TITLE 25. HEALTH SERVICES

PART 1. DEPARTMENT OF STATE HEALTH SERVICES

CHAPTER 97. COMMUNICABLE DISEASES

SUBCHAPTER B. IMMUNIZATION REQUIREMENTS IN TEXAS ELEMENTARY AND SECONDARY SCHOOLS AND INSTITUTIONS OF HIGHER EDUCATION

The executive commissioner of the Texas Health and Human Services Commission (HHSC), on behalf of the Department of State Health Services (DSHS), proposes amendment to §97.62, concerning Exclusions from Compliance and §97.64, concerning Required Vaccinations and Exclusions for Students Enrolled in Health-related and Veterinary Courses in Institutions of Higher Education.

BACKGROUND AND PURPOSE

The purpose of the proposal is to comply with Health and Safety Code §161.0041, as amended by House Bill (H.B.) 1586, 89th Legislature, Regular Session, which requires DSHS to develop a blank affidavit form to be used by a person claiming an exemption from a required immunization and make the affidavit form available on the DSHS website. DSHS will post a blank affidavit form on the website for a person to download and submit to their child-care facility, school, or institution of higher education, including students enrolled in health-related and veterinary courses.

The current process requires individuals to request an affidavit form from DSHS, which DSHS must print on security-sealed paper and mail to the requesting individual.

Individuals will print these documents themselves (or request that DSHS send them a blank affidavit, which does not need to be printed on this special paper), and thus DSHS anticipates the volume of requests to decrease to the point we will not need contractors. DSHS also anticipates envelope, postage, and printing costs to decrease.

To comply with H.B. 1586 implementation guidelines beginning with the 2025-2026 school year, a proposal was published in the July 4, 2025, issue of the Texas Register (50 TexReg 3854). DSHS withdrew that rule proposal to ensure the language from H.B. 1586 and related statutes are properly reflected in the Texas Administrative Code. The notice providing that the proposal was withdrawn is published in the July 25, 2025, issue of the Texas Register (50 TexReg 4411). DSHS now proposes these amendments.

SECTION-BY-SECTION SUMMARY

The proposed amendment to §97.62 allows a person claiming exclusion for reasons of conscience, including a religious belief, from a required immunization to obtain an affidavit form by downloading it from the department's internet website or submitting the request to the department.

The proposed amendment to §97.64 adds new subsection (f) to allow exclusions from compliance for students in institutions of higher education, including students enrolled in health-related and veterinary courses, based on medical contraindications, reasons of conscience, including a religious belief, and active duty with the armed forces of the United States, as defined in §97.62.

The proposal also removes the requirement for the submitted request to include full name and date of birth of child or student. Submitting a request (via online, fax, mail or hand-delivery) will only require a mailing address and number of affidavit forms requested. Those downloading the affidavit will not need to submit any information.

H.B. 1586 changes begin with the 2025-2026 school year.

FISCAL NOTE

Christy Havel-Burton, CFO, has determined that for each year of the first five years that the rules will be in effect, there will be an estimated reduction in cost to state government as a result of enforcing and administering the rules as proposed. Enforcing or administering the rules does not have foreseeable implications relating to costs or revenues of state or local government.

The effect on state government for each year of the first five years the proposed rules are in effect is an estimated reduction in cost of $177,746 in fiscal year (FY) 2026, $177,746 in FY 2027, $177,746 in FY 2028, $177,746 in FY 2029, and $177,746 in FY 2030.

GOVERNMENT GROWTH IMPACT STATEMENT

DSHS has determined that during the first five years that the rules will be in effect:

(1) the proposed rules will not create or eliminate a government program;

(2) implementation of the proposed rules will not affect the number of DSHS employee positions;

(3) implementation of the proposed rules will result in no assumed change in future legislative appropriations;

(4) the proposed rules will not affect fees paid to DSHS;

(5) the proposed rules will not create a new regulation;

(6) the proposed rules will not expand, limit, or repeal existing regulation;

(7) the proposed rules will not change the number of individuals subject to the rules; and

(8) DSHS has insufficient information to determine the proposed rules' effect on the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Christy Havel-Burton has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities because there is no involvement with small business, micro-business or rural community impact to satisfy the rules.

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to these rules because the rules are necessary to protect the health, safety, and welfare of the residents of Texas and to implement legislation that does not specifically state that Section 2001.0045 applies to the rules.

PUBLIC BENEFIT AND COSTS

Joshua Hutchison, Deputy Commissioner, Infectious Disease Prevention Division, has determined that for each year of the first five years the rules are in effect, the public benefit will be allowing individuals to download and print blank affidavit forms so they can submit to their child-care facility, school, or institution of higher education, including students enrolled in health-related and veterinary courses.

Christy Havel-Burton has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules because the rules would eliminate the need to hire contractors for the summer months between June-September. There would also be a reduction in cost due to reduced need for mailing supplies, including envelopes, postage and security paper.

TAKINGS IMPACT ASSESSMENT

DSHS has determined that the proposal does not restrict or limit an owner's right to the owner's property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Written comments on the proposal, including information related to the cost, benefit, or effect of the proposed rule, as well as any applicable data, research, or analysis, may be submitted to Rules Coordination Office, P.O. Box 13247, Mail Code 4102, Austin, Texas 78711-3247, or street address 4601 West Guadalupe Street, Austin, Texas 78751; or emailed to HHSRulesCoordinationOffice@hhs.texas.gov.

To be considered, comments must be submitted no later than 14 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rule 25R041" in the subject line.

STATUTORY AUTHORITY

The amendments are authorized by Texas Health and Safety Code §161.004 and §161.0041, which authorize the executive commissioner to adopt rules necessary to administer statewide immunization of children and exceptions; and Texas Government Code §524.0151 and Texas Health and Safety Code §1001.075, which authorize the executive commissioner of HHSC to adopt rules for the operation and provision of health and human services by DSHS and for the administration of Texas Health and Safety Code Chapter 1001.

These amendments affect Texas Health and Safety Code §161.0041 and Chapter 1001, and Texas Government Code §524.0151.

§ 97.62. Exclusions from Compliance.

Exclusions from compliance are allowable on an individual basis for medical contraindications, reasons of conscience, including a religious belief, and active duty with the armed forces of the United States. Children and students seeking enrollment in schools, child-care facilities, or institutions of higher education, including students enrolled in health-related and veterinary courses, [in these categories] must submit evidence for exclusion from compliance as specified in the Health and Safety Code[,] §161.004(d), Health and Safety Code[,] §161.0041, Education Code[,] Chapter 38, Education Code §51.933(d), [Chapter 51, and the] Human Resources Code[,] Chapter 42, and §97.64 of this subchapter (relating to Required Vaccinations and Exclusions for Students Enrolled in Health-related and Veterinary Courses in Institutions of Higher Education).

(1) To claim an exclusion for medical reasons, the child or student must present an exemption statement to the school or child-care facility, dated and signed by a physician (M.D. or D.O.), properly licensed and in good standing in any state in the United States who has examined the child or student. The statement must state that, in the physician's opinion, the vaccine required is medically contraindicated or poses a significant risk to the health and well-being of the child or student or any member of the child's or student's household. Unless it is written in the statement that a lifelong condition exists, the exemption statement is valid for only one year from the date signed by the physician.

(2) To claim an exclusion for reasons of conscience, including a religious belief, the child's parent, legal guardian, or a student 18 years of age or older must present to the school or child-care facility a completed, signed, and notarized affidavit on a form provided by the department stating that the child's parent, legal guardian, or the student declines vaccinations for reasons of conscience, including because of the person's religious beliefs. The affidavit will be valid for a two-year period from the date of notarization. A child or student, who has not received the required immunizations for reasons of conscience, including religious beliefs, may be excluded from school in times of emergency or epidemic declared by the commissioner of the department.

(A) A person claiming exclusion for reasons of conscience, including a religious belief, from a required immunization may only obtain the affidavit form from the department by:

(ii) submitting a request (via online, fax, mail, or hand-delivery) to the department.

(B) The request must include the following information:

(i) [(iii)] complete mailing address, including name, address, and telephone number; and

(ii) [(iv)] number of requested affidavit forms [(not to exceed 5)].

(C) [(B)] Requests for mailed affidavit forms must be submitted to the department through one of the following methods:

(i) written request through the United States Postal Service (or other commercial carrier) to the department at: DSHS Immunization Branch, Mail Code [code] 1946, P.O. Box 149347, Austin, Texas 78714-9347;

(ii) by fax [facsimile] to (512) 776-7544;

(iii) by hand-delivery to the department's physical address at 1100 West 49th Street, Austin, Texas 78756; or

(iv) via the department's Immunization program website (at www.ImmunizeTexas.com).

(D) [(C)] The department will mail the requested affidavit forms [form(s) (not to exceed five forms per child or student)] to the specified mailing address.

(E) [(D)] The department may [shall] not maintain a record of the personally identifiable information [names] of individuals who request an affidavit and must [shall] return the original documents (when applicable) with the requested affidavit forms.

(3) To claim an exclusion for armed forces, persons who can prove [that they are serving on] active duty service with the armed forces of the United States are exempted from the requirements in these sections.

§ 97.64. Required Vaccinations and Exclusions for Students Enrolled in Health-related and Veterinary Courses in Institutions of Higher Education.

(a) Students enrolled in (non-veterinary) health-related courses. This section applies to all students enrolled in health-related higher education courses which will involve direct patient contact with potential exposure to blood or bodily fluids in educational, medical, or dental care facilities.

(b) Vaccines Required. Students must have all of the following vaccinations before they may engage in the course activities described in subsection (a) of this section:

(1) Tetanus-Diphtheria Vaccine. Students must show receipt of one dose of tetanus-diphtheria-pertussis vaccine (Tdap). In addition, one dose of a tetanus-containing vaccine must have been received within the last ten years. Td vaccine is an acceptable substitute, if Tdap vaccine is medically contraindicated.

(2) Measles, Mumps, and Rubella (MMR) Vaccines.

(A) Students born on or after January 1, 1957, must show, prior to patient contact, acceptable evidence of vaccination of two doses of a measles-containing vaccine administered since January 1, 1968 (preferably MMR vaccine).

(B) Students born on or after January 1, 1957, must show, prior to patient contact, acceptable evidence of vaccination of two doses of a mumps vaccine.

(C) Students must show, prior to patient contact, acceptable evidence of one dose of rubella vaccine.

(3) Hepatitis B Vaccine. Students are required to receive a complete series of hepatitis B vaccine prior to the start of direct patient care.

(4) Varicella Vaccine. Students are required to have received two doses of varicella (chickenpox) vaccine.

(c) Limited Exceptions:

(1) Notwithstanding the other requirements in this section, a student may be provisionally enrolled in these courses if the student has received at least one dose of each specified vaccine prior to enrollment and goes on to complete each vaccination series as rapid as medically feasible in accordance with the Centers for Disease Control and Prevention's Recommended Adult Immunization Schedule as approved by the Advisory Committee on Immunization Practices (ACIP). However, the provisionally enrolled student may not participate in coursework activities involving the contact described in subsections (a) and/or (d) of this section until the full vaccination series has been administered.

(2) Students, who claim to have had the complete series of a required vaccination, but have not properly documented them, cannot participate in coursework activities involving the contact described in subsections (a) and/or (d) of this section until such time as proper documentation has been submitted and accepted.

(3) The immunization requirements in subsections (b) and (d) of this section are not applicable to individuals who can properly demonstrate proof of laboratory confirmation of immunity or laboratory confirmation of disease. Vaccines for which this may be potentially demonstrated, and acceptable methods for demonstration, are found in §97.65 of this subchapter [title] (relating to Exceptions to Immunization Requirements (Verification of Immunity/History of Illness)). Such a student cannot participate in coursework activities involving the contact described in subsection (a) of this section until such time as proper documentation has been submitted and accepted.

(d) Students enrolled in schools of veterinary medicine.

(1) Rabies Vaccine. Students enrolled in schools of veterinary medicine whose coursework involves direct contact with animals or animal remains shall receive a complete primary series of rabies vaccine prior to such contact. Serum antibody levels must be checked every two years, with a booster dose of rabies vaccine administered if the rabies virus-neutralizing antibody response is inadequate according to current Centers for Disease Control and Prevention guidelines.

(2) Hepatitis B Vaccine. Students enrolled in schools of veterinary medicine whose coursework involves potential exposure to human or animal blood or bodily fluids shall receive a complete series of hepatitis B vaccine prior to such contact.

(3) Tetanus-Diphtheria Vaccine. One dose of a tetanus-diphtheria toxoid (Td) is required within the last ten years. The booster dose may be in the form of a tetanus-diphtheria-pertussis containing vaccine (Tdap).

(e) Requirements regarding acceptable evidence of vaccination are found at §97.68 of this subchapter [title] (relating to Acceptable Evidence of Vaccination(s)).

The agency certifies that legal counsel has reviewed the proposal and found it to be within the state agency's legal authority to adopt.

Filed with the Office of the Secretary of State on August 4, 2025.

TRD-202502725

Cynthia Hernandez

General Counsel

Department of State Health Services

Earliest possible date of adoption: September 14, 2025

For further information, please call: (512) 776-6319