Analysis Item 13: Oregon Health Authority Meningitis Vaccination Program

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Gillian Byrd
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1 Analysis Item 13: Oregon Health Authority Meningitis Vaccination Program Analyst: Linda Ames Request: Acknowledge receipt of a report on the meningitis vaccination program in Lane County. Recommendation: Allocate $659,392 from the Emergency Fund to the Department of Administrative Services for distribution to the University of Oregon, Lane Community College, and Lane County Health Department to reimburse for expenses incurred as a result of the meningitis vaccination program in Lane County. Analysis: The Oregon Health Authority (OHA) and the University of Oregon were directed to report on the meningitis vaccination program in the following budget note (SB 5507): The Oregon Health Authority, in collaboration with the Department of Consumer and Business Services, shall work with the University of Oregon on the vaccination program for meningitis. The Department of Consumer and Business Services shall ensure timely insurance coverage is covering appropriate costs for those with insurance. The Oregon Health Authority shall, within existing emergency preparedness funds, work with the University of Oregon on funding appropriate costs. The Oregon Health Authority and the University of Oregon shall report to the appropriate legislative committee the final cost of the program including any additional funding needs by December 2015 and any recommendations to ensure effective and efficient response to any future events. OHA and the University of Oregon provided a preliminary report to the Interim Joint Committee on Ways and Means in January At that time the outbreak response was ongoing, but was formally closed in June The response involves the University of Oregon, OHA Public Health, Lane County Health Department, and Lane Community College, as well as the federal Centers for Disease Control and Prevention. The University of Oregon assumed the tasks and financial responsibilities associated with acquiring vaccine for its 22,000 undergraduate community, while Lane Community College did the same for at-risk members of its community. The report includes background information and details about the processes that were followed. Two specific activities lowered the overall cost of the vaccinations: 1) the University of Oregon was successful in negotiating a price agreement with one of the two pharmaceutical companies that provide the vaccines, and 2) the Department of Consumer and Business Services was successful in working with most insurance companies to cover the vaccinations. The report indicates that 30,462 vaccinations were reported to the ALERT Immunization Information System in OHA. A series of either two or three vaccinations are recommended, depending on the vaccine, so this represents about 19,000 students that received at least one vaccination, but only about 5,000 students that received the full series. Legislative Fiscal Office 1 Emergency Board December 2016

2 While the report includes final costs by entity, some of those costs were in-kind costs which are generally existing staff that were temporarily assigned to this effort. Direct costs, excluding those inkind costs, were $589,806 for University of Oregon, $19,000 for Lane Community College, $50,586 for Lane County Health Department, and $26,729 for OHA, for a total of $686,130. For the University of Oregon, most of this represents the cost of vaccines that have not been covered by insurance. The university estimates that between 14% and 19% of vaccinations administered were not covered by insurance. The most common reasons for this were that the student had no insurance (the university does not require insurance of U.S. students) or that the insurance did not cover the particular provider that gave the vaccination. The budget note mentions that some or all of the meningitis costs could be paid out of the $1 million General Fund that was included in the OHA Public Health budget for emergency preparedness and response to emerging events. At this point, that funding is expected to be fully utilized, primarily for the metals and emissions response (Safer Air Oregon/Cleaner Air Oregon) and the Umpqua Community College response and support. A total of $9,750 was spent for the meningitis outbreak. The Legislative Fiscal Office recommends acknowledging receipt of the report and allocating $659,392 from the Emergency Fund to the Department of Administrative Services, which will serve as paying agent for disbursement, to reimburse the University of Oregon ($589,806), Lane Community College ($19,000), and Lane County Health Department ($50,586) for expenses incurred as a result of the meningitis vaccination program in Lane County. Legislative Fiscal Office 2 Emergency Board December 2016

3 13 Oregon Health Authority MacDonald Request: Report on the investments associated with the University of Oregon meningitis outbreak. Recommendation: Acknowledge receipt of the report. Discussion: In mid-january 2015, an outbreak of bacterial meningitis occurred at the University of Oregon (UO), which resulted in seven confirmed cases of people contracting the disease, six of whom were UO undergraduate students. Of these cases, one resulted in the death of a student in February The budget report for Senate Bill 5526 (2015) contains the following budget note requiring the Oregon Health Authority (OHA) and UO to report the final costs, funding needs, and recommendations related to the outbreak response efforts: The Oregon Health Authority, in collaboration with the Department of Consumer and Business Services, shall work with the University of Oregon on the vaccination program for meningitis. The Department of Consumer and Business Services shall ensure timely insurance coverage is covering appropriate costs for those with insurance. The Oregon Health Authority shall, within existing emergency preparedness funds, work with the University of Oregon on funding appropriate costs. The Oregon Health Authority and the University of Oregon shall report to the appropriate legislative committee the final cost of the program including any additional funding needs by December 2015 and any recommendations to ensure effective and efficient response to any future events. Given the on-going nature of the response to the outbreak at that time, the agency s report submitted in December 2015 served as a preliminary update. OHA has now submitted a second report with new information and final cost data. Background: The response to the outbreak involved action at the local, state, and federal levels. Incident command activities were directed by UO, OHA, and Lane County Health Department and coordinated with Lane County Community College, the Centers for Disease Control and Prevention, and local health system partners. The key response activities included outbreak investigation, distribution of antibiotics, risk communications, and vaccination campaigns. Each organization was responsible for its own costs associated with the outbreak, with the most significant cost driver being the vaccination campaign. The shared recommendation from the Centers for Disease Control and Prevention, OHA, and Lane County Public Health was for UO to vaccinate all of its approximately 22,000 student population. With the assistance of the Department of Consumer and Business Services, OHA reports that in most cases insurers have agreed to cover the vaccination costs for insured students, thereby allocating an important part of the outbreak costs to the insurance industry. Department of Administrative Services 13-i December 14, 2016

4 Key Updates and Final Cost Reporting: In its follow-up report, OHA confirmed the outbreak response activities lasted through June 15, The agency revised the total vaccination dosages administered from the 20,129 initially reported to 30,462 in its final report. However, the actual number of UO students vaccinated is not reported due to the non-disclosure price agreement for the vaccines. When looking at the dosage requirements for the vaccines, over 10,000 individuals may have received optimal protection from the disease assuming they followed the required dosage regimen. At the time of the agency s initial report, total costs of the outbreak response were reported as $787,342 for both direct and in-kind costs through November 1, Based on final reporting, the total reported costs have increased to $879,859. Agency / Organization Initial Reported Costs through November 1, 2015 Final Reported Costs through June 15, 2016 University of Oregon $511,428 $589,806 Oregon Health Authority $137,898 $157,187 Lane County Health Department $113,866 $113,866 Lane Community College $24,150 $19,000 Total Costs: $787,342 $879,859 This financial reconciliation reflects an agreement among all parties to apply recognized federal disaster-related principles used by the Federal Emergency Management Action agency in order to achieve consistency with final reported costs. However, the total reported dollar amount does not reflect the meningitis vaccination costs covered by commercial insurers. The final report makes no recommendation for cost reimbursement for the key outbreak response stakeholders. For OHA s costs related to the outbreak, the agency leveraged its $1 million emergency preparedness fund. A total of $944,000 of that fund has been obligated in for the meningitis outbreak response; Zika surveillance; Umpqua Community College response and support; the Safer and Cleaner Air Oregon initiatives; healthy schools facilities water quality response; and enhancing gun safety. Department of Administrative Services 13-ii December 14, 2016

14 Lynne Saxton

Agency Report Item 11: Oregon Health Authority Meningitis Vaccination Program in Lane County

Agency Report Item 11: Oregon Health Authority Meningitis Vaccination Program in Lane County Analyst: Linda Ames Request: Acknowledge receipt of a report on the meningitis vaccination program in Lane County.