shall also develop operational guidelines prepared in conjunction with the medical director of the regional emergency medical system. These policies, protocols and guidelines shall be approved in writing by the medical director of the center and shall be available at the central telephone answering site.

(6) The center shall function as a source of comprehensive toxicology information and consultation to health professionals in the region, and shall report and/or conduct investigations of new toxic risks and injuries, as indicated. (d) Regional coordination of poison control activities. The designated regional poison control center shall function as the focal point for the coordination of all poison control activities in a region.

(1) All medical care treatment facilities in the region shall be evaluated by the center for participation in and contribution to the regional poison control treatment program. This information shall be available for the regional poison control center staff as a guide to the facilities' capabilities in managing the poison patient.

(2) One or more tertiary treatment centers for the management of pediatric, adolescent and adult poisoning victims shall be identified for the region. A formal relationship shall be established between such treatment centers and the regional poison control center for the treatment of poison victims and to improve management of the poisoned patient.

(3) Comprehensive analytical toxicology services from laboratories approved as required by law shall be identified and available within the region 24 hours a day, 365 days a year so that required emergency analysis can be performed within a time frame appropriate to the needs of patients. There shall be a written poison control center protocol describing the available tests and the process for submission of specimens and interpretation of results.

(4) The regional poison control center shall have a protocol for interacting with the transport service(s) and communication capability with the prehospital transport service(s) where this is available and needed for acute management of patients. Such services shall be available to all emergency patients.

(e) Health professional education, public education and public outreach programs. The regional poison control center shall provide the following educational services:

(1) instruction and programs in the prevention, care and management of poisonings for health care professionals involved directly in the regional treatment system, and to other professionals with an interest or involvement in care of poison patients; and

(2) public and professional outreach programs to promote or provide education on concepts related to poison prevention or control.

(f) Regional data collection system. Each regional program shall utilize a data collection system that includes recording of all inquiries and cases handled or admitted by the center. The center shall complete a record containing data elements prescribed by the commissioner for all poison-related calls or admissions. Such data elements shall include origin of call, type of call, substance involved, description of the victim, designation as an accidental or intentional incident, management and final disposition, and medical outcome, if any. The center shall assure the confidentiality of such data as required by section 405.25(a)(9) of this Title.

(g) Reporting and evaluation. (1) Regional poison control centers shall submit semiannually to the department a report which shall include, but not be limited to, a statement or regional program goals and specific objectives for each year and progress toward meeting the stated goals and objectives, and statistical data regarding the effectiveness of the regional poison prevention and control activities.

(2) Regional poison control centers shall submit to the department an annual report which shall include, but not be limited to the number and percentage of total calls received from each county, narrative information on program operations, the extent and type of targeted outreach and education to professional and public groups in the region, the relationship of center expenditures to program accomplishments, estimated cost savings, if any, evaluation of poison patient outcomes, and other overall findings and recommendations related to the program.

(3) The department shall conduct periodic onsite program reviews to determine whether each regional poison control center is in compliance with the standards set forth in this Part. A report summarizing the findings of each review shall be made available in writing to the center within 30 days of such review.

(i) If the review report identifies areas in which the center is out of compliance with the standards of this Part, the center shall submit to the commissioner, within 30 days of issuance of the report, a plan detailing steps to be taken for corrective action and a timetable for bringing the center into compliance with the applicable standards.

(ii) After receiving and accepting such a plan for corrective action, the department may conduct a follow-up onsite review to determine whether the plan has been implemented and whether the center has come into compliance with applicable standards.

(iii) Failure to submit an acceptable plan for corrective action shall constitute grounds for revocation of poison control center designation.

Doc Status: 
Complete

Section 68.4 - Revocation of designation as a regional poison control center

68.4 Revocation of designation as a regional poison control center.

(a) If a facility designated by the commissioner as a regional poison control center is determined by the department to be out of compliance with the standards set forth in this Part and such center remains out of compliance after follow-up review of any plan of correction approved by the department, the commissioner may revoke the designation of the facility as a regional poison control center.

(b) The facility shall be notified by the department in writing when revocation of the designation is proposed.

(c) Within 15 days of the receipt of the notice of proposed revocation, a facility wishing to contest the proposed revocation shall submit to the department written documentation demonstrating that the department's determination of noncompliance with standards is in fact erroneous or that extraordinary conditions have existed which have made compliance not feasible or not in the best interests of the population of the region.

(d) The facility shall be advised in writing of the department's decision on the proposed revocation. The facility may appeal a decision revoking its designation by submitting to the commissioner a written request for a hearing, within 15 days of receipt to the department's decision on the proposed revocation.

(e) If the commissioner does not receive a request for a hearing as provided herein, the facility shall be advised in writing that its designation is revoked.

(f) If the commissioner receives a written request for a hearing within the 15-day period established herein, a hearing shall be held in accordance with the provisions of Part 51 of this Title. Issues at the hearing shall be limited to the findings of the original onsite review, the center's plan for corrective action, if any, follow-up onsite reviews and any additional information pertinent to center compliance presented by either party to the action.
 

Doc Status: 
Complete

Section 68.5 - Reimbursement

68.5 Reimbursement.

(a) A hospital which has been designated as a regional poison control center shall submit an annual budget indicating the costs of operating such center and shall identify those costs associated with the provision of this service which are presently reflected in the hospital base year cost report. The hospital shall keep separate cost and statistical data related to the center for annual reporting under general hospital accounting and reporting provisions of this Title. Costs determined by the commissioner to be necessary and reasonable in order to comply with the requirements of this Part shall be reimbursable and shall be considered a specialized service eligible for a waiver of the maximum allowable payment for emergency services as authorized pursuant to the Public Health Law. Hospitals will be reimbursed based upon budget and cost data until the first full year of expenditures is experienced.

(b) Regional poison control centers requesting additional reimbursement for the operation of such centers shall submit rate appeals and supporting documentation in accordance with the provisions of Part 86 of this Chapter.

(c) The reasonable and necessary costs of the following items related directly to operation of the poison control center shall be considered by the commissioner to be reimbursable: personnel, computer and data services, telephone services, travel, printing and publication, audio-visual aids, outreach activities, plant and overhead, toxicology testing, supplies and equipment, contractual services.
 

Doc Status: 
Complete

Section 68.6 - Distributions from the Health Care Initiatives Pool for Poison Control Center Operations

68.6 Distributions from the Health Care Initiatives Pool for Poison Control Center Operations.

(a) The monies available for distribution from the Health Care Initiatives (HCI) Pool for poison control center operations shall be distributed on a semi-annual basis in accordance with the methodology below:

(1) Population density by county, as established by the latest available decennial census data for New York State (NYS) as determined by the U.S. Census Bureau, shall be the basis for allocating available HCI Pool monies for distribution to the regional poison control centers.

(2) Population density applicable to the total county geographic area served by each regional poison control center shall be determined and the center's percentage to total NYS population density shall be calculated.

(3) Available HCI Pool monies shall be distributed proportionally to each regional poison control center based on the center's percentage population density served to total NYS population density.

(b) The Commissioner shall consider only those applications for prospective revisions of the projected pool distributions which are in writing and are based on errors, whether mathematical or clerical, made by the department in the pool distribution calculation process. Applications made pursuant to this subdivision must be submitted within thirty days of receipt of notice of the projected pool distribution for the calendar year.

Effective Date: 
Wednesday, January 18, 2012
Doc Status: 
Complete