Capacity Rubric

Total Grade: 8.5 / 55 points


State Viral Hepatitis Elimination Plan Development

( 0 / 5 points )

In this section we assess whether a jurisdiction has drafted a publicly available viral hepatitis plan that is current and reflects the priorities outlined in the HHS Viral Hepatitis National Strategic Plan and the World Health Organization’s goals to eliminate hepatitis by 2030.

Does the state have a viral hepatitis elimination plan?1 0 / 3 points
  • If yes, is there a commitment to publish progress reports on at least an annual basis?
  • 0 / 1 point
  • If yes, are people with lived/living experience included in the development process?
  • 0 / 1 point

    1 A ‘plan’ is defined herein as one that: (a) has goals aligned with the HHS Viral Hepatitis National Strategic Plan and the World Health Organization’s goals to eliminate hepatitis by 2030; (b) includes specific actions, activities, and commitments to achieve goals; (c) is an active plan covering the current year; and (d) is available to the public.


    The state should convene a group of multidisciplinary stakeholders to develop a comprehensive plan to guide efforts to improve its viral hepatitis strategies and outcomes. This process can help identify capacity needs, build collaborative partnerships to pool limited resources, and create targeted interventions to reduce viral hepatitis incidence.


    Harm Reduction Laws

    ( 1.5 / 8.5 points )

    The Harm Reduction Laws section analyzes laws jurisdictions have in place that support the implementation of harm reduction strategies proven to reduce rates of viral hepatitis transmission, such as syringe service programs.

    Are syringe service programs (SSPs) legal? 0 / 3 points
    Is there a state law expressly authorizing SSPs? 0 / 1 point
  • If yes, is it a needs-based law, or does it require a 1-for-1 item trade for needles and syringes? (Needs-based= 1 point; 1-for-1 requirement = 0 points)
  • 0 / 1 point
    Are there Good Samaritan Laws in place to protect persons who assist others that are experiencing a substance use-related medical emergency? 1 / 1 point
    Are there laws in place to protect persons seeking medical assistance for a substance use-related medical emergency that they are experiencing? 0.5 / 0.5 points
    Is possessing substance use/injection drug use (IDU) equipment (‘works’) legalized, decriminalized, or illegal? (Legalized = 2 point; decriminalized = 1 point; illegal = 0 points) 0 / 2 points
  • Where IDU equipment is illegal, is there an exemption for syringes received from an SSP?
  • 0 / 0.5 points


    SSPs are not legal in the state, but there are Good Samaritan protections. Improved harm reduction policies that include allowing SSPs to be established will aid state efforts to engage with key populations at greatest risk for viral hepatitis transmission.


    Budget Allocation

    ( 0 / 5.5 points )

    How much and in what manner a jurisdiction allocates fiscal resources for its viral hepatitis elimination strategies is critical to providing the support needed to realize stated elimination goals.

    If a viral hepatitis elimination plan has been drafted and been made available to the public, have funds been specifically allocated to implement the plan’s strategies? 0 / 2 points
    Do the state budget allocations mention viral hepatitis? 0 / 1 point
    Do the state budget allocations mention elimination? 0 / 1 point
    Does the state corrections budget mention viral hepatitis? 0 / 1 point
  • If yes, does it specify hepatitis C treatment allocations?
  • 0 / 0.5 points


    There was no specific state budget allocation identified related to viral hepatitis. While viral hepatitis public health programs may be funded through various budget allocations, a designated line item for hepatitis signals a commitment to providing resources to support ongoing efforts to improve statewide viral hepatitis outcomes.


    Improving Viral Hepatitis Prevention, Treatment, and Outcomes

    ( 7 / 31 points )

    To improve prevention, treatment, and outcomes, jurisdictions must employ innovative and inclusive strategies that reflect best practice approaches and expand access to the health care interventions needed to diagnose and treat viral hepatitis.

    Does the jurisdiction provide/distribute viral hepatitis educational information and materials geared towards the public?2 1 / 1 point
    If yes, do they provide perinatal information/education for:
  • HBV
  • 1 / 1 point
  • HCV
  • 0 / 1 point
    Did the jurisdiction expand Medicaid? 3 / 3 points
    Does the jurisdiction offer or recommend provider training to increase workforce capacity to treat more people with viral hepatitis? 0 / 3 points
    If a plan has been drafted and made available to the public, does it include strategies to offer DAA treatment for HCV to all persons with a confirmed HCV diagnosis held in state corrections in accordance with the AASLD/IDSA treatment guidelines? 0 / 3 points
  • If no plan exists or state corrections are not mentioned in the state’s viral hepatitis plan, does a separate state-drafted guidance for the standard of care for HCV in state corrections exist – that was NOT drafted subsequent to viral hepatitis treatment access litigation brought against the jurisdiction – that provides DAA treatment for all persons with a confirmed HCV diagnosis held in state corrections in accordance with the AASLD/IDSA treatment guidelines?
  • 0 / 2 points
  • If a separate standard also does not exist, has there been litigation within the jurisdiction or a region of the jurisdiction (e.g., city or county) that has prompted changes to be made regarding hepatitis screening and treatment within corrections facilities? (NOTE: not scored)
  • No
    Does the jurisdiction utilize or provide support for (financial and/or in-kind) targeted interventions to expand access to viral hepatitis prevention, testing, and treatment services to key populations (e.g., BIPOC communities, people experiencing homelessness, people who use drugs) disproportionately affected by viral hepatitis? (Such interventions include but are not limited to mobile outreach units, non-traditionally located/on-location services, and programs targeting specific racial or cultural communities) 0 / 3 points
  • If no, are there non-governmental programs/community organizations located within the jurisdiction that are providing the aforementioned interventions to the key outreach populations listed above (as well as others) that are receiving funding from the federal government (HRSA, SAMHSA or another agency), or some other source?
  • 0 / 1 point
    Does the jurisdiction provide linguistically diverse informational materials on viral hepatitis prevention, screening, and treatment? 0 / 2 points
  • If yes, list languages available (NOTE: not scored)
  • N/A
    Is there an enduring collaborative network (i.e., task force, steering committee, etc.) within the state that is cross-cutting amongst state agencies, community organizations, advocacy groups, and healthcare providers to plan and coordinate activities and leverage resources? 0 / 2 points
  • If yes, does the jurisdiction lead this collaboration?
  • 0 / 1 point
  • If yes, are people with lived/living experience part of this collaboration?
  • 0 / 1 point
    Hepatitis C: State of Medicaid Access Grade3 2 / 10 points

    2 Jurisdictions can receive credit for this question for educational materials created by the state as well as for utilizing/distributing information such as the CDC’s “Know More Hepatitis” campaign.

    3 To date, there is no grading system that assesses hepatitis B treatment access. The Hepatitis B Foundation published an analysis of health insurance plans in 14 states that show evidence of one or more discriminatory practices in accessing hepatitis B treatment. Additional research is needed to assess state barriers to hepatitis B treatment.

    Complete list of state grades available at the State of Hep C website.


    The state public health hepatitis website has very limited information on viral hepatitis. It does not direct health professionals to additional training resources to improve awareness and capacity to screen for and treat viral hepatitis. At a minimum, the state should consider including training programs such as Hepatitis B Online and Hepatitis C Online.

    Additionally, the state continues to severely restrict access to HCV treatment based on liver damage and sobriety. Nebraska is one of only two states who restricts based on fibrosis level.


    Improving Viral Hepatitis Surveillance and Data Usage

    ( 0 / 5 points )

    Publishing epidemiological data at consistent intervals allows researchers, medical practitioners, and individuals to evaluate current diagnosis rates, demographic information, and other statistics to assess progress towards elimination. In this section of the rubric, we measure jurisdictions’ data sharing transparency.

    Has the state recently published a comprehensive viral hepatitis epidemiological report/profile (within the last two (2) years) that includes data on:
  • HAV (1 point)
  • 0 / 1 point
  • HBV (1 point)
  • 0 / 1 point
  • HCV (1 point)
  • 0 / 1 point
    Does a jurisdiction have a public-facing website with regularly updated (within the last two (2) years) viral hepatitis epidemiological data included on it? 0 / 2 points


    The state’s hepatitis site does not provide current epidemiological data on HAV, HBV, or HCV. To improve transparency, the state should consistently publish epidemiological data for HAV, HBV, and HCV.

    Updated July 12, 2022

    Key Terms

    AASLD: American Association for the Study of Liver Diseases
    DAA: Direct-Acting Antiviral Medications
    IDSA: Infectious Diseases Society of America
    IDU: Injection Drug Use
    PWID: People Who Inject Drugs
    PWUD: People Who Use Drugs
    “Works”: Drug use equipment, including, but not limited to, syringes, pipes, bongs, and roach clips