G
Excerpts from a Standard Memorandum of Agreement Between CDC and Local Hospitals

MEMORANDUM OF AGREEMENT BETWEEN THE CENTERS FOR DISEASE CONTROL AND PRVENTION (CDC) AND [LOCAL HOSPITAL] TO PREVENT THE INTRODUCTION, TRANSMISSION, AND SPREAD OF COMMUNICABLE DISEASES IN THE UNITED STATES (VERSION 4, 2004)

BACKGROUND


… CDC, through the Division of Global Migration and Quarantine, is authorized to detain, isolate, quarantine, or conditionally release individuals who are reasonably believed to be infected with, or a source of infection, to others of certain communicable diseases…. To implement this authority, CDC may, from time to time, request the assistance of public and private health care facilities to provide care and treatment of individuals affected by one of these diseases.


PURPOSE and SCOPE OF AGREEMENT


The purpose of this Memorandum of Agreement is to establish a framework for cooperation between CDC and [name of Hospital] for the care and treatment of persons reasonably believed to be infected with, or a source of infection to others, the communicable diseases listed by Executive Order, and who are arriving in the United States from a foreign country, moving or about to move from one state to another, or who might infect persons moving from state to state. The Agreement establishes a mechanism by which individuals subject to federal quarantine authority may receive diagnostic, isolation, and treatment services, and establishes standards for communication between CDC and the Hospital concerning the care required and provided to these individuals. In addition, this agreement may be used as the basis for facilitating the clinical evaluation, examination, diagnosis,



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Quarantine Stations at Ports of Entry: Protecting the Public’s Health G Excerpts from a Standard Memorandum of Agreement Between CDC and Local Hospitals MEMORANDUM OF AGREEMENT BETWEEN THE CENTERS FOR DISEASE CONTROL AND PRVENTION (CDC) AND [LOCAL HOSPITAL] TO PREVENT THE INTRODUCTION, TRANSMISSION, AND SPREAD OF COMMUNICABLE DISEASES IN THE UNITED STATES (VERSION 4, 2004) BACKGROUND … CDC, through the Division of Global Migration and Quarantine, is authorized to detain, isolate, quarantine, or conditionally release individuals who are reasonably believed to be infected with, or a source of infection, to others of certain communicable diseases…. To implement this authority, CDC may, from time to time, request the assistance of public and private health care facilities to provide care and treatment of individuals affected by one of these diseases. PURPOSE and SCOPE OF AGREEMENT The purpose of this Memorandum of Agreement is to establish a framework for cooperation between CDC and [name of Hospital] for the care and treatment of persons reasonably believed to be infected with, or a source of infection to others, the communicable diseases listed by Executive Order, and who are arriving in the United States from a foreign country, moving or about to move from one state to another, or who might infect persons moving from state to state. The Agreement establishes a mechanism by which individuals subject to federal quarantine authority may receive diagnostic, isolation, and treatment services, and establishes standards for communication between CDC and the Hospital concerning the care required and provided to these individuals. In addition, this agreement may be used as the basis for facilitating the clinical evaluation, examination, diagnosis,

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Quarantine Stations at Ports of Entry: Protecting the Public’s Health and treatment for persons affected by other diseases of urgent public health significance for which federal quarantine is not yet authorized. DESCRIPTION OF SERVICES The hospital agrees to provide the following services: Provide the referred individual such clinical evaluation, examination, diagnostic, and treatment services as indicated, based on consultation with CDC, for the disease(s) or abnormality(ies) for which the individual was referred. Admit the referred individual for care and subject to the availability of beds. Provide care for the individual using isolation and other standard infection control precautions…. Upon request, provide to CDC appropriate medical information and clinical specimens obtained from the referred individual. Consult with CDC on all decisions related to the care of the referred individual which may have a public health impact, including the discontinuation of isolation precautions and discharge from the hospital. Communicate information related to the referred individual to local or state public health authorities, as required by applicable state and local laws related to the reporting of persons with communicable diseases. Provide to CDC, within sixty days of execution of this agreement, a written statement outlining the fulfillment of the minimal criteria for hospitalization and care of persons with specified communicable diseases as outlined in Appendix 1. CDC agrees to provide the following services: [The first two items in this section are perfunctory and therefore were omitted from this abbreviated MOA.] Provide appropriate input and consultation related to the epidemiology, clinical and laboratory diagnosis, management, and prevention of transmission of disease(s) for which the referral was made. Collaborate with state and local public health authorities to assist with the design and implementation of appropriate infection control practices at the Hospital and in the community. Provide guidance to the Hospital on personal protective equipment and other measures to be used by healthcare workers in the care of referred individuals. SCOPE OF AUTHORITY The Hospital and CDC acknowledge that the Hospital retains primary responsibility for the clinical care of the referred individual, and that CDC will serve in a consultative capacity. The Hospital and CDC further acknowledge that CDC retains full authority for determining when to institute and/or discontinue isolation of individuals referred under this agreement. The Hospital and CDC finally acknowledge that CDC represents interests of public health, and that the Hospital may be asked to assist in the implementation of communicable disease control and prevention measures.

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Quarantine Stations at Ports of Entry: Protecting the Public’s Health EFFECT ON PROCEDURES AND LAWS … This agreement does not supersede any requirements or obligations of the Hospital that otherwise exist in federal, state, or local law…. REIMBURSEMENT OF COST Pursuant to section 322 of the Public Health Service Act, persons whose care and treatment is authorized in accordance with quarantine laws may receive such care and treatment at the expense of CDC subject to the following: Payment of such expenses shall be made in CDC’s sole discretion and subject to the availability of appropriated funds. Any payment of expenses shall be secondary to the obligation of the United States or any third party (including any State or local governmental entity, private insurance carrier, or employer), under any other law or contractual agreement, to pay for such care and treatment, and shall only be paid by CDC after all other available coverage from all third-party payers have made payment. Payment shall be limited to those amounts Hospital would customarily bill the Medicare system using the International Classification of Diseases, Clinical Modification (ICD-CM), and relevant federal regulations promulgated by the Centers for Medicare and Medicaid Services in existence at the time of billing. For diseases specified in an Executive Order of the President for which quarantine/isolation is authorized pursuant to section 361 of the Public Health Service Act, payment shall be limited to costs for services and items reasonable and necessary for the care and treatment of the person for the time period commencing when CDC refers the person to Hospital and ending when, as determined by CDC, the period of isolation or quarantine expires. For diseases other than those described in paragraph (4) above, such payment shall be limited to costs for services and items reasonable and necessary for care and treatment of the person for the time period commencing when CDC refers the person to Hospital and ending when the person’s condition is diagnosed, as determined by CDC, with a nonquarantinable disease. CONFIDENTIALITY Hospital agrees that it will not disclose the nature of this effort or the terms of this agreement to any person or entity, except as may be necessary to fulfill its obligations hereunder or pursuant to written agreement from CDC. To the extent permitted by federal law, CDC will not disclose the nature of this effort or the terms of this agreement to any person or entity, except as may be necessary to fulfill its mission and statutory and regulatory responsibilities. RELEASE OF HEALTH INFORMATION Pursuant to 45 CFR § 164.512(b) of the Health Insurance Portability and Accountability Act (HIPAA) Standards for Privacy of Individually Identifiable Health Information; Final Rule (Privacy Rule) (45 CFR § 164.501), the Hospital may disclose without individual authorization protected health information to public health authorities. CDC is authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability

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Quarantine Stations at Ports of Entry: Protecting the Public’s Health [Sections of MOA omitted here: Settlement of Disputes; No Private Right Created; Amendment, Termination, and Duration; Effective Date; Approving Authorities (signatories)] POINTS OF CONTACT The following Hospital and CDC representatives will serve as the points of contact to implement this agreement: [Name and address of Hospital representative] [Name and address of CDC Quarantine Station] APPENDIX I Preparedness Criteria for Healthcare Facilities The healthcare facility should be equipped and prepared to care for a limited number of patients with a communicable disease as specified in the Memorandum of Agreement as part of routine operations. The purpose of this document is to establish the preparedness criteria that healthcare facilities must meet in order to comply with the terms of the agreement. [Twenty specific criteria are outlined in a total of six areas: preparedness planning; clinical evaluation; infection control, isolation, and environmental controls; exposure reporting and evaluation of risk; communication and reporting; and administrative issues.] APPENDIX II Certification of Satisfaction of Preparedness Standards Number of private rooms _____

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Quarantine Stations at Ports of Entry: Protecting the Public’s Health Number of airborne infection isolation (AII) rooms _____ Number of isolation beds _____ Number of infectious disease physicians _____ Number of infection control practitioners _____ Hospital 24-hour phone number _____ Number of ICU nurses _____ Number of ICU beds _____ Number of critical care physicians _____ Number of critical care nurses _____ EMS Services Does hospital have a relationship with EMS that will require a separate MOA? Yes _ No _ If yes, EMS Contact Name ______________________________________ EMS Telephone ______________________________________ EMS Email ______________________________________ On behalf of the hospital/healthcare facility named below, I certify that we are in full compliance with the Preparedness Standards as outlined in Appendix I. [signature] _______________ SOURCE: Centers for Disease Control and Prevention, 2004.