Archive for October, 2009

President Obama Signs Emergency Declaration for H1N1 Flu

In keeping with the administration’s proactive approach to H1N1 Flu, President Obama last night signed a proclamation declaring 2009-H1N1 Influenza a national emergency. The proclamation enhances the ability of our Nation’s medical treatment facilities to handle a surge in H1N1 patients by allowing, as needed, the waiver of certain standard federal requirements on a case-by-case basis. A copy of the proclamation and the accompanying message to Congress are attached.

The foundation of our national approach to the H1N1 flu has been preparedness at all levels –- personal, business, and government –- and this proclamation helps that effort by advancing our overall response capability.

Please check Flu.gov for the most up-to-date news on H1N1, preparedness, and vaccine distribution.

Sources: http://www.flu.gov/professional/federal/h1n1emergency10242009.html and http://www.historyguy.com/obamapresidency/obama_h1n1_swine_flu_emergency_declaration.htm

October 24, 2009 – President Obama Signs Emergency Declaration for H1N1 Flu

Authority

Section 1135 of the Social Security Act [42 USC §1320b–5] permits the Secretary of Health and Human Services to waive certain regulatory requirements for healthcare facilities in response to emergencies.  Two conditions must be met for the Secretary to be able to issue such “1135 waivers”:  first, the Secretary must have declared a Public Health Emergency; second, the President must have declared a National Emergency either through a Stafford Act Declaration or National Emergencies act Declaration.  If these conditions are met, then healthcare facilities may petition for 1135 waivers in response to particular needs, and only within the geographic and temporal limits of the emergency declarations.

Under Section 1135:

The Secretary may tailor authorities granted under Section 1135 waivers to match the specific situational needs, but the requirements that may be waived include those related to Medicare, Medicaid or the Children’s Health Insurance Program (CHIP), the Emergency Medical Treatment and Active Labor Act (EMTALA), and the Health Insurance Portability and Accountability Act (HIPAA).  These requirements provide important protections for patients during normal day-to-day operations, but they may impede the ability of healthcare facilities to fully implement disaster operations plans that enable appropriate care during emergencies.  For example, requirements under the Emergency Medical Treatment and Active Labor Act (EMTALA) would prohibit hospitals from certain rapid triage or sorting activities and prevent the establishment of off-site, alternate care facilities that could off-load emergency department demand.

• Waivers are permitted only to the extent they ensure that sufficient health care items and services are available to meet the needs of Medicare, Medicaid, and CHIP beneficiaries in the emergency area during the emergency period.  The “emergency area” and the “emergency period” are the geographic area, in which, and the time period, during which, the dual declarations exist. 
• Permitted actions include the waiver or modification of conditions of participation, other certification requirements, program participation requirements, pre-approval requirements for health care providers; waiver of sanctions for certain directions or relocations and transfers that otherwise would violate the Emergency Medical Treatment and Labor Act (EMTALA); waiver of sanctions related to Stark self-referral prohibitions; modifications to deadlines and timetables for the performance of required activities; and waiver of sanctions and penalties arising from noncompliance with certain Health Insurance Portability and Accountability Act (HIPAA) privacy regulations.

Examples of use of waivers:

• Hospitals request to set up an alternative screening location for patients away from the hospital’s main campus (requiring waiver of the Emergency Medical Treatment and Labor Act-EMTALA)
• Hospitals request to facilitate transfer of patients between ERs and inpatient wards between hospitals (requiring waiver of both EMTALA and HIPAA regulations)
• Critical Access Hospitals requesting waiver of 42 CFR 485.620, which requires a 25-bed limit and average patient stays less than 96 hours
• Skilled Nursing Facilities requesting a waiver of 42 CFR 483.5, which requires CMS approval prior to increasing the number of certified beds in a distinct part

Past instances where authority to grant Section 1135 waivers was enabled for recent disaster events include

• Hurricane Katrina (2005)
• 56th Presidential Inauguration (2009)
• Hurricanes Ike and Gustav (2008)
• North Dakota flooding (2009)

Q:  Why do this now; why can’t we wait until a hospital or region needs these 1135 Waivers?

            A:  The H1N1 epidemic is moving rapidly.  By the time regions or healthcare systems recognize they are becoming overburdened, they need to implement disaster plans quickly.  1135 Waivers still require specific requests be submitted to HHS and processed, and some State laws may need to be addressed as well.  Adding a potential delay while waiting for a National Emergency Declaration is not in the best interest of the public, particularly if this step can be done proactively as the President has done today. 

Q:  Has the authority to grant 1135 waivers been granted before?

            A:  Yes, there are several instances where 1135 Waiver authority has been granted under the Stafford Disaster Relief and Emergency Assistance Act (vice National Emergencies Act) to help healthcare facilities cope with large patient burdens.  Recent examples include Hurricane Katrina (2005), Hurricanes Ike and Gustav (2008), and the North Dakota flooding (2009).  In addition, 1135 waiver authority has been granted previously as a precautionary measure, as in the case of the recent 56th Presidential Inauguration (2009).

Q:  Specifically, what will this NEA Declaration enable and what will this allow hospitals to do, if a waiver is requested and granted?

            A:  An NEA Declaration fulfills the second of the two conditions required for the Secretary of HHS to be able to grant 1135 waivers.  If requested, and HHS grants an 1135 waiver, healthcare facilities will be able to utilize alternate care sites, modified patient triage protocols, patient transfer procedures, and other actions that occur when they fully implement disaster operations plans.

Q:  Is the HIPAA Privacy Rule suspended during a national or public health emergency?

            A (from the HHS Office of Civil Rights website):  No; however, the Secretary of HHS may waive certain provisions of the Rule under the Project Bioshield Act of 2004 (PL 108-276) and section 1135(b)(7) of the Social Security Act.

What provisions may be waived

If the President declares an emergency or disaster and the Secretary declares a public health emergency, the Secretary may waive sanctions and penalties against a covered hospital that does not comply with certain provisions of the HIPAA Privacy Rule:

1. the requirements to obtain a patient’s agreement to speak with family members or friends involved in the patient’s care (45 CFR 164.510(b))
2. the requirement to honor a request to opt out of the facility directory (45 CFR 164.510(a))
3. the requirement to distribute a notice of privacy practices (45 CFR 164.520)
4. the patient’s right to request privacy restrictions (45 CFR 164.522(a))
5. the patient’s right to request confidential communications (45 CFR 164.522(b))

When and to what entities does the waiver apply

If the Secretary issues such a waiver, it only applies:

   1. In the emergency area and for the emergency period identified in the public health emergency declaration.

   2. To hospitals that have instituted a disaster protocol.  The waiver would apply to all patients at such hospitals.

   3. For up to 72 hours from the time the hospital implements its disaster protocol.

When the Presidential or Secretarial declaration terminates, a hospital must then comply with all the requirements of the Privacy Rule for any patient still under its care, even if 72 hours has not elapsed since implementation of its disaster protocol. 

Regardless of the activation of an emergency waiver, the HIPAA Privacy Rule permits disclosures for treatment purposes and certain disclosures to disaster relief organizations. For instance, the Privacy Rule allows covered entities to share patient information with the American Red Cross so it can notify family members of the patient’s location.  See 45 CFR 164.510(b)(4).

Learn More:  * See http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/emergency/katrinanhipaa.pdf for information on sharing information in emergency situations.

White House Claims That Stimulus Money is Saving Jobs in Education

The Obama administration claimed on Monday, October 19, 2009, that the economic stimulus had saved or created 250,000 education jobs.  Republicans in Congress say that the stimulus package is wasteful and has not actually saved or created as many jobs as Obama claims.  Many school districts around the country complain that the stimulus money targeted for education comes with too many strings attached, and that hiring people is problematic since the stimulus money will dry up, and leave districts with employees they can no longer afford to pay.

The White House released this on the official White House blog:

MONDAY, OCTOBER 19TH, 2009 AT 10:06 AM

Recovery in Focus: Saving and Hiring 250,000 Teachers

Posted by Jesse Lee

The Recovery Act, which the President signed in February, is having positive impacts on almost every conceivable sector of our economy, both in the short term and in terms of creating a new foundation for the future.   But one of the areas that might be felt even more directly by families than most – again, in both the short and the long terms — is in education.  A new report out today from the Domestic Policy Council documents just how broad the impact has been. 

Read the Report: Educational Impact of the American Recovery and Reinvestment Act” (pdf)

From the introduction:

Immediately after President Obama signed ARRA into law on February 17th, the Department acted swiftly to move the first phase of these funds to states in response to drastic budget shortfalls. Over $67 billion in formula grants have been disbursed as of September 30th. As part of the unprecedented transparency requirements of ARRA, the first quarterly public accounting of all expenditures to date will be posted by the Recovery, Accountability, and Transparency Board on October 30th. Initial reporting from states find that the October 30 release will show at least 250,000 education jobs created or saved across the nation that are supporting our students and fueling our economy.

The report meticulously looks at the impact the Recovery Act had on state budgets, which had legislators facing awful choices on how to close massive shortfalls. And as it goes on to explain, the benefits of the Recovery Act ended up going to virtually every student in the schools that were affected, since teacher layoffs effect virtually every student:

Saving and generating jobs for teachers has had clear effects in the classroom. As local school districts are faced with budget shortfalls in a slowing economy, the number of teachers employed may decline.

However, the need to educate students does not decrease. Fewer teacher jobs, without fewer students, may lead to larger and often unacceptable class sizes.

Faced with these circumstances, some school districts have chosen to use ARRA funds to avert such class size expansion. For example, reports indicate that Peoria, IL used ARRA funding to focus on increasing the number of teaching positions and reducing class sizes in kindergarten, and at the first- and second-grade levels. At the Rothschild Middle School in Columbus, GA, the principal was able use ARRA funds to hire more math teachers to deliver individualized attention to students through smaller classes.

ARRA has also provided significant funding for low-income students ($10 billion Title I ARRA appropriation) and for students with disabilities ($12.2 billion under the Individuals with Disabilities Education Act). These funds have all been disbursed by the Department and are currently supporting essential special education professionals and programs throughout the nation and bolstering schools in many of our poorest communities.

Along the lines of the aforementioned “new foundation,” the Recovery Act funds have also helped our schools move towards the kind of reform that the President has spoken about, and which has been embraced across the political spectrum:

The overall goals for education in the ARRA are to stimulate the economy in the short term and to invest in education advancements to ensure the long-term economic health and success of our nation.

• Currently ARRA is, in fact, providing urgent fiscal relief to states and restoring education budgets in school districts, while also advancing the Administration’s four reform priorities:
• Rigorous college- and career-ready standards and high-quality assessments that are valid and reliable for all students;
• Pre-K-to college and career data systems that track progress and foster continuous improvement;
• Improvements in teacher effectiveness and in the equitable distribution of qualified teachers for all students; and
• Intensive support and effective interventions for the lowest-performing schools.

Media and direct accounts from districts across the country provide examples of local initiatives that are focusing ARRA funds towards one or more of these reform priorities.
 
It’s always hard to step back and gauge the entire impact of the Recovery Act, but this is one area where the benefits to the country and our children are beyond dispute.

President Obama released a statement addressing the many problems in Sudan, including the ongoing genocide in Darfur, and the unraveling of the peace agreement that ended (or paused?) the bloody Sudan Civil War between the North Sudan and South Sudan.

Statement of President Barack Obama on Sudan Strategy

October 19, 2009

Today, my Administration is releasing a comprehensive strategy to confront the serious and urgent situation in Sudan.

For years, the people of Sudan have faced enormous and unacceptable hardship. The genocide in Darfur has claimed the lives of hundreds of thousands of people and left millions more displaced. Conflict in the region has wrought more suffering, posing dangers beyond Sudan’s borders and blocking the potential of this important part of Africa. Sudan is now poised to fall further into chaos if swift action is not taken.

Our conscience and our interests in peace and security call upon the United States and the international community to act with a sense of urgency and purpose. First, we must seek a definitive end to conflict, gross human rights abuses and genocide in Darfur. Second, the Comprehensive Peace Agreement between the North and South in Sudan must be implemented to create the possibility of long-term peace. These two goals must both be pursued simultaneously with urgency. Achieving them requires the commitment of the United States, as well as the active participation of international partners. Concurrently, we will work aggressively to ensure that Sudan does not provide a safe-haven for international terrorists.

The United States Special Envoy has worked actively and effectively to engage all of the parties involved, and he will continue to pursue engagement that saves lives and achieves results. Later this week, I will renew the declaration of a National Emergency with respect to Sudan, which will continue tough sanctions on the Sudanese Government. If the Government of Sudan acts to improve the situation on the ground and to advance peace, there will be incentives; if it does not, then there will be increased pressure imposed by the United States and the international community. As the United States and our international partners meet our responsibility to act, the Government of Sudan must meet its responsibilities to take concrete steps in a new direction.

Over the last several years, governments, non-governmental organizations, and individuals, and from around the world have taken action to address the situation in Sudan, and to end the genocide in Darfur. Going forward, all of our efforts must be measured by the lives that are led by the people of Sudan. After so much suffering, they deserve a future that allows them to live with greater dignity, security, and opportunity. It will not be easy, and there are no simple answers to the extraordinary challenges that confront this part of the world. But now is the time for all of us to come together, and to make a strong and sustained effort on behalf of a better future for the people of Sudan.

Source: http://www.whitehouse.gov/the_press_office/Statement-of-President-Barack-Obama-on-Sudan-Strategy/

See also: http://www.historyguy.com/obamapresidency/obama_sudan_strategy_2009.htm

And http://www.historyguy.com/obamapresidency/

 Maria Shriver has partnered with the Center for American Progress to produce the Shriver Report, a look at the changing nature of women’s roles in society, particularly their rise in the workplace. Maria Shriver is promoting her new report, A Woman’s Nation, on television, including Meet the Press, and The Today Show.

Maria Shriver is the First Lady of California, a member of the Kennedy and Shriver political families, a former media personality at NBC, and is a best-selling author.

Her Biography can be read at: http://www.historyguy.com/biofiles/shriver_maria.html