Rocky Mountain Region COVID-19 Healthcare Update (CO, ID, MT, NE, NM, UT, WY)

Healthcare Essential Businesses

Essential Procedures

PPE

Relaxation of Licensing Requirements

Visitation to LTC

Telehealth

Safer-at-Home Order

Executive Order D 2020-044

“Critical Business,” as defined by Colorado Stay at Home

Executive Order D 2020-024 includes the following Healthcare Operations:

• Hospitals, clinics, and walk-in health facilities
• Medical and dental care, including ambulatory providers
• Research and laboratory services
• Medical wholesale and distribution
• Home health care companies, workers and aides
• Pharmacies
• Pharmaceutical and biotechnology companies
• Behavioral health care providers
• Veterinary care and livestock services
• Nursing homes, residential health care, or congregate care facilities
• Medical supplies and equipment manufacturers and providers, including durable medical equipment technicians and suppliers
• Blood banks

Temporary Cessation of All Elective and Non-Essential Surgeries

Executive Order 2020-027

• Expired April 26, 2020

Procedures and Preserving PPE and Ventilators

Executive Order 2020-027

• Expired April 26, 2020

Division of Professions and Occupations Emergency Licensing Measures for Healthcare Professionals

Nursing

Nurse Practice Act and Nurse Aide Practice Act

• Allows for rending of nursing assistance and nursing aid services in the case of an emergency
• DORA will waive licensing requirements and rules to allow for late renewals, reinstatements, and reactivations of the volunteer nurses and other qualified licensed providers from out of state
• DORA also anticipates these provisions will allow LPNs to conduct COVID-19 screening tests

Suspension of Nursing Board Rule 1.11.E.2

• Allow for clinical instruction to continue via simulation, ensuring continued training and an accessible workforce
• Suspends current requirements that no less than 16 hours of clinical instruction occur under the direct supervision of an RN or LPN

Physician

Medical Practice Act

• Allows physicians who are not licensed in CO to provide medical care in an emergency if the services are free of charge
• Allows physicians licensed and lawfully practicing medicine in another state or territory without restrictions to provide occasional services in Colorado. The physician must not have a regular practice in CO and have medical malpractice insurance.

Scope of Practice

• Suspension of C.R.S. § 12-240-107(5)
• Allows for expanded scope of practice
• Suspends the requirement that all licensees designated in § 12-240-107(3), C.R.S., must confine themselves strictly to the field for which they are licensed and to the scope of their respective licenses

Endorsement

• Suspension of requirements for endorsement under C.R.S. § 12-240-110(1)(d)(I)(C), C.R.S., which requires active practice for at least five of the immediately preceding seven years.
• Suspension of requirement under § 12-240-118(1), C.R.S., that requires a physician to have been on inactive status for not more than two years prior to receiving a pro bono license

Competency

• Suspension of Colorado Medical Board Rules 120 and 410 requiring demonstration of continuing competency for licensure, reinstatement or reactivation for physicians and physician assistants

Restricting Visitors at all Colorado SNFs, ALRs, and ICFs

Public Health Order 20-20

Full GRSM Article

• Requires screening, limiting and restricting visitors
• Requires facilities to provide alternative means of communication for residents and family
• Requires revising polices, when necessary, concerning third parties
• Update to Order 20-20 requires all LTCFs to provide a Prevention and Response Plan to the state by May 1, 2020

CO’s One-Stop Shop for LTCFs Responding to COVID

Temporary Suspension of Certain Statutes to Expand the Use of Telehealth Services Due

Executive Order 2020-020

• Expired May 1, 2020
• Relaxes and suspends certain statutory requirements surrounding telehealth to make it easier for patients to receive care via telehealth

Healthcare Essential Businesses

Essential Procedures

PPE

Relaxation of Licensing Requirements

Visitation to LTC

Telehealth

Order to Self-Isolate

(Idaho Dept. of Health and Welfare, Order of the Director – March 25, 2020)

Per Section 8(v)(b):

“Healthcare operations” include:

• Hospitals,
• Clinics,
• Dentists,
• Pharmacies,
• Pharmaceutical and biotechnology companies,
• Other healthcare facilities,
• Healthcare suppliers,
• Home healthcare services providers,
• Mental health providers, or any related and/or ancillary healthcare services,
• Veterinary care and all healthcare services provided to animals.

“Healthcare Operations” does not include fitness and exercise gyms and similar facilities.

All “healthcare operations” are deemed essential and remain open.

• No restrictions on healthcare procedures

Idaho Department of Health and Wellness Guidance re: N95 respirators

• Gives various approaches to conserve supplies of N95 Respirators
• Provides links to additional CDC resource on PPE

See also Idaho State Resources for Healthcare Providers

Idaho State Board of Medicine Actions – March 27, 2020

Out-of-state physicians and PAs do not need an Idaho license to practice in Idaho during COVID-19

• 120-day licenses to retired and inactive physicians
• Relaxed examination requirements for prescriptions
• Requirement waived for physicians supervising PAs
• Renewal cycle extended for 90 days

Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Residential Assisted Living Facilities

All facilities should restrict visitation of all visitors and non-essential health care personnel, except for certain compassionate care situations, such as an end-of-life situation in which case visitors are assessed on case by case basis.

Temporary suspension of rules to increase telehealth access for coronavirus.

• Telemedicine encouraged
• Regulations relaxed to allow for increased us of telemedicine

Healthcare Essential Businesses

Essential Procedures

PPE

Relaxation of Licensing Requirements

Visitation to LTC

Telehealth

Stay at Home and Essential Functions

Executive Order (extended through April 24, 2020)

• Expired on April 26
• Now in a phased plan to open non-essential business
• Essential businesses still open

“Essential Businesses” included the following healthcare facilities:

• hospitals;
• clinics;
• dental offices; pharmacies;
• public health entities, including those that compile, model, analyze and communicate public health information;
• pharmaceutical, pharmacy, medical device and equipment, and biotechnology companies (including operations, research and development, manufacture, and supply chain);
• organizations collecting blood, platelets, plasma, and other necessary materials;
• licensed medical cannabis dispensaries and licensed cannabis cultivation centers; reproductive health care providers;
• eye care centers, including those that sell glasses and contact lenses;
• home Health Care services providers;
• mental health and substance use providers;
• other Health Care facilities and suppliers and providers of any related and/or ancillary Health Care services;
• and entities that transport and dispose of medical materials and remains.

While many Montana healthcare providers have voluntarily ceased elective and non-essential procedures, there has been no state-mandated requirement to do so.

N/A

The Montana Department of Labor & Industry has implemented a COVID-19 Emergency Healthcare Registration for out-of-state healthcare licensees requesting to actively work in Montana for a defined period of time. The Department will evaluate home state license(s) according to licensing regulations in Montana, to verify it is currently active, unrestricted, and in good standing, and issue a registration to work in Montana. The registration is only valid until the current emergency directives are rescinded.

N/A

Four major health insurance companies operating in Montana have voluntarily expanded their coverage of telehealth services to aid in the state’s response to the virus known as COVID-19, but there has been no state mandate to do so.

Healthcare Essential Businesses

Essential Procedures

PPE

Relaxation of Licensing Requirements

Visitation to LTC

Telehealth

Ban of Gatherings

(Executive Order 20-06)

• Bars gatherings of more than 10 people in Douglas, Sarpie, Cass, and Washington Counties of Nebraska through April 30, 2020

• Does not apply to office buildings, traditional office settings, or manufacturing facilities

Ban of Gatherings

(Directed Health Measure Order 2020-010)

• Bars gatherings of more than 10 people in all 93 counties of Nebraska

• “Gathering” does not include normal operations at healthcare facilities enumerated in

Health Care Facility Licensure Act NEB. REV. STAT.§§

71-401 to 71-475)

No stay-at-home order has been issued for Nebraska.

Elective Surgeries and Procedures are Prohibited

(DHHS Directed Health Measure Order 2020-010)

• Elective medical and dental surgeries and elective medical and dental procedures are prohibited.

• Surgeries or procedures that must be done to preserve the patient’s life or physical health, but do not need to be performed immediately, are allowed by a case-by-case determination of the medical provider

N/A

Relief for Hospital & Health Care Facilities

Executive Order (20-12)

• Waives specific statutes and regulations arising from the Health Care facility Licensure Act, the Assisted Living Facility Act, the Nebraska Healthcare Certificate of Need Act, and Nebraska Revised Statute §71-6039(c), § 71-6039.01(3), and § 71-6725(4) which could impair Nebraskans' ability to receive care and treatment in licensed hospitals and health care facilities during the COVID-19 state of emergency

Additional Healthcare Workforce Capacity

(Executive Order 20-10)

• Waives specific statutes and regulations to access needed healthcare practitioners in Nebraska for thirty (30) days from March 21, 2020

• Temporarily allows individuals who are actively licensed in a U.S. state or territory other than Nebraska to practice in Nebraska without needing a Nebraska license. The license in the other state must be active, in good standing and free from disciplinary action

Please see http://dhhs.ne.gov/Documents/COVID-19%20Executive%20Order%2020-10%20FAQ.pdf for FAQ’s.

DHHS Guidance

• Discontinue communal dining and group activities;

• Restrict all visitation except for certain compassionate care situation, such as end of life situations or hospice; and

• Restrict volunteers and non-essential healthcare personnel

General Statewide Telehealth

• Nebraska statutes, including but not limited to N.R.S. § 38-1,143, currently authorize any credential holder under the Uniform Credentialing Act to use telehealth in establishing a provider-patient relationship

• Out-of-state providers who work in Nebraska pursuant to Executive Order 20-10, Coronavirus, Additional Healthcare Workforce Capacity, are authorized to use telehealth under the same statutory provisions that permit Nebraska health care providers to use telehealth

• Health care providers are not required to obtain a patient’s signature on a written agreement prior to providing telehealth services.

• Nebraska Medicaid will abide by any federal guidance issued related to HIPPA approved or allowable technologies.

Healthcare Essential Businesses

Essential Procedures

PPE

Relaxation of Licensing Requirements

Visitation to LTC

Telehealth

Stay-at-Home

(March 23, 2020 Order)

“Essential Businesses” include the following healthcare operations:

• hospitals;

• walk-in-care facilities;

• pharmacies;

• medical wholesale and distribution;

• home health care workers;

• emergency dental facilities;

• nursing homes;

• residential health care facilities;

• research facilities;

• congregate care facilities;

• intermediate care facilities for those with intellectual or developmental disabilities;

• supportive living homes;

• home health care providers; and

• medical supplies and equipment manufacturers and providers

Temporary Restriction on Non-essential Health Care Services

(March 24, 2020 Public Health Order)

• Prohibits non-essential health care services, procedures, and surgeries

• Non-essential means procedures which can be delayed for 3 months without undue risk

• Does not apply to emergency medical care, surgery that if not performed would result in a serious condition of worsening, and family planning services

• Requires healthcare providers to provide NMDH with policy addressing compliance

Temporary Regulation of the Sale and Distribution of PPE

(March 24, 2020 Public Health Order)

• Restricts health care providers and medical suppliers with an inventory of PPE from reducing its inventory via selling, distributing, etc. without prior approval from NWHD

• Doesn’t apply to use of PPE or over the counter sales to individuals

• Requires each provider and supplier to report inventory of PPE to NMHD

Healthcare Staffing

(April 2, 2020 Order)

• Permits the New Mexico Department of Health (NMDOH) to allow Canadian nursing professionals who are licensed and in good standing to work in any New Mexico healthcare facility during the Pendency of the COVID-19 pandemic

Licensure Process during Covid-19 Pandemic

Nursing

Licensure

• No option for an emergency temporary license
• Can request a graduate permit if you are new to the nurse/APRN role or a temporary license if you are endorsing an APRN license or a LPN/RN license from California (RN only), Michigan, and Pennsylvania
• Nurses currently licensed to practice as a RN or LPN in a jurisdiction of the United States may practice in New Mexico without making application for a New Mexico license for a period not to exceed 30 days
• No emergency exception for APRN roles in the NM Nursing Practice Act or NM BON rules
• Employers can consider loosening the requirement for new hires to hold permanent licenses prior to the first day of work during the COVID-19 pandemic

Licensure Renewal

• No automatic extensions granted
• Normal licensure renewal process at this time

Physicians

Licensure

• Required for all practitioners caring for patients in NM during the pandemic
• NMMB utilizing all available personnel and resources to focus on quickly licensing individuals

Federal Emergency Licensure Provision and Application

• Provides temporary license to individuals who can provide proof of medical school graduation, passing the USMLE tests, and two years of post-graduate training
• Waives the remaining documentation requirements such as work verification, recommendation letters, specialty board

• certifications and some licensure verification

• Applicant must certify they cannot obtain the remaining documentation or documentation will be delayed because of COVID-19

• License will last for between three and fifteen months

Aging and Long-Term Services Department

(April 2, 2020 Order)

• Authorizes emergency funds for the Aging and Long-term Services Department to assist in relief efforts during the state wide public health emergency due to COVID-19

Telehealth Guidance

• Use of electronic means are not considered unethical or a violation of NMMB rules
• Includes internet, email, texting, and telephone
• Prescribing controlled substances still must be medically appropriate, well-documented and continue to conform to NMMB pain rules
• Telemedicine application processes that are simple and quickly processed
• NMMB encourages applicants to access this licensure type if the focus of the medical practice will remain telemedicine in nature

• NM-licensed LPNs/RNs/APRNs are not prohibited by the Board from providing care through electronic means
• – Care must be provided professionally, competently, and safely and conform with practice obligations and other rules

Healthcare Essential Businesses

Essential Procedures

PPE

Relaxation of Licensing Requirements

Visitation to LTC

Telehealth

Business Restrictions and Guidance

(March 21 Order)

Utah Stay at Home Directive

(April 17, 2020)

Effective through May 1, 2020

Salt Lake County Stay Smart, Stay Safe Public Health Order

(April 17, 2020 Order)

Effective through May 1, 2020

Order to Postpone All Elective Surgeries/Procedures

• Effective March 25, 2020 at 12:01 a.m. until April 25, 2020 at 11:59 p.m.

Order Allowing Elective Procedures to Resume

• Rescinds March 23, 2020 Order relating to elective surgeries and procedures

• To follow protocols issued by Utah Health Association in Roadmap for Resuming Elective Procedures

• Effective 12:01 a.m. April 22, 2020 through May 1, 2020

Healthcare Providers Ordered to Implement Protocols Related to PPE and Worker Safety

• See Order Allowing Elective Procedures to Resume

• Does not apply to:

• Hospitals

• Ambulatory surgical facilities

• Healthcare providers with privileges while practicing at hospitals or ambulatory surgical facilities

• Healthcare providers required to wear face shields or goggles that seal around the eyes when performing procedures that create an aerosol

• Required to wear facemask when any individual within 6 feet of another individual

• Front desk employees required to wear facemasks

• No more than 1 individual allowed to accompany a patient

• No individual allowed to congregate in facility to extent practicable

• Screen each individual entering healthcare facility for temperature and symptoms of individual and those in individual’s household

• Install protective barrier at front desk

• Maintain patient contact information for contact tracing

Live CE Requirements

• Temporary suspension of live CE requirements through September 30, 2020

Long Term Care

• To follow guidance issued by Centers for Medicare and Medicaid Services, Center for Clinical Standards and Quality.

Suspending Enforcement of Telehealth Statutes

Allowed to offer telehealth services that do not comply with statutory requirements so long as:

• inform patient telehealth service does not comply with security and privacy standards in Utah statute

• provide patient opportunity to decline service

• take reasonable care to ensure privacy and security of service

Utah Telehealth Resource Center

Healthcare Essential Businesses

Essential Procedures

PPE

Relaxation of Licensing Requirements

Visitation to LTC

Telehealth

Essential Businesses

(Extended to April 30, 2020)

Ban of Gatherings

(Third continuation of Statewide Public Health Order #2 dated 4/28/2020; Second dated 4/3/2020; Original order 3/20/2020.)

• Bans gatherings of ten (10) or more people through May 15, 2020

Exclusions include healthcare facilities (hospitals, medical facilities, home health agencies, personal care agencies, hospices, adult family homes, mental health centers, and pharmacies), alcohol and drug treatment centers, and long-term care and assisted living facilities.

N/A

N/A

Nursing

Advisory Opinion Practice During COVID 19 Declared State of Emergency

• Nursing facility still responsible for care to patients and residents

Licensure

• No disciplinary action will be taken against persons practicing as CNA, LPN, RN, or APRN without the required licensure when acting to protect a patient’s health or safety
• Board can issue temporary 6 month permits to CNA, LPN, RN, or APRN who were previously licensed in WY
• Board may waive the current re-licensure requirements
• Graduates of nursing and nurse aide programs have the option of applying for a temporary graduate permit as exam
• candidates
• Temporary permit expirations have been extended for six months

Scope of Practice

• Primary care trained and certified APRNs may provide low risk treatment services to acute care patients as an interdisciplinary team member.
• Emergency intubation and ventilation support within the scope of practice of an RN with facilities to offer additional clinical training and oversight for these interventions
• RNs may perform a nursing history and physical, screening and assessment exams with facility inservice required
• If an RN is not available on site, an LPN may provide nursing care management, unsupervised
• RNs may direct unlicensed personnel and CNAs to perform nursing tasks via covert supervision
• CNA I can perform the eight skills offered in the level II curriculum under the delegation of a nurse after being oriented by the facilities in the skills
• RNs may use a CNA to hand non-narcotic medications to patients and observe the patient swallowing
• RNs may be unable to obtain provider orders in specific settings (ie. school, community). The RNs will use their best clinical judgement to provide emergency treatments and make all attempts to post-rectify orders.
• Many licensees or volunteers may need to work outside their defined facility job description.

Physician

COVID-19 PUBLIC HEALTH EMERGENCY FREQUENTLY ASKED QUESTIONS.

Consultation Exemption

• Physicians and physicians assistants not licensed to practice in WY must apply for the exemption and then be approved by the WY Board of Medicine and State Health Officer
• Must be currently and fully licensed in another US jurisdiction or county
• Licensure lasts until the end of the Public Health Emergency or termination by the State Health Officer

Licensure

• Conventional applications are being reviewed on a daily basis to expedite licensure

Supervision

• Allowing WY licensed physician assistants to practice under emergency supervision of a WY licensed physician not previously approved as their supervisor

N/A

• Staff are encouraged to use telehealth technology to connect with isolated patients.
• Nurses are not required to do face-to-face initial visit during the state of emergency.
• Physicians licensed in another state may provide services via telehealth to a WY resident if there is already an established physician-patient relationship, but may not provide care that treats a new diagnosis if patient was not seen face-to-face for it in your home state.
• Technology must allow you to meet the standard of care at all times.