(1) With the exceptions specified in (2) and (3) below:

(a) No public or private school, as defined in (10) below, or school cooperative may initially employ or continue to employ a person unless that person has provided the school, the cooperative, or the district to which the school belongs with:

(i) documentation of the results of a tuberculin skin test done within the year prior to initial employment, along with the name of the tester and the date and type of test administered, unless the person provides written medical documentation that s/he is a known tuberculin reactor, in which case (6) of this rule applies; and

(ii) if the test results are positive, documentation in the form of a written statement from a physician that the physician has confirmed that the person does not have communicable tuberculosis. For purposes of this subsection, a person who is rehired from one school year to the next is considered to be continuously employed, and the required documentation need not be submitted again prior to employment for any school year subsequent to the first year of employment.

(b) No person, including the owner or operator, may provide care directly to children in a day care facility as defined in 52-2-703 , MCA, unless s/he has, on site at the facility, the documentation described in (a) above.

(2) If a person is already employed by a school, school district, or cooperative, or providing direct child care in a day care facility on December 25, 1992, but has not, by that date, provided the documentation required by (1) above, s/he must provide the required documentation by January 25, 1993; if a skin test is required, it must have been performed after January 25, 1992.

(3)(a) A person who is not a known tuberculin reactor, is not known to have communicable tuberculosis, and has not had a tuberculin skin test performed as required in (1) above may be employed in a school or work in a day care facility until the date specified in (b) below if s/he provides the employer with:

(i) a signed and dated written statement by a licensed physician that no such skin test should be performed at that date for medical reasons, along with the specific medical reasons why the test is temporarily inadvisable and the date after which the test may be administered; and

(ii) a signed and dated written statement by a licensed physician that s/he has examined the person to determine whether or not symptoms of tuberculosis exist and has found no such symptoms.

(b) If, within two weeks after the date upon which the physician's statement indicates the test is once again medically acceptable, the person has not provided the school, school district, cooperative, or day care facility with the documentation required by (1)(a) above, the school, district, cooperative, or day care facility must suspend that person's employment, or, in the case of a day care facility, that person's direct child care services, immediately until the documentation is submitted to it.

(4)(a) Each private school and public school district, including a district within a cooperative, must keep in its central offices documentation for each current employee of either the date, type, tester, and results of the tuberculin skin test, or the fact that (6) of this rule applies, and, if the test results are positive, the required documentation that the employee is not communicable.

(b) Each day care facility must keep on site the documentation required in (a) above for each person providing direct child care at that facility.

(5) If the day care worker or school employee's tuberculin skin test is negative, that person need not receive further routine screening for tuberculosis unless s/he has frequent or close exposure to a person with a communicable pulmonary tuberculosis.

(6)(a) If the tuberculin skin test results are significant or if the school employee or day care worker has ever, in the past, had a positive tuberculin skin test with purified-protein derivative and has not had adequate chemoprophylaxis, s/he must be evaluated by a physician, either before or within one week after receiving the results of the test, in the case of a test with significant results, or one week after commencing employment, in the case of an untreated person with a past positive test result, to ascertain whether or not s/he has any of the following conditions:

(i) x-rays indicative of tuberculosis infection;

(ii) history of exposure to a case of communicable tuberculosis within the previous two years;

(iii) history of a negative tuberculin skin test within the previous two years;

(iv) severe or poorly controlled diabetes mellitus;

(v) disease associated with severe immunologic deficiencies (e.g., cancer, reticuloendothelial disease, or HIV infection);

(vi) immunosuppressive therapy (i.e., corticosteroids, ACTH, cytotoxins);

(vii) gastrectomy;

(viii) chronic obstructive pulmonary disease;

(ix) renal transplantation; and/or

(x) ileal bypass surgery for obesity.

(b) If any of the conditions listed in (6)(a) of this rule are present, the tuberculin-positive school employee or day care worker must be counseled that s/he is at relatively high risk of developing tuberculosis disease and that s/he should complete six months of chemoprophylaxis if s/he has not already done so, unless medically contraindicated according to the standards contained in "Treatment of Tuberculosis and Tuberculosis Infection in Adults and Children", a joint statement of the Centers for Disease Control and the American Thoracic Society, adopted March, 1986.

(c) Further surveillance is not required of a tuberculin-positive school employee or day care worker with any condition listed in (6)(a) of this rule who completes six months of chemoprophylaxis.

(d) A tuberculin positive school employee or day care worker with any of the conditions listed in (6)(a) of this rule who does not complete six months of chemoprophylaxis must annually provide his or her employer with documentation from a physician that s/he is free of communicable tuberculosis, or, in the case of a day care facility worker, provide the facility with that documentation.

(e) A tuberculin-positive school employee or day care worker with none of the conditions listed in (6)(a) of this rule or with a history of close exposure to a case of communicable pulmonary tuberculosis within the previous two years or a history of a negative tuberculin test within the previous two years may be released from further routine tuberculosis surveillance following two negative chest x-rays one year apart. However, if such an employee or worker does not complete six months of chemoprophylaxis as well, s/he must be examined by a physician every five years after the second negative x-ray is taken to determine whether symptoms of tuberculosis exist.

(7) If a school employee or day care worker is diagnosed as having communicable tuberculosis or being infected with tuberculosis, that person may not work in a school or daycare facility unless proper medical treatment is being followed and, if communicable, until s/he is no longer communicable.

(8) If a school employee or day care worker violates any requirement of this rule, that person may not work in a school or daycare facility until s/he complies with the terms of this rule.

(9)(a) A person employed by a school district who transfers to any other school within the same district need not repeat the actions required by (1) above, and the documentation required by (4)(a) above must be maintained at the district's central offices.

(b) If a person employed by a cooperative transfers from one district within the cooperative to another, the actions required by (1) need not be repeated, but the documentation required by (4)(a) must be transferred from the first district to the second.

(10) For purposes of this rule:

(a) the term "school" includes both a preschool, as defined in 20-5-402 , MCA, and a place or institution for the teaching of individuals, the curriculum of which is comprised of the work of any combination of kindergarten through grade 12, and does not include a postsecondary school as defined in 20-5-402 , MCA;

(b) the term "employ" includes contracting with either an individual or a business or other entity for the services of the entity's employees.

(11) The department hereby adopts and incorporates by reference the portion of the joint statement of the American Thoracic Society and the Centers for Disease Control entitled "Treatment of Tuberculosis and Tuberculosis Infection in Adults and Children" (March, 1986) which specifies medical contraindications to chemoprophylaxis. A copy of the statement may be obtained from the Department of Public Health and Human Services, Health Policy and Services Division, Communicable Disease Control and Prevention Bureau, 1400 Broadway, P.O. Box 202951, Helena, MT 59620-2951, phone: (406)444-0273.