Public Health Determination Regarding an Exception for Unaccompanied Noncitizen Children From the Order Suspending the Right To Introduce Certain Persons From Countries Where a Quarantinable Communicable Disease Exists, 38717-38720 [2021-15699]
Download as PDF
<![CDATA[
38717
Federal Register / Vol. 86, No. 138 / Thursday, July 22, 2021 / Notices
EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN—Continued
Number of
respondents
Form name
Total burden
hours
Average
hourly wage
rate
Total cost
burden
Electronic Health Record (EHR) Extracts
Initial data pull for 10% of hospitals that do not confer rights to their NHSN
data (once at baseline for ICU and non-ICU cohorts, 800 units total) ........
Initial data pull for hospital onset bacteremia (including MSSA) and MRSApositive clinical cultures (not available in NHSN) (once at baseline for ICU
and non-ICU cohorts, 800 units total) ..........................................................
Initial data pull for 10% of units that submit point prevalence survey data
(once at baseline for ICU and non-ICU cohorts, 800 units total) ................
Initial data pull for 20% of surgical settings that do not confer rights to
NHSN data (once at baseline for Surgical cohort, 300 settings total) ........
Initial data pull (once at baseline for LTC cohort, 300 facilities total) .............
Quarterly data (quarterly during 18 months of implementation for ICU and
non-ICU cohorts, 1,100 units total) ..............................................................
Quarterly data collection of monthly data for 20% of hospitals that do not
confer rights to their NHSN data (quarterly during 18 months of implementation for surgical cohorts, 300 units total) ............................................
Monthly data (monthly per facility during 18 months of implementation for
LTC cohort, 100 facilities total) ....................................................................
Total ..........................................................................................................
27
135
∧ 35.17
4,747.95
267
935
∧ 35.17
32,866.37
27
14
∧ 35.17
474.80
20
100
10
500
∧ 35.17
∧ 35.17
351.70
17,585.00
267
801
∧ 35.17
28,171.17
20
60
∧ 35.17
2,110.20
100
900
∧ 35.17
31,653.00
13,429
11,552
........................
540,325.83
* This is an average of the average hourly wage rate for physician, nurse, nurse practitioner, physician’s assistant, and nurse’s aide from the
May 2019 National Occupational Employment and Wage Estimates, United States, U.S. Bureau of Labor Statistics (https://www.bls.gov/oes/current/oes_nat.htm#00-0000).
∧ This is an average of the average hourly wage rate for nurse and IT specialist from the May 2019 National Occupational Employment and
Wage Estimates, United States, U.S. Bureau of Labor Statistics (https://www.bls.gov/oes/current/oes_nat.htm#00-0000).
lotter on DSK11XQN23PROD with NOTICES1
Request for Comments
In accordance with the Paperwork
Reduction Act, 44 U.S.C. 3501–3520,
comments on AHRQ’s information
collection are requested with regard to
any of the following: (a) Whether the
proposed collection of information is
necessary for the proper performance of
AHRQ’s health care research and health
care information dissemination
functions, including whether the
information will have practical utility;
(b) the accuracy of AHRQ’s estimate of
burden (including hours and costs) of
the proposed collection(s) of
information; (c) ways to enhance the
quality, utility and clarity of the
information to be collected; and (d)
ways to minimize the burden of the
collection of information upon the
respondents, including the use of
automated collection techniques or
other forms of information technology.
Comments submitted in response to
this notice will be summarized and
included in the Agency’s subsequent
request for OMB approval of the
proposed information collection. All
comments will become a matter of
public record.
Dated: July 19, 2021.
Marquita Cullom,
Associate Director.
[FR Doc. 2021–15621 Filed 7–21–21; 8:45 am]
BILLING CODE 4160–90–P
VerDate Sep<11>2014
17:10 Jul 21, 2021
Jkt 253001
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
Public Health Determination Regarding
an Exception for Unaccompanied
Noncitizen Children From the Order
Suspending the Right To Introduce
Certain Persons From Countries
Where a Quarantinable Communicable
Disease Exists
Centers for Disease Control and
Prevention (CDC), Department of Health
and Human Services (HHS).
ACTION: Notice.
AGENCY:
The Centers for Disease
Control and Prevention (CDC), a
component of the Department of Health
and Human Services (HHS), announces
an Order excepting unaccompanied
noncitizen children (UC) from the Order
Suspending the Right to Introduce
Certain Persons from Countries Where a
Quarantinable Communicable Disease
Exists, issued on October 13, 2020
(October Order). CDC finds that, at this
time, there is appropriate infrastructure
in place to protect the children,
caregivers, and local communities from
elevated risk of COVID–19 transmission
as a result of the introduction of UC,
and U.S. healthcare resources are not
significantly impacted by providing UC
necessary care. CDC believes the
SUMMARY:
PO 00000
Frm 00043
Fmt 4703
Sfmt 4703
COVID–19-related public health
concerns associated with UC
introduction can be adequately
addressed without the UC being subject
to the October Order, thereby permitting
the government to better address the
humanitarian challenges for these
children. Therefore, CDC is fully
excepting UC from the October Order,
and the Notice regarding the temporary
exception of UC published February 17,
2021 is hereby superseded.
DATES: This Order went into effect July
16, 2021.
FOR FURTHER INFORMATION CONTACT:
Tiffany Brown, Deputy Chief of Staff,
Centers for Disease Control and
Prevention, 1600 Clifton Road NE, MS
H21–10, Atlanta, GA 30329. Phone:
404–639–7000. Email: cdcregulations@
cdc.gov.
As part of
government efforts to mitigate the
introduction, transmission, and spread
of COVID–19, CDC issued the October
Order,1 suspending the right to
SUPPLEMENTARY INFORMATION:
1 Order Suspending the Right to Introduce Certain
Persons from Countries Where a Quarantinable
Communicable Disease Exists, 85 FR 65806 (Oct.
16, 2020). The October Order replaced the Order
Suspending Introduction of Certain Persons from
Countries Where a Communicable Disease Exists,
issued on March 20, 2020. 85 FR 17060 (Mar. 26,
2020); Extension of Order Under Sections 362 and
365 of the Public Health Service Act; Order
Suspending Introduction of Certain Persons From
Countries Where a Communicable Disease Exists,
E:\FR\FM\22JYN1.SGM
Continued
22JYN1
38718
Federal Register / Vol. 86, No. 138 / Thursday, July 22, 2021 / Notices
lotter on DSK11XQN23PROD with NOTICES1
introduce certain persons into the
United States (U.S.) from countries or
places where a quarantinable
communicable disease exists to protect
the public’s health from an increase in
risk of the introduction of COVID–19.
The Order applied specifically to certain
noncitizens as defined 2 who would
otherwise be introduced into a
congregate setting in land or coastal
ports of entry (POE) or Border Patrol
stations at or near the U.S. borders with
Canada and Mexico. On February 17,
2021,3 CDC published a notice
announcing the temporary exception
from expulsion of unaccompanied
noncitizen children 4 (UC) encountered
in the United States from the October
Order.5
As detailed in the Order, CDC has
reviewed the current situation with
regards to the COVID–19 public health
emergency and UC in immigrations
facilities and has concluded that it is
appropriate to fully except UC from the
October Order given the measures in
place to prevent and mitigate
transmission of COVID–19 in this
population. CDC finds that the robust
network UC care facilities operated by
the Office of Refugee Resettlement
(ORR), a component of HHS, the testing
and medical care available therein, as
well as COVID–19 mitigation protocols
including vaccination for personnel and
eligible UC, result in very low
likelihood that processing UC in
accordance with existing immigration
procedures under Title 8 of the U.S.
Code will result in undue strain on the
U.S. healthcare system or healthcare
resources. Moreover, UC released to a
vetted sponsor or placed in a permanent
ORR shelter do not pose a significant
level of risk for COVID–19 spread into
the community because they are
released after having undergone testing,
quarantine and/or isolation, and
85 FR 22424 (Apr. 22, 2020); Amendment and
Extension of Order Under Sections 362 and 365 of
the Public Health Service Act; Order Suspending
Introduction of Certain Persons from Countries
Where a Communicable Disease Exists, 85 FR 31503
(May 26, 2020).
2 See 85 FR 65806, 65807.
3 Notice of Temporary Exception from Expulsion
of Unaccompanied Noncitizen Children
Encountered in the United States Pending
Forthcoming Public Health Determination, 86 FR
9942 (Feb. 17, 2021).
4 CDC’s understanding is that this class of
individuals is similar to or the same as those
individuals who would be considered
‘‘unaccompanied alien children’’ (see 6 U.S.C. 279)
for purposes of HHS ORR custody, were DHS to
make the necessary immigration determinations
under Title 8 of the U.S. Code.
5 Notice of Temporary Exception from Expulsion
of Unaccompanied Noncitizen Children
Encountered in the United States Pending
Forthcoming Public Health Determination, 86 FR
9942 (Feb. 17, 2021).
VerDate Sep<11>2014
17:10 Jul 21, 2021
Jkt 253001
vaccination when possible, and their
sponsors are provided with appropriate
medical and public health direction.
A copy of the Order is provided
below, and a copy of the signed Order
can be found at https://www.cdc.gov/
coronavirus/2019-ncov/more/pdf/Notice
UnaccompaniedChildren.pdf.
U.S. DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention (CDC)
Order Under Sections 362 & 365 of the
Public Health Service Act (42 U.S.C.
265, 268) and 42 CFR 71.40
Public Health Determination Regarding
an Exception for Unaccompanied
Noncitizen Children From the Order
Suspending the right to Introduce
Certain Persons From Countries Where
a Quarantinable Communicable Disease
Exists
As part of U.S. government efforts to
mitigate the introduction, transmission,
and spread of COVID–19, CDC issued an
Order on March 20, 2020 (March Order),
later replaced on October 13, 2020
(October Order),6 suspending the right
to introduce 7 certain persons into the
United States from countries or places
where a quarantinable communicable
disease 8 exists in order to protect the
6 Order Suspending the Right to Introduce Certain
Persons from Countries Where a Quarantinable
Communicable Disease Exists, 85 FR 65806 (Oct.
16, 2020). The October Order replaced the Order
Suspending Introduction of Certain Persons from
Countries Where a Communicable Disease Exists,
issued on March 20, 2020, extended on April 20,
2020, and amended May 19, 2020. Notice of Order
Under Sections 362 and 365 of the Public Health
Service Act Suspending Introduction of Certain
Persons from Countries Where a Communicable
Disease Exists, 85 FR 17060 (Mar. 26, 2020);
Extension of Order Under Sections 362 and 365 of
the Public Health Service Act; Order Suspending
Introduction of Certain Persons From Countries
Where a Communicable Disease Exists, 85 FR 22424
(Apr. 22, 2020); Amendment and Extension of
Order Under Sections 362 and 365 of the Public
Health Service Act; Order Suspending Introduction
of Certain Persons from Countries Where a
Communicable Disease Exists, 85 FR 31503 (May
26, 2020).
7 ‘‘Suspension of the right to introduce’’ means to
cause the temporary cessation of the effect of any
law, rule, decree, or order pursuant to which a
person might otherwise have the right to be
introduced or seek introduction into the United
States. 42 CFR 71.40(b)(5).
8 Quarantinable communicable diseases are any
of the communicable diseases listed in Executive
Order, as provided under § 361 of the Public Health
Service Act (42 U.S.C. 264). 42 CFR 71.1. The list
of quarantinable communicable diseases currently
includes cholera, diphtheria, infectious
tuberculosis, plague, smallpox, yellow fever, viral
hemorrhagic fevers (Lassa, Marburg, Ebola,
Crimean-Congo, South American, and others not yet
isolated or named), severe acute respiratory
syndromes (including Middle East respiratory
syndrome and COVID–19), and influenza caused by
novel or reemergent influenza viruses that are
PO 00000
Frm 00044
Fmt 4703
Sfmt 4703
public health from an increase in risk of
the introduction of COVID–19. The
Orders applied specifically to covered
noncitizens 9 who would otherwise be
introduced into a congregate setting in
land or coastal ports of entry (POE) or
Border Patrol stations at or near the U.S.
borders 10 with Canada and Mexico. On
February 17, 2021, CDC published a
notice 11 (February Notice) announcing
the temporary exception of
unaccompanied noncitizen children
from the October Order; the February
Notice stated that CDC would complete
a public health assessment and publish
an additional notice or a modified
Order. As explained below, CDC has
concluded that it is appropriate to
except unaccompanied noncitizen
children 12 (UC) from the October Order
given the measures in place to prevent
and mitigate transmission of COVID–19
in this population.
Under the March and October Orders,
UC were included as part of the covered
noncitizens for whom the right of
introduction into the United States was
suspended; however, UC largely have
been excepted from the application of
the Order, first pursuant to judicial
causing, or have the potential to cause, a pandemic.
See Exec. Order 13295, 68 FR 17255 (Apr. 4, 2003),
as amended by Exec. Order 13375, 70 FR 17299
(Apr. 1, 2005) and Exec. Order 13674, 79 FR 45671
(July 31, 2014).
9 This Order is using the term ‘‘covered
noncitizens’’ to have the same meaning as ‘‘covered
aliens’’ in the October Order. See October Order, 85
FR 65806, 65807 (defining ‘‘covered aliens’’ as
‘‘persons traveling from Canada or Mexico
(regardless of their country of origin) who would
otherwise be introduced into a congregate setting in
a land or coastal Port of Entry (POE) or Border
Patrol station at or near the United States borders
with Canada or Mexico,’’ subject to certain
exceptions. These persons ‘‘would typically be
aliens seeking to enter the United States at POEs
who do not have proper travel documents, aliens
whose entry is otherwise contrary to law, and aliens
who are apprehended near the border seeking to
unlawfully enter the United States between
POEs.’’).
10 When U.S. Customs and Border Protection
(CBP) or the U.S. Department of Homeland Security
(DHS) partner agencies encounter noncitizens off
the coast closely adjacent to the land borders, it
transfers the noncitizens for processing in POE or
Border Patrol stations closest to the encounter.
Absent the October Order, such noncitizens would
be held in the same congregate settings and holding
facilities as any encounters along the land border,
resulting in similar public health concerns related
to the introduction, transmission, and spread of
COVID–19.
11 Notice of Temporary Exception from Expulsion
of Unaccompanied Noncitizen Children
Encountered in the United States Pending
Forthcoming Public Health Determination, 86 FR
9942 (Feb. 17, 2021).
12 CDC’s understanding is that this class of
individuals is similar to or the same as those
individuals who would be considered
‘‘unaccompanied alien children’’ (see 6 U.S.C. 279)
for purposes of HHS ORR custody, were DHS to
make the necessary immigration determinations
under Title 8 of the U.S. Code.
E:\FR\FM\22JYN1.SGM
22JYN1
Federal Register / Vol. 86, No. 138 / Thursday, July 22, 2021 / Notices
lotter on DSK11XQN23PROD with NOTICES1
action,13 and later under the February
Notice. As a result, since November 18,
2020, UC have generally been processed
under regular immigration processes
under Title 8 of the U.S. Code and
therefore referred from U.S. Customs
and Border Protection (CBP), an agency
within the U.S. Department of
Homeland Security (DHS), to the Office
of Refugee Resettlement (ORR) within
the U.S. Department of Health and
Human Services’ (HHS) Administration
for Children and Families (ACF) for care
and custody, according to the usual
legal framework governing such
referrals.14 Pursuant to these
requirements, UC encountered in the
United States by CBP generally are
transferred to ORR within 72 hours of
intake at a POE or Border Patrol
station.15 Upon transfer to ORR custody,
UC are transported to facilities that
operate under cooperative agreements or
contracts with HHS and must meet ORR
requirements to ensure a high level of
quality, child-focused care by
appropriately trained staff. ORR
operates 210 facilities in 22 states. At
these facilities, case managers work to
identify and ultimately place UC with
vetted sponsors (usually family
members within the United States).
Beginning in mid-2020, the United
States began experiencing an increase in
the number of UC arriving daily at the
southern border. By February 2021, due
to the record numbers of transfers to
ORR, UC being held in CBP custody
awaiting ORR transfer increased due to
a lack of available space in ORR
facilities. ORR and other government
agencies responded to the influx of UC
by rapidly expanding capacity and
developing robust, safe COVID–19
protocols in consultation with CDC.
In conjunction with the Federal
Emergency Management Agency
(FEMA) and with the assistance of the
Department of Defense, HHS and ORR
opened temporary intake facilities along
the U.S. southern border and in the
interior to add capacity. A total of 14
Emergency Intake Sites (EIS) 16 were
opened across the United States. CDC
13 Dkt. No. 80, P.J.E.S. v. Mayorkas et al., No.
1:20–cv–02245 (D.D.C. Nov. 18, 2020).
14 See 8 U.S.C. 1232; Stipulated Settlement
Agreement, Flores v. Reno, No. CV 85–cv–4544
(C.D. Cal. Jan. 17, 1997).
15 8 U.S.C. 1232(b)(3).
16 EIS are intended to be a temporary measure
providing a standard of care consistent with the
best interest of children during an emergency
situation. When fully operational with appropriate
staffing and basic medical resources, EIS provide a
safer, less crowded environment where UC are
cared for, processed as quickly as possible, and are
either released to a sponsor or transferred to an
appropriate ORR facility for longer-term care. When
no longer necessary, EIS facilities are demobilized.
VerDate Sep<11>2014
17:10 Jul 21, 2021
Jkt 253001
assisted ORR by sending medical
epidemiologists and other public health
professionals to provide technical
assistance on COVID–19 mitigation
protocols. ORR now has a capacity of
over 20,000 beds; currently, over 15,100
children are in its care. ORR has
successfully processed and discharged
over 55,000 UC since January 20, 2021.
The successful efforts to expand
capacity for UC have resulted in
sufficient capacity at ORR sites—both
along the border and in the interior—
significantly reducing the length of time
that UC remain in CBP custody. As of
July 13, 2021, the current average time
a UC remained in CBP custody before
transferring to ORR custody was 26
hours, and four UC have been in CBP
custody for over 72 hours.17 This
represents a substantial improvement
from early 2021.18 While the number of
UC encountered may remain at elevated
levels, expanded ORR capacity and
improved processing methods have
resulted in UC remaining in CBP
custody for shorter periods of time.
The processes in place at the EIS and
at ORR’s regular facilities afford
sufficient resources and time to identify
SARS–CoV–2 cases and implement
environmental controls to attenuate the
risk of COVID–19 infection and
spread.19 With CDC’s assistance and
guidance, ORR also has implemented
COVID–19 testing regimes for UC in its
care and continues to practice other
mitigation measures to further prevent
and curtail any transmission of the
SARS–CoV–2 virus among UC in its
care. These strategies include universal
and proper wearing of masks, physical
distancing, frequent hand washing,
17 HHS Executive Leadership Information Brief
(internal document). Published July 12, 2021.
18 For comparison, on March 29, 2021, nearly
5,500 UC were in CBP custody, with 3,540 of those
UC in custody for longer than 72 hours; as of March
31, 2021, the average time in CBP custody for UC
was 131 hours.
19 Specifically, ORR currently uses the following
COVID–19 protocols for UC at EIS: UC are tested
for COVID–19 by CBP prior to being transported to
an EIS and then are also tested upon arrival to EIS.
UC are required to quarantine for the first 7 days
after admission to an EIS and can be released from
quarantine on the morning of day 8 if they remain
asymptomatic and had a negative COVID–19 test in
the 48 hours prior. In addition to testing at
admission and during quarantine, UC are routinely
tested during their stay at EIS (e.g., every three
days), and any UC that develops symptoms
consistent with COVID–19 infection is immediately
tested. UC who test positive for COVID–19 are
required to be isolated for 10 days from the date the
positive test was collected, or 10 days from the date
of symptom onset if asymptomatic. Contact tracing
is conducted whenever anyone tests positive for
COVID–19; UC exposed to COVID–19 are
quarantined for seven days, tested on the 5th, 6th,
or 7th day of their quarantine, and are released
upon receiving a negative test result. ORR has also
issued similar COVID–19 guidance to licensed
facilities.
PO 00000
Frm 00045
Fmt 4703
Sfmt 4703
38719
cleaning and disinfection, improved
ventilation, staff vaccination, and
cohorting UC according to their COVID–
19 test status. Per CDC recommendation,
ORR conducts serial testing of staff to
allow early detection of a possible
outbreak.20 ORR contract staff working
in facilities serving UC are encouraged
to receive the COVID–19 vaccine.21 As
advised by CDC, ORR restricts
movement of unvaccinated personnel
between facilities to reduce potential
outbreaks resulting from transfer of
unvaccinated staff between shelters.
These measures help reduce the spread
of COVID–19 among UC prior to being
introduced into U.S. communities.
In addition to the mitigation measures
at EIS and ORR facilities outlined above,
following FDA expansion of the
emergency use authorization for the
Pfizer-BioNTech COVID–19 vaccine for
adolescents 12 to 15 years of age, CDC
provided updated recommendations to
ORR regarding the vaccination of UC
ages 12 and older. ORR subsequently
approved the administration of COVID–
19 vaccine for age-eligible children.
Under ORR care, children ages 12 and
over are offered a COVID–19 vaccine as
soon as possible, as long as there are no
contraindications and vaccination does
not delay unification of UC with
sponsors. Of the total population of UC
in ORR care, approximately 90% are
eligible for vaccination and, as of July
12, 2021, ORR has administered at least
one dose of the COVID–19 vaccine to
10,124 UC. CDC considers these
vaccination efforts to be a critical risk
reduction measure that supports
excepting UC from the October Order.
Although 8,435 UC have tested
positive for COVID–19 while at ORR
shelters during the period of March 24,
2020 to July 8, 2021, 8,081 of those UC
testing positive have successfully
completed medical isolation, with few
requiring medical treatment. Similarly,
6,590 COVID–19 cases have been
reported among 14 EIS as of July 7,
2021; however only 14 (0.5%) of the UC
in this group have required
hospitalization (including two severe
20 In ORR facilities where the risk of transmission
is moderate to high, public health officials working
collaboratively with ORR facilities can determine
the appropriateness of offering screening and repeat
testing of randomly selected asymptomatic staff and
children at the facility, as feasible, to identify cases
and prevent secondary transmission.
21 Additional criteria (e.g., continued symptom
monitoring and correct and consistent wearing of
masks) should be met by ORR as outlined on CDC’s
website. See Science Brief: Options to Reduce
Quarantine for Contacts of Persons with SARS–
CoV–2 Infection Using Symptom Monitoring and
Diagnostic Testing, Centers for Disease Control and
Prevention, https://www.cdc.gov/coronavirus/2019ncov/more/scientific-brief-options-to-reducequarantine.html (last updated Dec. 2, 2020).
E:\FR\FM\22JYN1.SGM
22JYN1
lotter on DSK11XQN23PROD with NOTICES1
38720
Federal Register / Vol. 86, No. 138 / Thursday, July 22, 2021 / Notices
cases requiring intensive care). These
numbers indicate that the risk of
overburdening the local healthcare
systems by UC presenting with severe
COVID–19 disease remains low. Based
on the robust network of ORR care
facilities and the testing and medical
care available therein, as well as
COVID–19 mitigation protocols
including vaccination for personnel and
eligible UC, there is very low likelihood
that processing UC in accordance with
existing Title 8 procedures will result in
undue strain on the U.S. healthcare
system or healthcare resources.
Moreover, UC released to a vetted
sponsor or placed in a permanent ORR
shelter do not pose a significant level of
risk for COVID–19 spread into the
community because they are released
after having undergone testing,
quarantine and/or isolation, and
vaccination when possible, and their
sponsors are provided with appropriate
medical and public health direction.
CDC thus finds that, at this time,22
there is appropriate infrastructure in
place to protect the children, caregivers,
and local communities from elevated
risk of COVID–19 transmission as a
result of the introduction of UC, and
U.S. healthcare resources are not
significantly impacted by providing UC
necessary care. CDC believes the
COVID–19-related public health
concerns associated with UC
introduction can be adequately
addressed without UC being subject to
the October Order, thereby permitting
the government to better address the
humanitarian challenges for these
children. Based on the foregoing, CDC is
fully excepting UC from the October
Order,23 and the February Notice is
hereby superseded. This Order shall be
immediately effective. I consulted with
DHS and other federal departments as
needed before I issued this Order and
requested that DHS continue to aid in
the enforcement of this Order because
CDC does not have the capability,
resources, or personnel needed to do
so.24
This Order is not a rule subject to
notice and comment under the
Administrative Procedure Act (APA).
Even if it were, notice and comment and
a delay in effective date are not required
because there is good cause to dispense
with prior public notice and the
opportunity to comment on this Order
and a delayed effective date. Given the
public health emergency caused by
22 This situation could change based on an
increased influx of UC, changes in COVID–19
infection dynamics among UC, or unforeseen
reductions in housing capacity.
23 See 86 FR 9942.
24 42 U.S.C. 268; 42 CFR 71.40(d).
VerDate Sep<11>2014
17:10 Jul 21, 2021
Jkt 253001
COVID–19 and the highly unpredictable
nature of its transmission and spread, it
would be impracticable and contrary to
public health practices and the public
interest to delay the issuing and
effective date of this Order with respect
to UC. In addition, because this Order
concerns the ongoing discussions with
Canada and Mexico on how best to
control COVID–19 transmission over
our shared borders, it directly
‘‘involve[s] . . . a . . . foreign affairs
function of the United States.’’ 5 U.S.C.
553(a)(1). Notice and comment and a
delay in effective date would not be
required for that reason as well.
Authority
The authority for this Order is
Sections 362 and 365 of the Public
Health Service Act (42 U.S.C. 265, 268)
and 42 CFR 71.40.
Dated: July 19,2021.
Sherri Berger,
Chief of Staff, Centers for Disease Control
and Prevention.
[FR Doc. 2021–15699 Filed 7–20–21; 4:15 pm]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
[Docket No. CDC–2021–0071; NIOSH–341]
World Trade Center Health Program;
Request for Information
Centers for Disease Control and
Prevention, HHS.
ACTION: Request for information.
AGENCY:
The National Institute for
Occupational Safety and Health
(NIOSH), within the Centers for Disease
Control and Prevention (CDC), is
soliciting public comment on the scope
of an upcoming funding announcement
for FY2022 regarding the World Trade
Center (WTC) Health Program’s research
priorities involving WTC survivors. The
WTC Health Program’s research
program helps answer critical questions
about potential 9/11-related physical
and mental health conditions as well as
diagnosing and treating health
conditions on the List of WTC-Related
Health Conditions.
DATES: Comments must be received by
August 23, 2021.
ADDRESSES: Comments may be
submitted through either of the
following two methods:
• Federal eRulemaking Portal: https://
www.regulations.gov (follow the
instructions for submitting comments),
or
SUMMARY:
PO 00000
Frm 00046
Fmt 4703
Sfmt 4703
• By Mail: NIOSH Docket Office,
Robert A. Taft Laboratories, MS C–34,
1090 Tusculum Avenue, Cincinnati,
Ohio 45226–1998.
Instructions: All written submissions
received in response to this notice must
include the agency name (Centers for
Disease Control and Prevention, HHS)
and docket number (CDC–2021–0071;
NIOSH–341) for this action. All relevant
comments, including any personal
information provided, will be posted
without change to https://
www.regulations.gov.
FOR FURTHER INFORMATION CONTACT:
Rachel Weiss, Program Analyst, 1090
Tusculum Avenue, MS: C–48,
Cincinnati, OH 45226; telephone (855)
818–1629 (this is a toll-free number);
email NIOSHregs@cdc.gov.
SUPPLEMENTARY INFORMATION: Title I of
the James Zadroga 9/11 Health and
Compensation Act of 2010 (Pub. L. 111–
347, as amended by Pub. L. 114–113
and Pub. L. 116–59), added Title XXXIII
to the Public Health Service (PHS) Act,1
establishing the WTC Health Program
within the Department of Health and
Human Services (HHS). The WTC
Health Program provides medical
monitoring and treatment benefits for
health conditions on the List of WTCRelated Health Conditions (List) 2 to
eligible firefighters and related
personnel, law enforcement officers,
and rescue, recovery, and cleanup
workers who responded to the
September 11, 2001, terrorist attacks in
New York City, at the Pentagon, and in
Shanksville, Pennsylvania (responders).
The Program also provides benefits to
eligible persons who were present in the
dust or dust cloud on September 11,
2001, or who worked, resided, or
attended school, childcare, or adult
daycare in the New York City disaster
area (survivors).
The Zadroga Act also requires that the
Program establish a research program on
health conditions resulting from the
September 11, 2001, terrorist attacks,
addressing the following topics: 3
• Physical and mental health
conditions that may be related to the
September 11, 2001, terrorist attacks;
1 Title XXXIII of the PHS Act is codified at 42
U.S.C. 300mm to 300mm–61. Those portions of the
James Zadroga 9/11 Health and Compensation Act
of 2010 found in Titles II and III of Public Law 111–
347 do not pertain to the WTC Health Program and
are codified elsewhere.
2 The List of WTC-Related Health Conditions is
established in 42 U.S.C. 300mm–22(a)(3)–(4) and
300mm–32(b); additional conditions may be added
through rulemaking and the complete list is
provided in WTC Health Program regulations at 42
CFR 88.15.
3 42 U.S.C. 300mm–51(a).
E:\FR\FM\22JYN1.SGM
22JYN1
]]>Agencies
[Federal Register Volume 86, Number 138 (Thursday, July 22, 2021)]
[Notices]
[Pages 38717-38720]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-15699]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
Public Health Determination Regarding an Exception for
Unaccompanied Noncitizen Children From the Order Suspending the Right
To Introduce Certain Persons From Countries Where a Quarantinable
Communicable Disease Exists
AGENCY: Centers for Disease Control and Prevention (CDC), Department of
Health and Human Services (HHS).
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Centers for Disease Control and Prevention (CDC), a
component of the Department of Health and Human Services (HHS),
announces an Order excepting unaccompanied noncitizen children (UC)
from the Order Suspending the Right to Introduce Certain Persons from
Countries Where a Quarantinable Communicable Disease Exists, issued on
October 13, 2020 (October Order). CDC finds that, at this time, there
is appropriate infrastructure in place to protect the children,
caregivers, and local communities from elevated risk of COVID-19
transmission as a result of the introduction of UC, and U.S. healthcare
resources are not significantly impacted by providing UC necessary
care. CDC believes the COVID-19-related public health concerns
associated with UC introduction can be adequately addressed without the
UC being subject to the October Order, thereby permitting the
government to better address the humanitarian challenges for these
children. Therefore, CDC is fully excepting UC from the October Order,
and the Notice regarding the temporary exception of UC published
February 17, 2021 is hereby superseded.
DATES: This Order went into effect July 16, 2021.
FOR FURTHER INFORMATION CONTACT: Tiffany Brown, Deputy Chief of Staff,
Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS
H21-10, Atlanta, GA 30329. Phone: 404-639-7000. Email:
[email protected].
SUPPLEMENTARY INFORMATION: As part of government efforts to mitigate
the introduction, transmission, and spread of COVID-19, CDC issued the
October Order,\1\ suspending the right to
[[Page 38718]]
introduce certain persons into the United States (U.S.) from countries
or places where a quarantinable communicable disease exists to protect
the public's health from an increase in risk of the introduction of
COVID-19. The Order applied specifically to certain noncitizens as
defined \2\ who would otherwise be introduced into a congregate setting
in land or coastal ports of entry (POE) or Border Patrol stations at or
near the U.S. borders with Canada and Mexico. On February 17, 2021,\3\
CDC published a notice announcing the temporary exception from
expulsion of unaccompanied noncitizen children \4\ (UC) encountered in
the United States from the October Order.\5\
---------------------------------------------------------------------------
\1\ Order Suspending the Right to Introduce Certain Persons from
Countries Where a Quarantinable Communicable Disease Exists, 85 FR
65806 (Oct. 16, 2020). The October Order replaced the Order
Suspending Introduction of Certain Persons from Countries Where a
Communicable Disease Exists, issued on March 20, 2020. 85 FR 17060
(Mar. 26, 2020); Extension of Order Under Sections 362 and 365 of
the Public Health Service Act; Order Suspending Introduction of
Certain Persons From Countries Where a Communicable Disease Exists,
85 FR 22424 (Apr. 22, 2020); Amendment and Extension of Order Under
Sections 362 and 365 of the Public Health Service Act; Order
Suspending Introduction of Certain Persons from Countries Where a
Communicable Disease Exists, 85 FR 31503 (May 26, 2020).
\2\ See 85 FR 65806, 65807.
\3\ Notice of Temporary Exception from Expulsion of
Unaccompanied Noncitizen Children Encountered in the United States
Pending Forthcoming Public Health Determination, 86 FR 9942 (Feb.
17, 2021).
\4\ CDC's understanding is that this class of individuals is
similar to or the same as those individuals who would be considered
``unaccompanied alien children'' (see 6 U.S.C. 279) for purposes of
HHS ORR custody, were DHS to make the necessary immigration
determinations under Title 8 of the U.S. Code.
\5\ Notice of Temporary Exception from Expulsion of
Unaccompanied Noncitizen Children Encountered in the United States
Pending Forthcoming Public Health Determination, 86 FR 9942 (Feb.
17, 2021).
---------------------------------------------------------------------------
As detailed in the Order, CDC has reviewed the current situation
with regards to the COVID-19 public health emergency and UC in
immigrations facilities and has concluded that it is appropriate to
fully except UC from the October Order given the measures in place to
prevent and mitigate transmission of COVID-19 in this population. CDC
finds that the robust network UC care facilities operated by the Office
of Refugee Resettlement (ORR), a component of HHS, the testing and
medical care available therein, as well as COVID-19 mitigation
protocols including vaccination for personnel and eligible UC, result
in very low likelihood that processing UC in accordance with existing
immigration procedures under Title 8 of the U.S. Code will result in
undue strain on the U.S. healthcare system or healthcare resources.
Moreover, UC released to a vetted sponsor or placed in a permanent ORR
shelter do not pose a significant level of risk for COVID-19 spread
into the community because they are released after having undergone
testing, quarantine and/or isolation, and vaccination when possible,
and their sponsors are provided with appropriate medical and public
health direction.
A copy of the Order is provided below, and a copy of the signed
Order can be found at https://www.cdc.gov/coronavirus/2019-ncov/more/pdf/NoticeUnaccompaniedChildren.pdf.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention (CDC)
Order Under Sections 362 & 365 of the Public Health Service Act (42
U.S.C. 265, 268) and 42 CFR 71.40
Public Health Determination Regarding an Exception for Unaccompanied
Noncitizen Children From the Order Suspending the right to Introduce
Certain Persons From Countries Where a Quarantinable Communicable
Disease Exists
As part of U.S. government efforts to mitigate the introduction,
transmission, and spread of COVID-19, CDC issued an Order on March 20,
2020 (March Order), later replaced on October 13, 2020 (October
Order),\6\ suspending the right to introduce \7\ certain persons into
the United States from countries or places where a quarantinable
communicable disease \8\ exists in order to protect the public health
from an increase in risk of the introduction of COVID-19. The Orders
applied specifically to covered noncitizens \9\ who would otherwise be
introduced into a congregate setting in land or coastal ports of entry
(POE) or Border Patrol stations at or near the U.S. borders \10\ with
Canada and Mexico. On February 17, 2021, CDC published a notice \11\
(February Notice) announcing the temporary exception of unaccompanied
noncitizen children from the October Order; the February Notice stated
that CDC would complete a public health assessment and publish an
additional notice or a modified Order. As explained below, CDC has
concluded that it is appropriate to except unaccompanied noncitizen
children \12\ (UC) from the October Order given the measures in place
to prevent and mitigate transmission of COVID-19 in this population.
---------------------------------------------------------------------------
\6\ Order Suspending the Right to Introduce Certain Persons from
Countries Where a Quarantinable Communicable Disease Exists, 85 FR
65806 (Oct. 16, 2020). The October Order replaced the Order
Suspending Introduction of Certain Persons from Countries Where a
Communicable Disease Exists, issued on March 20, 2020, extended on
April 20, 2020, and amended May 19, 2020. Notice of Order Under
Sections 362 and 365 of the Public Health Service Act Suspending
Introduction of Certain Persons from Countries Where a Communicable
Disease Exists, 85 FR 17060 (Mar. 26, 2020); Extension of Order
Under Sections 362 and 365 of the Public Health Service Act; Order
Suspending Introduction of Certain Persons From Countries Where a
Communicable Disease Exists, 85 FR 22424 (Apr. 22, 2020); Amendment
and Extension of Order Under Sections 362 and 365 of the Public
Health Service Act; Order Suspending Introduction of Certain Persons
from Countries Where a Communicable Disease Exists, 85 FR 31503 (May
26, 2020).
\7\ ``Suspension of the right to introduce'' means to cause the
temporary cessation of the effect of any law, rule, decree, or order
pursuant to which a person might otherwise have the right to be
introduced or seek introduction into the United States. 42 CFR
71.40(b)(5).
\8\ Quarantinable communicable diseases are any of the
communicable diseases listed in Executive Order, as provided under
Sec. 361 of the Public Health Service Act (42 U.S.C. 264). 42 CFR
71.1. The list of quarantinable communicable diseases currently
includes cholera, diphtheria, infectious tuberculosis, plague,
smallpox, yellow fever, viral hemorrhagic fevers (Lassa, Marburg,
Ebola, Crimean-Congo, South American, and others not yet isolated or
named), severe acute respiratory syndromes (including Middle East
respiratory syndrome and COVID-19), and influenza caused by novel or
reemergent influenza viruses that are causing, or have the potential
to cause, a pandemic. See Exec. Order 13295, 68 FR 17255 (Apr. 4,
2003), as amended by Exec. Order 13375, 70 FR 17299 (Apr. 1, 2005)
and Exec. Order 13674, 79 FR 45671 (July 31, 2014).
\9\ This Order is using the term ``covered noncitizens'' to have
the same meaning as ``covered aliens'' in the October Order. See
October Order, 85 FR 65806, 65807 (defining ``covered aliens'' as
``persons traveling from Canada or Mexico (regardless of their
country of origin) who would otherwise be introduced into a
congregate setting in a land or coastal Port of Entry (POE) or
Border Patrol station at or near the United States borders with
Canada or Mexico,'' subject to certain exceptions. These persons
``would typically be aliens seeking to enter the United States at
POEs who do not have proper travel documents, aliens whose entry is
otherwise contrary to law, and aliens who are apprehended near the
border seeking to unlawfully enter the United States between
POEs.'').
\10\ When U.S. Customs and Border Protection (CBP) or the U.S.
Department of Homeland Security (DHS) partner agencies encounter
noncitizens off the coast closely adjacent to the land borders, it
transfers the noncitizens for processing in POE or Border Patrol
stations closest to the encounter. Absent the October Order, such
noncitizens would be held in the same congregate settings and
holding facilities as any encounters along the land border,
resulting in similar public health concerns related to the
introduction, transmission, and spread of COVID-19.
\11\ Notice of Temporary Exception from Expulsion of
Unaccompanied Noncitizen Children Encountered in the United States
Pending Forthcoming Public Health Determination, 86 FR 9942 (Feb.
17, 2021).
\12\ CDC's understanding is that this class of individuals is
similar to or the same as those individuals who would be considered
``unaccompanied alien children'' (see 6 U.S.C. 279) for purposes of
HHS ORR custody, were DHS to make the necessary immigration
determinations under Title 8 of the U.S. Code.
---------------------------------------------------------------------------
Under the March and October Orders, UC were included as part of the
covered noncitizens for whom the right of introduction into the United
States was suspended; however, UC largely have been excepted from the
application of the Order, first pursuant to judicial
[[Page 38719]]
action,\13\ and later under the February Notice. As a result, since
November 18, 2020, UC have generally been processed under regular
immigration processes under Title 8 of the U.S. Code and therefore
referred from U.S. Customs and Border Protection (CBP), an agency
within the U.S. Department of Homeland Security (DHS), to the Office of
Refugee Resettlement (ORR) within the U.S. Department of Health and
Human Services' (HHS) Administration for Children and Families (ACF)
for care and custody, according to the usual legal framework governing
such referrals.\14\ Pursuant to these requirements, UC encountered in
the United States by CBP generally are transferred to ORR within 72
hours of intake at a POE or Border Patrol station.\15\ Upon transfer to
ORR custody, UC are transported to facilities that operate under
cooperative agreements or contracts with HHS and must meet ORR
requirements to ensure a high level of quality, child-focused care by
appropriately trained staff. ORR operates 210 facilities in 22 states.
At these facilities, case managers work to identify and ultimately
place UC with vetted sponsors (usually family members within the United
States).
---------------------------------------------------------------------------
\13\ Dkt. No. 80, P.J.E.S. v. Mayorkas et al., No. 1:20-cv-02245
(D.D.C. Nov. 18, 2020).
\14\ See 8 U.S.C. 1232; Stipulated Settlement Agreement, Flores
v. Reno, No. CV 85-cv-4544 (C.D. Cal. Jan. 17, 1997).
\15\ 8 U.S.C. 1232(b)(3).
---------------------------------------------------------------------------
Beginning in mid-2020, the United States began experiencing an
increase in the number of UC arriving daily at the southern border. By
February 2021, due to the record numbers of transfers to ORR, UC being
held in CBP custody awaiting ORR transfer increased due to a lack of
available space in ORR facilities. ORR and other government agencies
responded to the influx of UC by rapidly expanding capacity and
developing robust, safe COVID-19 protocols in consultation with CDC.
In conjunction with the Federal Emergency Management Agency (FEMA)
and with the assistance of the Department of Defense, HHS and ORR
opened temporary intake facilities along the U.S. southern border and
in the interior to add capacity. A total of 14 Emergency Intake Sites
(EIS) \16\ were opened across the United States. CDC assisted ORR by
sending medical epidemiologists and other public health professionals
to provide technical assistance on COVID-19 mitigation protocols. ORR
now has a capacity of over 20,000 beds; currently, over 15,100 children
are in its care. ORR has successfully processed and discharged over
55,000 UC since January 20, 2021. The successful efforts to expand
capacity for UC have resulted in sufficient capacity at ORR sites--both
along the border and in the interior--significantly reducing the length
of time that UC remain in CBP custody. As of July 13, 2021, the current
average time a UC remained in CBP custody before transferring to ORR
custody was 26 hours, and four UC have been in CBP custody for over 72
hours.\17\ This represents a substantial improvement from early
2021.\18\ While the number of UC encountered may remain at elevated
levels, expanded ORR capacity and improved processing methods have
resulted in UC remaining in CBP custody for shorter periods of time.
---------------------------------------------------------------------------
\16\ EIS are intended to be a temporary measure providing a
standard of care consistent with the best interest of children
during an emergency situation. When fully operational with
appropriate staffing and basic medical resources, EIS provide a
safer, less crowded environment where UC are cared for, processed as
quickly as possible, and are either released to a sponsor or
transferred to an appropriate ORR facility for longer-term care.
When no longer necessary, EIS facilities are demobilized.
\17\ HHS Executive Leadership Information Brief (internal
document). Published July 12, 2021.
\18\ For comparison, on March 29, 2021, nearly 5,500 UC were in
CBP custody, with 3,540 of those UC in custody for longer than 72
hours; as of March 31, 2021, the average time in CBP custody for UC
was 131 hours.
---------------------------------------------------------------------------
The processes in place at the EIS and at ORR's regular facilities
afford sufficient resources and time to identify SARS-CoV-2 cases and
implement environmental controls to attenuate the risk of COVID-19
infection and spread.\19\ With CDC's assistance and guidance, ORR also
has implemented COVID-19 testing regimes for UC in its care and
continues to practice other mitigation measures to further prevent and
curtail any transmission of the SARS-CoV-2 virus among UC in its care.
These strategies include universal and proper wearing of masks,
physical distancing, frequent hand washing, cleaning and disinfection,
improved ventilation, staff vaccination, and cohorting UC according to
their COVID-19 test status. Per CDC recommendation, ORR conducts serial
testing of staff to allow early detection of a possible outbreak.\20\
ORR contract staff working in facilities serving UC are encouraged to
receive the COVID-19 vaccine.\21\ As advised by CDC, ORR restricts
movement of unvaccinated personnel between facilities to reduce
potential outbreaks resulting from transfer of unvaccinated staff
between shelters. These measures help reduce the spread of COVID-19
among UC prior to being introduced into U.S. communities.
---------------------------------------------------------------------------
\19\ Specifically, ORR currently uses the following COVID-19
protocols for UC at EIS: UC are tested for COVID-19 by CBP prior to
being transported to an EIS and then are also tested upon arrival to
EIS. UC are required to quarantine for the first 7 days after
admission to an EIS and can be released from quarantine on the
morning of day 8 if they remain asymptomatic and had a negative
COVID-19 test in the 48 hours prior. In addition to testing at
admission and during quarantine, UC are routinely tested during
their stay at EIS (e.g., every three days), and any UC that develops
symptoms consistent with COVID-19 infection is immediately tested.
UC who test positive for COVID-19 are required to be isolated for 10
days from the date the positive test was collected, or 10 days from
the date of symptom onset if asymptomatic. Contact tracing is
conducted whenever anyone tests positive for COVID-19; UC exposed to
COVID-19 are quarantined for seven days, tested on the 5th, 6th, or
7th day of their quarantine, and are released upon receiving a
negative test result. ORR has also issued similar COVID-19 guidance
to licensed facilities.
\20\ In ORR facilities where the risk of transmission is
moderate to high, public health officials working collaboratively
with ORR facilities can determine the appropriateness of offering
screening and repeat testing of randomly selected asymptomatic staff
and children at the facility, as feasible, to identify cases and
prevent secondary transmission.
\21\ Additional criteria (e.g., continued symptom monitoring and
correct and consistent wearing of masks) should be met by ORR as
outlined on CDC's website. See Science Brief: Options to Reduce
Quarantine for Contacts of Persons with SARS-CoV-2 Infection Using
Symptom Monitoring and Diagnostic Testing, Centers for Disease
Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-options-to-reduce-quarantine.html (last
updated Dec. 2, 2020).
---------------------------------------------------------------------------
In addition to the mitigation measures at EIS and ORR facilities
outlined above, following FDA expansion of the emergency use
authorization for the Pfizer-BioNTech COVID-19 vaccine for adolescents
12 to 15 years of age, CDC provided updated recommendations to ORR
regarding the vaccination of UC ages 12 and older. ORR subsequently
approved the administration of COVID-19 vaccine for age-eligible
children. Under ORR care, children ages 12 and over are offered a
COVID-19 vaccine as soon as possible, as long as there are no
contraindications and vaccination does not delay unification of UC with
sponsors. Of the total population of UC in ORR care, approximately 90%
are eligible for vaccination and, as of July 12, 2021, ORR has
administered at least one dose of the COVID-19 vaccine to 10,124 UC.
CDC considers these vaccination efforts to be a critical risk reduction
measure that supports excepting UC from the October Order.
Although 8,435 UC have tested positive for COVID-19 while at ORR
shelters during the period of March 24, 2020 to July 8, 2021, 8,081 of
those UC testing positive have successfully completed medical
isolation, with few requiring medical treatment. Similarly, 6,590
COVID-19 cases have been reported among 14 EIS as of July 7, 2021;
however only 14 (0.5%) of the UC in this group have required
hospitalization (including two severe
[[Page 38720]]
cases requiring intensive care). These numbers indicate that the risk
of overburdening the local healthcare systems by UC presenting with
severe COVID-19 disease remains low. Based on the robust network of ORR
care facilities and the testing and medical care available therein, as
well as COVID-19 mitigation protocols including vaccination for
personnel and eligible UC, there is very low likelihood that processing
UC in accordance with existing Title 8 procedures will result in undue
strain on the U.S. healthcare system or healthcare resources. Moreover,
UC released to a vetted sponsor or placed in a permanent ORR shelter do
not pose a significant level of risk for COVID-19 spread into the
community because they are released after having undergone testing,
quarantine and/or isolation, and vaccination when possible, and their
sponsors are provided with appropriate medical and public health
direction.
CDC thus finds that, at this time,\22\ there is appropriate
infrastructure in place to protect the children, caregivers, and local
communities from elevated risk of COVID-19 transmission as a result of
the introduction of UC, and U.S. healthcare resources are not
significantly impacted by providing UC necessary care. CDC believes the
COVID-19-related public health concerns associated with UC introduction
can be adequately addressed without UC being subject to the October
Order, thereby permitting the government to better address the
humanitarian challenges for these children. Based on the foregoing, CDC
is fully excepting UC from the October Order,\23\ and the February
Notice is hereby superseded. This Order shall be immediately effective.
I consulted with DHS and other federal departments as needed before I
issued this Order and requested that DHS continue to aid in the
enforcement of this Order because CDC does not have the capability,
resources, or personnel needed to do so.\24\
---------------------------------------------------------------------------
\22\ This situation could change based on an increased influx of
UC, changes in COVID-19 infection dynamics among UC, or unforeseen
reductions in housing capacity.
\23\ See 86 FR 9942.
\24\ 42 U.S.C. 268; 42 CFR 71.40(d).
---------------------------------------------------------------------------
This Order is not a rule subject to notice and comment under the
Administrative Procedure Act (APA). Even if it were, notice and comment
and a delay in effective date are not required because there is good
cause to dispense with prior public notice and the opportunity to
comment on this Order and a delayed effective date. Given the public
health emergency caused by COVID-19 and the highly unpredictable nature
of its transmission and spread, it would be impracticable and contrary
to public health practices and the public interest to delay the issuing
and effective date of this Order with respect to UC. In addition,
because this Order concerns the ongoing discussions with Canada and
Mexico on how best to control COVID-19 transmission over our shared
borders, it directly ``involve[s] . . . a . . . foreign affairs
function of the United States.'' 5 U.S.C. 553(a)(1). Notice and comment
and a delay in effective date would not be required for that reason as
well.
Authority
The authority for this Order is Sections 362 and 365 of the Public
Health Service Act (42 U.S.C. 265, 268) and 42 CFR 71.40.
Dated: July 19,2021.
Sherri Berger,
Chief of Staff, Centers for Disease Control and Prevention.
[FR Doc. 2021-15699 Filed 7-20-21; 4:15 pm]
BILLING CODE 4163-18-P
