COVID-19 Emergency Legal Preparedness Primer As of September 17, 2020 Leila Barraza, JD, MPH Associate Professor, Mel and Enid Zuckerman College of Public Health Senior Consultant, Network for Public Health Law – Western Region
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Contents ❑ COVID-19 Epi Trends ❑ Emergency Legal Preparedness/ Response/Recovery Federal | State | Tribal | Local ❑ Public Health Emergency Powers ❑ Vaccine Allocation 5
COVID-19 Confirmed Cases & Deaths Global Cases 29.9 million | Deaths: 942,259 U.S. Cases 6.61 million | Deaths: 196,104 U.S. Stats 23% all cases | 21% all deaths 6 6 Source: https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
Emerging Epi & Medical Trends Asymptomatic persons Antibodies may be insufficient to could account for 40-45% of ward off additional infections infections spread Multiple potential vaccines are COVID-19 can cause milder in Phase III clinical trials for outpatient illnesses among young 7 safety & efficacy adults & others
Emergency Declarations Public health authorities & powers vary depending on the type of emergency declared at every level of government WHO Public Health Emergency Declarations Emergency of Int’l Concern by Foreign Governments International January 30, 2020 Ongoing HHS Public Health Stafford Act or National Federal Emergencies Act Emergency Emergency or Public Health State/Tribal Disaster Emergency Public Emergency or Local Health Disaster Emergency 8
Federal Emergencies/Invocations HHS National Stafford PREP Defense HHS Public Emer- Act Act Production Health gencies Emergency Declar- Act Emergency Act ation Mar. Mar. Mar. Jan. Feb. 20 13 13 31 4 9 9 9
HHS Public Health Emergency Jan. 31: HHS Sec. Alex Azar declares national public health emergency effective as of Jan. 27 • Encourages interjurisdictional coordination • Allows waivers of specific federal laws • Authorizes real-time countermeasures through emergency use authorizations • Supports social distancing measures July 25: Sec. Alex Azar renews PHE declaration for 90 additional days. 10
National Emergencies Mar. 13: President Trump declares dual emergencies via the National Emergencies Act & § 501(b) of the Stafford Act authorizing: • Access to FEMA’s Disaster Relief Fund & reimbursement for eligible emergency protective response measures. • Waivers under SSA § 1135 of select Medicare, Medicaid, S-CHIP, HIPAA Privacy Rule requirements • Additional types of federal assistance to states & localities 11
Select Congressional Bills 7/27 6/24 Senate proposes a Emergency House $1 trillion relief bill Protections & Relief providing for a new Act introduced to round of stimulus prevent evictions, checks, expanded foreclosures & unemployment unsafe housing benefits & additional conditions resulting school funding. from COVID-19. 6/24 5/15 6/22 Senate introduces a House passes House introduces a bill to provide funding HEROES Act bill to require COVID- to address health 19 drugs developed providing more workforce shortages with federal support economic stimulus & disparities to be affordable & & funds for contact highlighted by accessible. tracing COVID-19. 12
Major Enacted Federal Legislation Families First CARES Act PPP & HEA Mar. 18: Families First Mar. 27: CARES Act Apr. 24: Paycheck Coronavirus Response • Largest stimulus package Protection Program & Act in history Healthcare Enhancement • Private health plans • Requires insurance Act must provide $0 cost • providers to cover Additional funding for coverage for COVID- COVID-19 testing, hospitals & HCPs 19 tests • vaccines & preventative Supports testing & • Temporarily increases contact tracing efforts services federal portion of • • Protects volunteer HCWs Requires governors to Medicaid from liability submit 2020 testing plan • Requires 14 days of • • Authorizes PHI HHS Secretary must paid sick leave for disclosure with written report on testing, cases 13 certain employees patient consent & deaths
Federal Agency Coordination Right click on each image to link to COVID-19 sites 14
Emergency Waivers Mar. 13: HHS Sec. Azar issues § 1135 national waivers (retroactive effect on March 1) re: • EMTALA sanctions for patient relocation purposes • HIPAA Privacy Rule regulations (for limited duration) • In-state licensure requirements for health care workers • Participation restrictions on Medicare, Medicaid & S- CHIP • Medicare Advantage payment limitations • Stark Law sanctions April 15 : CMS updates waivers for health care providers re: • Telemedicine provisions , facilitating Medicare services • Patient rights surrounding access to medical records, visitation & seclusion • Physical environments to allow care in non-hospital 15 settings during surge
COVID State & Select Tribal/Local Emergency Declarations Mason Co. 3/6 Des Moines 3/6 Click on the date of each state to view declarations Edmond 3/5 Auburn 3/6 Cowlitz Co. 3/4 Bellevue 3/3 Snohomish Co. 3/4 Umatilla Reservation 3/4 Minneapolis (MN) 3/16 Pierce Co. 3/6 Kitsap Co. 3/9 Lummi Nation 3/3 Milwaukee (WI) 3/13 Whatcom Co. 3/10 Redmond 3/3 Seattle 3/3 Oglala Sioux Tribe 3/11 Boston (MA) 3/15 Kansas City St. Paul (MN) 3/15 Northern Arapaho 3/11 Seattle-King Co. 2/29 Cooke Co. (IL) 3/9 (MO) 3/12 Cuyahoga Co. Washington Co. 3/4 WA McHenry Co. (IL) 3/11 (OH) 3/12 3/12 2/29 Cincinnati Clackamas Co. 3/2 VT ME Montgomery Hoopa Valley Tribe 3/4 MT (OH) 3/11 ND 3/13 3/13 Sacramento Co. 3/4 3/12 Co. (PA) 3/9 MN Nevada Co. 3/4 OR 3/8 Delaware Co. NH 3/13 ID 3/7 WI Santa Rosa 3/2 (PA) 3/9 3/13 3/13 SD NY 3/13 3/12 3/10 Solano Co. 2/27 3/10 7/30 3/10 WY Marin Co. 3/3 MI RI 3/9 3/13 Mendocino Co. 3/4 3/9 New PA IA 3/6 3/9 Sonoma Co. 3/2 NE 3/13 3/9 York NV OH Placer Co. 3/3 3/9 3/5 3/16 IN DE City 3/12 IL Santa Cruz Co. 3/2 UT WV 3/6 3/12 3/12 Alameda Co. 2/19 CO CA 3/6 3/4 VA D.C. MO 3/12 KS San Fran City 2/25 3/10 3/4 KY 3/11 3/13 3/12 Santa Clara Co. 2/10 3/6 Lexington (KY) NC Los Angeles Co. 3/4 3/6 TN 3/12 3/10 Los Angeles 3/4 3/11 AZ OK 3/15 Pasadena 3/4 NM AR SC Long Beach 3/4 3/11 3/13 3/11 Orange Co. 2/27 GA AL San Diego Co. 2/19 MS 3/14 3/13 3/14 TX LA Salt Lake Co. (UT) 3/6 3/13 3/11 Salt Lake City (UT) 3/11 Emergency - 33 Navajo Nation 3/11 FL Disaster - 4 Eagle Co. (UT) 3/7 3/1 San Antonio 3/2 Houston 3/11 Broward Co. 3/10 Phoenix (AZ) 3/13 Bexar Co. 3/2 3/9 Public Health Miami-Dade Co. 3/11 Austin 3/6 Emergency/Disaster - 9 Travis Co. 3/6 Emergency + Public Health Emergency - 4 AK – Alaska Co. of Hawai’i 2/28 Public Health Disaster 3/9 Honolulu Co. 3/4 County/City Emergency 3/4 HI - Hawaii Maui, Kaua’i 3/4 Link here for updates re: jurisdictional PR - (Puerto Rico) Emergency 3/12 16 Tribal requests for FEMA disaster relief VI - (Virgin Islands) Emergency 3/13
Select State Emergency Powers Explicitly Invoked by Declarations Note: this table tracks select, express authorities referenced via state emergency declarations (link on each state acronym for access). Additional emergency powers may be authorized under state law through which the declarations are issued . Emergency Powers A A A C C C D F H I I I K L M M M M N N N N O O P R T V U W W W K Z R A O T E L I L N A Y A E D A I J M Y C H R A I N A T A V I Altered Contracts | ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Procurements ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Emergency Plans | ICS Funding | Resource ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Allocation Intrastate Coordination ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Isolation | Quarantine ■ ■ ■ ■ ■ ■ ■ Licensure Reciprocity Price Controls re: ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Gouging ■ ■ ■ ■ Surveillance | Reporting Testing | Screening | ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Treatment ■ ■ ■ ■ ■ ■ ■ ■ Travel Restrictions ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Waivers | Suspensions 17
Emergency Declaration Initial Timing & Projected Expiration by Month (2020) 49 50 Number of states whose Number of states 45 emergency declarations are issuing initial projected to expire per month, emergency 40 absent further intervention declarations 35 30 25 For more information 20 on the current status 16 15 of state/territorial 15 12 declarations, see the National Governors 10 Association online 5 resource. 5 2 1 0 18
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