State H1N1 Information

H1N1 Declarations and Policies

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The Department of Health and Human Services (HHS) issued a nationwide public health emergency declaration on April 26, 2009 in response to the H1N1 outbreak. Following this nationwide declaration, several states and at least one territory issued statewide or territorial emergency declarations. These actions were situation dependent and in the context of the potential for the outbreak to exceed the jurisdictions’ normal powers, authorities and capabilities. Several states have issued emergency declarations or executive orders that influence how the states and territories are able to respond to the H1N1 pandemic. States have focused on a variety of aspects, including: vaccination campaign (Maine); vaccine liability (Maine); vaccination authority/protocol (Georgia, Maine, Massachusetts); staffing issues (California); Strategic National Stockpile issues (Maryland, Minnesota); state aid (New York); reducing administrative hurdles for goods and services (California); amending isolation and quarantine procedures (Minnesota); and insurance (New York).

On Oct. 24th, President Obama declared the H1N1 pandemic a national emergency. The declaration authorizes HHS to waive certain regulatory requirements for healthcare facilities in responding to the pandemic. Some of the concessions include allowing hospitals to set up alternate care facilities for people with H1N1 without jeopardizing their Medicare and Medicaid reimbursement payments. Hospitals also would be able to transfer patients to other facilities if they do not have the capacity to deal with high numbers of patients as a result of flu, and to set up triage centers to determine levels of care and treat the sickest patients first. More information is available at http://www.flu.gov/professional/federal/h1n1emergency10242009.html.

Illinois, Maine, New York and Ohio issued their own declarations recently that give them more flexibility in vaccination campaigns and authorize different types of medical personnel to administer vaccines in response to H1N1. Ohio also suspended standard state purchasing procedures to facilitate easy procurement of supplies to respond to the H1N1 crises. (Updated November 12, 2009)

 This information is updated as appropriate. Please email infocenter@astho.org with questions, comments, or materials to be considered for posting.

 
American Samoa
Declarations and Policies
Summary: American Samoa declared a State of Public Health Emergency on May 1, 2009, in order to strengthen response capabilities, including use of all preventative measures that will require access to available services, personnel, equipment and facilities to respond to H1N1.
California
Declarations and Policies
Summary: California declared a State of Emergency on April 28, 2009, to support and facilitate the state health departments’ response to the outbreak and strengthen response capabilities. More specifically, the proclamation ordered all state agencies/departments to utilize state personnel, equipment, and facilities to assist the Dept of PH and State Emergency Plan; ordered DPH and Emergency Medical Services Authority to enter into any/all necessary contracts for providing services, materials, personnel and equipment to supplement extraordinary preventive measures; suspended non-competitive bid contracts for services, material, personnel, and equipment needed to respond to outbreak; and waived select certificate requirements for public health laboratories to help in expansion of testing capabilities.
 
 
On October 5, the Governor issued an Executive Order that increases the state's flexibility to respond by reducing contracting barriers to obtain goods and services.
Florida
Declarations and Policies
Summary: Florida issued a Declaration of Public Health Emergency on May 1, 2009, as a consequence of confirmed cases in two counties and because of the potential for the disease to spread further throughout the state; the declaration suspended the pharmaceutical pedigree requirements as applicable to wholesale distribution of prescriptions Tamiflu and Relenza needed to cope with the emergency.
Georgia
Declarations and Policies
Summary: On April 28, 2009, the Governor signed into law a bill that permits pharmacists and nurses to order and dispense flu shots pursuant to a protocol agreement with a physician. The bill also granted the Governor broader emergency powers if a pandemic influenza were declared by the World Health Organization or the Centers for Disease Control.
Illinois
Declarations and Policies
Summary: On October 14, Governor Quinn issued a gubernatorial proclamation that "will assist the Illinois Emergency Management Agency and the Illinois Department of Public Health in coordinating State efforts in response to the H1N1 influenza virus, including the modification of scopes of practice for occupations with training to give vaccinations."
Iowa
Declarations and Policies
Summary: Iowa issued a Public Health Emergency on May 2, 2009, after the CDC confirmed the first case of H1N1 in the state with an additional 7 probable cases undergoing confirmatory testing. The declaration of a public health emergency gave the state additional flexibility in acquiring medical supplies, deploying public health response teams, adopting measures to prevent transmission, and isolating individuals or groups of individuals if necessary.
Louisiana
Declarations and Policies
Summary: The Louisiana Department of Health and Hospitals issued an “Emergency Order and Protocol for the Administration of Influenza Vaccination by Eligible Pharmacists” on September 14, 2009. This order changes Louisiana pharmacist authorization for administering vaccinations by protocol, rather than by physician prescription.
Maine
Declarations and Policies
Summary: Maine issued a Proclamation of Civil Emergency due to a highly infectious agent on April 29, 2009, because H1N1 was reported in 2 counties, posed an imminent threat of death or disease, and required extraordinary measures to contain the spread of disease, treat patients, and protect public health. The proclamation allowed the expenditure of funds from state disaster emergency fund and the transfer of unexpended surplus funds from all state agencies to meet emergency needs and for all state departments/agencies to take whatever action necessary in response to the emergency.
 
 
The governor re-signed a Proclamation of Civil Emergency Due to a Highly Infectious Agent on Oct. 29, 2009. It was originally signed on Sept. 1 and again on Sept. 30, 2009. This proclamation enables the state to conduct a statewide vaccination campaign, while protecting school districts and other vaccination clinic participants from liability, and providing immunity from tort liability for approved healthcare workers who administer the flu vaccines.
Maryland
Declarations and Policies
Summary: Maryland declared a Public Health Emergency on May 1, 2009, because of 11 probable H1N1 cases and in abundance of caution to prepare for swine flu, particularly for students; the policy immediately closed down 4 schools in the state.
 
 
The Maryland Office of the Governor passed the Declaration of Emergency: Influenza Response and Mitigation to ensure proper storage, distribution, and administration of SNS materials; school closures when necessary; and appropriate guidance for providers and medical volunteers.
Massachusetts
Declarations and Policies
Summary: Public Health Council Emergency Regulation, (August 12, 2009). The Massachusetts Public Health Council passed emergency regulations to allow the governor to authorize a healthcare professional, such as a dentist, paramedic or pharmacist, to administer influenza vaccine and to require clinics and hospitals to offer vaccinations for seasonal and novel influenza to all employees.
Michigan
Declarations and Policies
Summary: Michigan issued a statute authorizing physicians to delegate administration of vaccine to appropriately trained individuals.
Minnesota
Declarations and Policies
Summary: Minnesota recently amended their statue extending the authority of the Commissioner of Health to respond to requests of local officials by expanding the categories of persons authorized to administer vaccine.
 
Nebraska
Declarations and Policies
Summary: Nebraska declared a State of Emergency on April 30, 2009 because of the nature of the influenza outbreak being a public health incident of international significance and because of the first confirmed case of H1N1 virus in the state. The declaration activated state emergency plans, including plans, protocols, and procedures for the authorization, distribution and dispensing of federal and state government-provided antiviral medicines, and suspended statues and regulations that would impede the implementation of the plans and state response.
New York
Declarations and Policies
Summary: On Aug. 7, 2009, the State Health Commissioner declared H1N1 a threat to public health in New York State, triggering additional support to local health departments under Article 6 of the Public Health Law. The law permits increased state aid reimbursement of approved local health department expenditures for the costs of public health emergency measures. Reimbursement by the State would be increased from 36 percent to 50 percent of expenditures related to novel H1N1 influenza virus that exceed approved local health department budgets.
 
 
A Sept. 10, 2009 directive announced that insurers must cover seasonal flu and novel H1N1 vaccinations for children who are aged 19 and younger and enrolled in comprehensive health plans. The policy is consistent with New York’s preventive and primary care provisions known as the Child Wellness Law; they must be covered and are not subject to co-payment, co-insurance or annual deductible.
 
 
The governor issued an executive order on Oct. 29, 2009 that will permit other healthcare workers(other than physicians, certified nurse practitioners and nurses) to administer vaccinations after they receive training. These include physician and specialist assistants, pharmacists, dentists, certain dental hygienists, midwives, and emergency medical personnel. It also authorizes school-based health centers to vaccinate adults and children, and allows hospitals to operate part-time immunization clinics on school campuses.
North Carolina
Declarations and Policies
Summary: NC is sending letters to all the nurses in the state – retired or not, licensed or not – asking for help. They are allowing retired nurses to vaccinate under the supervision of RN. State nursing law “permits the delegation of tasks to unlicensed assistive personnel by the RN and LPN.”
Ohio
Declarations and Policies
Summary: Ohio issued a Proclamation of Emergency on April 28, 2009, because H1N1 was identified in Ohio, its potential to impact many Ohioans, and H1N1 assistance was being provided to state residents.
 
 
On October 7, 2009, Governor Strickland signed an emergency proclamation that "permit[s] the State to identify and obtain the necessary resources and assets to respond to this developing situation" including allowing appropriately trained and supervised EMT-Intermediates and Paramedics to provide immunizations and administer drugs.
Texas
Declarations and Policies
Summary: Texas issued a Disaster Declaration on April 29, 2009, to allow the state to implement the emergency protective measures and seek reimbursement under the Federal Stafford Act for protective measures associated with the state’s response to H1N1.
Virginia
Declarations and Policies
Summary: Though there were no confirmed cases in the state yet, Virginia declared a Public Health Emergency on April 27, 2009, to prepare for the outbreak, increase communication with healthcare providers, and prepare to receive additional antiviral medication from the CDC; the declaration gave the Health Commissioner access to more tools to coordinate the response.
 
 
Wisconsin
Declarations and Policies
Summary: Wisconsin declared a Public Health Emergency on April 30, 2009, in response to the presence of H1N1 in the state; this directed DHS to take all measures to prevent and respond to H1N1, including accessing and distributing state and federal antiviral stockpiles and making antivirals available to all persons regardless of insurance or health coverage.