The State Board of Health voted unanimously today to approve rules that would require parents to submit non-medical exemption forms opting children out of immunizations more frequently to schools and child care facilities.

The change, which will take effect July 1, 2016, requires parents of K-12 children to submit personal belief or religious exemption forms annually and parents of younger children to submit the forms up to five times prior to kindergarten. (See this story for more background.)

A related provision meant to reduce the paperwork burden on schools will create an online exemption form that parents can submit directly to the state health department.

Currently parents have to submit an exemption form just once during their children’s schooling.

Health department officials say the more stringent requirements, which are still far from the strictest in the country, will help reduce exemptions claimed out of convenience rather than conviction and help push down Colorado’s higher-then-average immunization exemption rates.

Today’s hearing comes about a year after the state legislature passed House Bill 14-1288, which required schools to release immunization and exemption rates upon request and assigned the Board of Health to examine the exemption frequency issue.

The vote took place after a public comment session that featured a number of speakers who expressed strong support for the change, several who opposed the change, and several who said they wished the rules made it even harder to claim exemptions.

In the brief discussion that followed public comment, some board members agreed that the rules need to be even tougher, but said the change strikes a balance between two extremes.

“I am concerned that it doesn’t go far enough, but I do think it is a good first step,” said Board Member Jill Hunsaker-Ryan.

In addition to the exemption frequency rule, the Board of Health approved a plan to create a public database of immunization and exemption rates for all Colorado schools and child care facilities. That database represents a major expansion of the work Chalkbeat Colorado started in February when it published a first-of-its-kind database of immunization compliance and exemption rates for more than 400 schools in the state’s 20 largest districts.

The state’s database, expected in the 2016-17 school year, will create a standardized system for reporting school immunization rates, and set an annual Dec. 1 deadline for districts to report their data to the state. Since such a reporting deadline doesn’t currently exist, Chalkbeat’s database included rates that were compiled at all different times during the school year.

Finally, the rule changes approved today include an overview of a new online immunization module that’s being created by the state for parents who want more information. The module will include information on vaccine benefits and risks, vaccine safety, Colorado immunization rates, vaccination schedules, and a video on how vaccines work.

At least two public commenters argued that the module should include information on the National Vaccine Injury Compensation Program, which provides financial compensation to people hurt by vaccines. After the public comment period, state officials said that was a reasonable suggestion and information on the topic would be added.