Administrative Rules of the State of Montana

BEFORE THE DEPARTMENT OF PUBLIC

HEALTH AND HUMAN SERVICES

OF THE STATE OF MONTANA

In the matter of the amendment of ARM 37.114.101, 37.114.105, 37.114.201, 37.114.203, 37.114.204, 37.114.205, 37.114.301, 37.114.312, 37.114.313, 37.114.314, 37.114.315, 37.114.501, 37.114.503, 37.114.512, 37.114.515, 37.114.530, 37.114.531, 37.114.540, 37.114.542, 37.114.546, 37.114.552, 37.114.561, 37.114.563, 37.114.571, and 37.114.583, and the repeal of ARM 37.114.504, 37.114.506, 37.114.507, 37.114.509, 37.114.510, 37.114.514, 37.114.516, 37.114.518, 37.114.519, 37.114.521, 37.114.522, 37.114.524, 37.114.525, 37.114.528, 37.114.533, 37.114.534, 37.114.536, 37.114.537, 37.114.539, 37.114.544, 37.114.548, 37.114.549, 37.114.551, 37.114.554, 37.114.555, 37.114.557, 37.114.558, 37.114.560, 37.114.565, 37.114.566, 37.114.568, 37.114.570, 37.114.573, 37.114.574, 37.114.575, 37.114.577, 37.114.578, 37.114.579, 37.114.581, 37.114.582, 37.114.585, 37.114.588, 37.114.589, 37.114.591, 37.114.592, and 37.114.595, pertaining to communicable disease control

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AMENDED NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT AND REPEAL

TO: All Concerned Persons

1. On January 17, 2013, the Department of Public Health and Human Services published MAR Notice No. 37-624 pertaining to the public hearing on the proposed amendment and repeal of the above-stated rules at page 14 of the 2013 Montana Administrative Register, Issue Number 1.

2. The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice. If you require an accommodation, contact Department of Public Health and Human Services no later than 5:00 p.m. on April 16, 2013, to advise us of the nature of the accommodation that you need. Please contact Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena MT 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail [email protected].

3. The department found several typographical errors in the proposed rule notice and is correcting those errors. In ARM 37.114.105 the department is correcting an error in a telephone number and in ARM 37.114.203 and 37.114.204 the department is correcting the spelling of the word "dengue."

In ARM 37.114.204(2)(a)(iv), the department is adding terms for clarification in recognition that mortality and hospitalization reporting is needed for all cases. "Influenza-associated mortality, pediatric" is now going to read "Influenza-associated hospitalization and mortality."

In ARM 37.114.204(3), the department is removing the term "suspected" in recognition of reporting problems associated with the subjective nature of the term "suspected" specifically as it applies to aggregate influenza reporting.

The department received comments internally and was questioned by the Centers for Disease Control and Prevention on whether our state department of health had Carbapenen-Resistant Enterobacteriaceae (CRE) reporting. Research indicated the importance of laboratory reporting of CRE and made a change in ARM 37.114.313 as a result to incorporate CRE laboratory-based reporting.

The department received notice of changes to Centers for Disease Control and Prevention (CDC) guidance documents regarding pertussis control measures after the public hearing. Changes were made to ARM 37.114.563 to better align with the new CDC information.

4. The rules as proposed are being amended as follows, new matter underlined, deleted matter interlined:

37.114.105 INCORPORATION BY REFERENCE (1) The department adopts and incorporates by reference the following publications:

(a) remains as proposed.

(b) The "2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings" published by the U.S. Centers for Disease Control and Prevention, which specifies precautions that should be taken to prevent transmission of communicable diseases for cases admitted to a hospital or other health care facility. A copy of this document is available from the Department of Public Health and Human Services, Public Health and Safety Division, Communicable Disease Epidemiology Section, 1400 Broadway, P.O. Box 202951, Helena, Montana 59620-2951, phone: (406) ~~444-0272~~ 444-0273.

AUTH: 50-1-202, MCA

IMP: 50-1-202, MCA

37.114.203 REPORTABLE DISEASES AND CONDITIONS (1) The following communicable diseases and conditions are reportable:

(a) through (o) remain as proposed.

(p) ~~Denque~~ Dengue virus infections;

(q) through (bp) remain as proposed.

AUTH: 50-1-202, 50-17-103, 50-18-105, 50-18-106, MCA

IMP: 50-1-202, 50-2-118, 50-17-103, 50-18-102, 50-18-106, MCA

37.114.204 REPORTS AND REPORT DEADLINES (1) remains as proposed.

(2) A local health officer must transmit by telephone or secure electronic means to the department the information required by ARM 37.114.205(1) and (2) for each suspected or confirmed case of one of the following diseases, within the time limit noted for each:

(a) through (a)(iii) remain as proposed.

(iv) Influenza-associated hospitalization and mortality~~, pediatric~~;

(v) through (b)(xi) remain as proposed.

(xii) ~~Denque~~ Dengue virus infections;

(xiii) through (xlvi) remain as proposed.

(3) Each week during which a ~~suspected or~~ laboratory-confirmed case of influenza is reported to the local health officer, the officer must transmit by secure electronic means to the department on Friday of that week the total number of the cases of influenza reported.

(4) and (5) remain as proposed.

AUTH: 50-1-202, 50-17-103, 50-18-105, MCA

IMP: 50-1-202, 50-17-103, 50-18-102, 50-18-106, MCA

37.114.313 CONFIRMATION OF DISEASE (1) Subject to the limitation in (2), if a local health officer receives information about a case of any of the following diseases, the officer must ensure that a specimen from the case is submitted to the department, when possible, which will be analyzed to confirm the existence or absence of the disease in question, or for use in surveillance:

(a) through (d) remain as proposed.

(e) Carbapenem-Resistant Enterobacteriaceae (CRE);

(e) through (af) remain as proposed but are renumbered (f) through (ag).

(2) through (4) remain as proposed.

AUTH: 50-1-202, 50-1-204, MCA

IMP: 50-1-202, 50-1-204, MCA

37.114.563 PERTUSSIS (1) remains as proposed.

(2) An individual identified by the local health officer as a ~~close contact~~ household contact or individual at high risk of severe illness or an individual who has close contact with a person at high risk of severe illness must be referred by the officer to a physician for chemoprophylaxis. Persons at high risk for severe illness include infants under 12 months, pregnant women, or individuals with preexisting health conditions that may be exacerbated by a pertussis infection. Other individuals identified as close contacts may be referred for chemoprophylaxis depending on the circumstances of the case or cases.

(3) A person identified by the local health officer as a close contact must be monitored by the local health officer for respiratory symptoms for 20 21 days after the person's last contact with the case.

(4) and (5) remain as proposed.

AUTH: 50-1-202, 50-2-118, MCA

IMP: 50-1-202, 50-2-118, MCA

5. Concerned persons may submit their data, views, or arguments concerning the proposed action in writing to: Kenneth Mordan, Office of Legal Affairs, Department of Public Health and Human Services, P.O. Box 4210, Helena MT 59604-4210, no later than 5:00 p.m. on April 19, 2013. Comments may also be faxed to (406) 444-9744 or e-mailed to [email protected].

/s/ Shannon L. McDonald /s/ Richard H. Opper

Shannon L. McDonald Richard H. Opper, Director

Rule Reviewer Public Health and Human Services

Certified to the Secretary of State April 1, 2013.