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ospitals and health care systems now often mandate influenza vaccinations for their employees, and they may apply to everyone in the system, from janitors to chief executive officers. The Centers for Disease Control and Prevention (CDC) reported that vaccination coverage among health care personnel during the 2014-2015 season was 44.0% in settings where vaccine was not offered, promoted, or required and 73.6% or 83.9%, respectively, when vaccine was offered free on site for 1 day or multiple days. “There are no direct data, but there are some indications that clearly show a trend toward more and more hospitals and health systems adopting policies that mandate their employees be immunized yearly against influenza,” said Paul Carson, MD, FACP, director of infection control and prevention at Sanford Medical Center in Fargo, N. “Based upon self-reporting to the Immunization Action Coalition, it is probably safe to assume that, at a minimum, somewhere around 10% of hospitals have adopted these policies, and likely it is much higher than that,” he said.For many health care organizations and infectious disease specialists, the reasons for mandating the yearly vaccine are compelling.“The fundamental concept is that influenza vaccination for health care workers is both an ethical and professional obligation because it is a patient safety issue,” said William Schaffner, MD, MACP, an infectious diseases specialist at Vanderbilt University School of Medicine in Nashville, Tenn.“The logic of this is so compelling that 1 professional society after another supports not only the recommendation but also the mandate that all health care workers be vaccinated. In 2010, the ACP Board of Regents formally agreed that all health care workers with direct patient care activities should be required to have the annual influenza vaccination, with exemptions allowed for medical contraindications or religious objections.Any benefits plan which pays or provides hospital and medical expense benefits for covered services, and is delivered or issued for delivery in New Jersey by or through a carrier must provide a mandated health benefit.Health benefits plans do not include the following plans, policies or contracts: accident only, credit, disability, long-term care, coverage arising out of workers' compensation or similar law, automobile medical payment insurance, personal injury protection insurance issued pursuant to P. 1972, c.70 (C.39:6A-1 et seq.) or hospital confinement indemnity coverage.Congress passed EMTALA to eliminate the practice of "patient dumping," i.e., refusal to treat people because of inability to pay or insufficient insurance, or transferring or discharging emergency patients on the basis of high anticipated diagnosis and treatment costs.The law applies when an individual seeks treatment for a medical condition "or a request is made on the individual's behalf for examination or treatment for that medical condition." The U. government defines an emergency department as "a specially equipped and staffed area of the hospital used a significant portion of the time for initial evaluation and treatment of outpatients for emergency medical conditions ." An emergency medical condition (EMC) is defined as "a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual's health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs." For example, a pregnant woman with an emergency condition must be treated until delivery is complete unless a transfer under the statute is appropriate.

Not all medical conditions qualify for uncompensated mandated services imposed by EMTALA, which is contrary to the misperception that many individuals assume that if they are ill, they will be treated, regardless of their ability to pay.The commission is to review any bill introduced in either House of the Legislature that would require a carrier to provide a mandated health benefit within 60 days after the date the review is requested, and provide its comments and recommendations in writing to the prime sponsor, committee chair and presiding officer of the House in which the bill is pending. If the presiding officer of the House in which the bill is pending determines that the bill is an urgent matter, the presiding officer will notify in writing the Commission and the chair of the standing reference committee to which the bill is referred, and the House or committee may consider and vote upon the bill as soon as practicable; or, if the chair of the standing reference committee to which the bill is referred, in consultation with the Commissioner of Health, determines that the bill is of such an urgent matter that it would seriously impair the public health to wait for the Commission to issue its report, the chair will notify in writing the presiding officer of the House in which the bill is pending, and the Commission, of that determination, and the standing reference committee, with the agreement of the presiding officer of the House, may consider and vote upon the bill as soon as practicable.The Act limits the Commission's review of a particular mandated health benefit bill to include the social and financial impact as well as the medical efficacy of the mandated benefit. How can I obtain a copy of the Commission's report?By means of vaccine policy, which was previously discussed in these pages,(1) the federal government is effectively making critical medical decisions for an entire generation of American children. "Recommendations" issue from the Advisory Committee on Immunization Practices (ACIP), a small group whose members have incestuous ties(2) with agencies that stand to gain power, or manufacturers that stand to gain enormous profits, from the policy that is made.Even if such members recuse themselves from specific votes, they are permitted to participate in discussions and thus influence the decision.The Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), the CDC, and other groups have long recommended yearly vaccination of health care workers to reduce health care-acquired influenza.