Public Health Emergency - Leading a Nation Prepared
Should incident needs severely challenge or exceed State, Tribal, and jurisdictional response capabilities, Federal resources may be called on to provide additional surge capacity and capability. When this occurs, Federal agencies and resources function in support of State, Tribal, and jurisdictional response efforts. When catastrophic events overwhelm State, Tribal, and jurisdictional response capabilities, Federal resources can be mobilized in advance of a formal request for assistance per the Catastrophic Incident Annex of the NRP; however, the proactive deployment of these resources is closely coordinated with affected State, Tribal, or local authorities.
The authority for Federal public health and medical response may come from a Presidential declaration of a major disaster or emergency (commonly known as a Stafford Act declaration), a declaration of an Incident of National Significance by the DHS Secretary, at the request of another Federal department or agency, or under the Public Health Service Act.
Federal public health and medical assistance consists of medical materiel, personnel, and technical assistance. These resources may provide response capability for the triage, treatment, and transportation of victims or persons with special medical needs; evacuation of patients; infection control; mental health screening and counseling; environmental health services; and other emergency response needs. Below is an example of the full range of support available through ESF #8. A variety of Federal public health and medical assets may be provided, including the following:
ESF #8 involves supplemental assistance to State, Tribal, and jurisdictional governments in identifying and meeting the public health and medical needs of victims of major disasters or public health emergencies. This support is categorized in the following functional areas:
In addition, the Federal Government may temporarily waive or modify certain normal requirements of Federal programs during a national emergency or disaster that is also a public health emergency to facilitate the delivery of public health and medical assistance. For example, Section 1135 of the Social Security Act authorizes the Secretary of HHS to temporarily waive or modify normal operating requirements of Medicare, Medicaid, or the State Children's Health Insurance Program (SCHIP) during a national emergency or disaster declared by the President that is also a public health emergency declared by the HHS Secretary (see below). This action ensures that affected healthcare providers who are unable to comply with certain Federal requirements because of a national emergency or disaster that is also a public health emergency, but who operate in good faith, are given sufficient flexibilities to continue providing services to beneficiaries and receive reimbursement for those services.
Waiving Healthcare Requirements in Hurricane Katrina
One way the Federal Government facilitates the delivery of medical care and public health services during a major emergency or disaster is by temporarily waiving or modifying normal operating requirements of Federal programs. For example, during the response to Hurricane Katrina, the Secretary of HHS, pursuant to Section 1135 of the Social Security Act, waived the following requirements: (Department of Health and Human Services, Waiver Under Section 1135 of the Social Security Act, September4, 2005)
The 1135 waiver typically ends with the termination of the emergency period, or 60 days from the date the waiver is first published unless the Secretary of HHS extends the waiver by notice for additional periods of up to 60 days. During Katrina, waivers for EMTALA and HIPAA requirements were in effect for a period not to exceed 72 hours from implementation of a hospital disaster protocol. The 1135 waiver applies only to Federal requirements and does not automatically apply to State requirements for licensure or conditions of participation.
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