COVID-19 Emergency Legal Preparedness Primer As of September 10, 2020 James G. Hodge, Jr., J.D., L.L.M. Peter Kiewit Foundation Professor of Law Director, Western Region Office, Network for Public Health Law ASU and Day O’Connor College of Law [email protected] Contents ❑ COVID-19 Epi Trends ❑ Emergency Legal Preparedness/ Response/Recovery Federal | State | Tribal | Local ❑ Public Health Emergency Powers ❑ Constitutional & Other Challenges ❑ Additional Resources/Ask the Network 2 COVID-19 Confirmed Cases & Deaths Global Cases 27.5 million | Deaths: 897,789 U.S. Cases 6.35 million | Deaths: 189,500 U.S. Stats 23% all cases | 21% all deaths 3 3 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 4 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 International Emergency of Int’l Concern by Foreign Governments January 30, 2020 Ongoing Stafford Act or National HHS Public Health Federal Emergencies Act Emergency Emergency or Public Health State/Tribal Disaster Emergency Emergency or Public Local Disaster Health 5 Emergency Federal Emergencies/Invocations HHS National PREP Stafford Defense HHS Public Emer- Act Act Production Health gencies Declar- Emergency Act Emergency ation Act Jan. Feb. Mar. Mar. Mar. 31 4 13 13 20 6 6 6 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. 7 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 & 8 localities 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 6/22 5/15 Senate introduces a House introduces a House passes bill to provide funding bill to require COVID- HEROES Act to address health 19 drugs developed providing more workforce shortages with federal support & disparities economic stimulus to be affordable & highlighted by & funds for contact accessible. COVID-19. tracing 9 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 services contact tracing efforts 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 10 certain employees patient consent & deaths Federal Agency Coordination Right click on each image to link to COVID-19 sites 11 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 12 settings during surge Joe Biden’s COVID Plan • RestoreFamilies trust First & credibility in public officials • Reinstate daily briefings, ensure decisions are made by public health officials & not politicians, restore the White House National Security Council for Global Health Security & Biodefense • Effective national emergency response • Make testing widely available, create more capacity for prevention, response & treatment, accelerate development of treatment & vaccines, provide timely data & information • Eliminate cost barriers to prevention & treatment • Ensure everyone irrespective of insurance coverage has access to free testing, preventative services & vaccines. • Support workers, small businesses & stabilize the economy • Provide guaranteed paid sick & care-giving leave, expanded unemployment relief & state/local emergency funds. • Lead global responses to COVID-19 • Create a Global Health Emergency Board, advance global pandemic 13 preparedness COVID State & Select Tribal/Local Emergency Declarations Mason Co. 3/6 Des Moines 3/6 Edmond 3/5 Auburn 3/6 Cowlitz Co. 3/4 Bellevue 3/3 Click on the date of each state to view declarations Snohomish Co. 3/4 Umatilla Reservation 3/4 Minneapolis (MN) 3/16 Lummi Nation 3/3 Kitsap Co. 3/9 Pierce Co. 3/6 Milwaukee (WI) 3/13 Redmond 3/3 Seattle 3/3 Whatcom Co. 3/10 Oglala Sioux Tribe 3/11 Kansas City St. Paul (MN) 3/15 Boston (MA) 3/15 Seattle-King Co. 2/29 Northern Arapaho 3/11 (MO) 3/12 Cooke Co. (IL) 3/9 Cuyahoga Co. Washington Co. 3/4 WA McHenry Co. (IL) 3/11 Clackamas Co. 3/2 2/29 Cincinnati (OH) 3/12 VT 3/12 Hoopa Valley Tribe 3/4 MT ND 3/13 (OH) 3/11 Montgomery 3/13 ME Sacramento Co. 3/4 3/12 MN Co. (PA) 3/9 Nevada Co. 3/4 OR 3/8 3/13 Delaware Co. NH Santa Rosa 3/2 ID WI 3/7 3/13 (PA) 3/9 3/13 Solano Co. 2/27 SD 3/13 3/12 3/10 NY 3/10 3/10 Marin Co. 3/3 WY 7/30 MI RI 3/9 Mendocino Co. 3/4 3/13 3/9 New IA 3/9 PA 3/6 Sonoma Co. 3/2 NE 3/13 3/9 York Placer Co. 3/3 NV 3/9 OH 3/16 3/5 DE Santa Cruz Co. 3/2 3/12 IL IN City UT 3/6 WV 3/12 Alameda Co. 2/19 CA CO 3/12 3/6 KS MO 3/4 VA 3/12 D.C. San Fran City 2/25 3/4 3/10 Santa Clara Co. 2/10 3/12 3/13 KY 3/11 3/6 Lexington (KY) Los Angeles Co. 3/4 NC Los Angeles 3/4 TN 3/12 3/10 3/6 Pasadena 3/4 AZ 3/11 OK 3/15 NM AR SC Long Beach 3/4 3/11 3/11 3/13 Orange Co. 2/27 GA San Diego Co. 2/19 AL MS 3/13 3/14 3/14 Salt Lake Co. (UT) 3/6 TX LA Emergency - 33 Salt Lake City (UT) 3/11 3/13 3/11 Navajo Nation 3/11 FL Disaster - 4 Eagle Co. (UT) 3/7 San Antonio 3/2 Houston 3/11 3/1 Phoenix (AZ) 3/13 Bexar Co. 3/2 3/9 Broward Co. 3/10 Public Health Miami-Dade Co. 3/11 Emergency/Disaster - 9 Austin 3/6 Travis Co. 3/6 Emergency + Public Health Emergency - 4 Co. of Hawai’i 2/28 AK – Alaska Public Health Disaster 3/9 County/City Honolulu Co. 3/4 Emergency 3/4 Maui, Kaua’i 3/4 HI - Hawaii Link here for updates re: jurisdictional PR - (Puerto Rico) Emergency 3/12 14 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 ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ 15 Emergency Declaration Initial Timing & Projected Expiration by Month (2020) 50 49 Number of states Number of states whose 45 issuing initial emergency declarations are projected to expire per month, 40 emergency declarations absent further intervention 35 30 26 25 For more information 20 on the current status 16 of state/territorial 15 declarations, see the National Governors 10 Association online resource. 5 5 1 1 2 0 16 Legal Triage Legal Triage: efforts of legal actors & others Legal Triage during declared Government emergencies to build a favorable legal Laws environment by Actors prioritizing issues & From this . solutions facilitating Partners legitimate. public health responses 17 Balancing Individual & Communal Interests Privacy Religious Freedoms Surveillance Treatment Individual Communal Interests Interests Due Equal Isolation & Curfews & Process Protection Quarantine Closures Emergency Preparedness & Response 18 Select Structural & Rights-based Constitutional Issues Judicial Separation of Federalism Supremacy Preemption Powers Deference Freedom of Right to Freedom of Freedom of Due Process Expression Assembly Religion Privacy Cruel & Equal Right to Takings Right to Bear Unusual 19 Protection Travel Arms Punishment Current & Emerging Legal Issues Emergency Powers - Testing/ Triage Screening/ Treatment/ Crisis Vaccination Standards of Care Topics Surveillance Social & Reporting Distancing Measures Privacy Liability 20 Screening & Testing March 3: VP Pence: “Any American can be tested .